6 Surprisingly Effective Treatments for Depression

Caffeine is a funny one, since it can act as a depressant in large quantities. This is because it increases the release of stress hormones like adrenalin, which can exacerbate anxiety and depression. No wonder it is in the less helpful treatment box.

This is a great chart. It corresponds well with an older survey of clinical results by the Australian National University (http://bluepages.anu.edu.au/treatments/what_works/).

I’m surprised that bibliotherapy isn’t in there as an effective treatment. Was it not popular enough to make it on the chart?

I love this. It’s a great reminder isn’t it? Exercise is so good for lifting depression but seeing it in this way, from people using Cure Together is a double whammy of a reminder.

great work.

I’m really interested in the analysing of the data too and how giving it back to the community may influence the choices your users make in their own healthcare. Keep us posted

Hi Katie,
Thank you! Interesting question – I wonder how we could measure the impact of sharing this information with our members, and with the general public. Any ideas on the best way to measure this?
Yes, we’ll keep posting new discoveries here as they come. Stay tuned!
Be well,
Alex

Great results (the “surprisingly effective” results show the power of tracking data, and being open to “unexpected” results). I also *love* the easy to interpret and super intuitive data visualization. Simple and easy to understand, useful, and enlightening. Thank you!

[...] Cure Together has just published a very interesting chart on treatments for depression. [...]

This is cool to see – could be used for some good suggestions or to reinforce what one is already doing. I’m not clear on what the unlabeled dots are, though, or how to find out.

Anne Marie:
I like your mark-up of the infographic. Can you explain in more detail why the surprisingly effective group could be a result of average effectiveness? At first I thought this may be because individuals for whom the therapy is ineffective no longer use the therapy, therefore reducing it’s popularity. However, if these individuals complete the survey, they would indicate that the therapy is of low effectiveness for them, thereby reducing the average effectiveness.

Hi Annemarie, thanks for your excellent feedback!

By ‘surprisingly effective’, we did not mean ‘extremely effective’ or ‘amazingly effective’. We were trying to say that those treatments are of surprising effectiveness in that you would expect them to be more popular than they are, relative to other treatments of similar rated effectiveness – even if, yes, they are not very effective relative to CBT and exercise. It’s also surprising that treatments of lower effectiveness are more popular. And yes, of course they would not become more effective if more people took them.

That being said, it does suggest that more people should be taking the surprising ones and that fewer people should be taking the popular but less effective ones. Perfect information about the effectiveness of treatments should lead to a high correlation between popularity and effectiveness. Poor correlation is evidence of poor information about what works and what doesn’t.

Hope that helps! We’ll try to make future infographics clearer to incorporate all this amazing feedback.
Be well,
Alex

Hi Jeremy,

Thank you for your specific and insightful comments! I think the self-experimentation guide you’re referring to is http://curetogether.com/blog/2010/03/12/how-to-run-a-successful-self-experiment/

I agree with you that long-term, with enough data and sophisticated algorithms, we’ll be able to segment people into sub-categories of conditions and offer more personalized predictions for which treatments are statistically most likely to work effectively with the fewest side effects.

Thanks, I’m excited to see what’s next too!
Hope you are well,
Alex

Yes, great point Anne Marie – we do not receive any funding from pharmaceutical companies and have no vested interests in recommending any particular treatment over another. We simply gather, analyze, and present data contributed by our members in as neutral a way as possible.

I will let my co-founder Daniel Reda address the rest of your comment, since he has a deeper knowledge of the statistical side of things than I do. I also want to say that we very much appreciate your taking the time to think through how we are presenting data – we have received many helpful suggestions from the voices of Harvard professors, doctors, researchers, and engaged patients; all of which we will try to incorporate into the design of our next infographic.

Thanks everyone!
Be well,
Alex

Anne Marie:

Your central point seems to be that we ought to have less confidence in treatments that were tried by a smaller fraction of respondents (i.e. dots toward the left side of the chart) and that therefore these treatments are probably not as effective as the chart suggests.

A good analogy of your point is if you’re shopping at Amazon.com and are comparing two products, one of which has an average rating of 4.9 but only 5 ratings and the other has an average rating of 4.7 but has 40 ratings. It may appear that the 4.9 product has a higher rating, but it may have just been lucky to get a few positive ratings and if we waited until it had 40 ratings of its own, it might end up at 4.3.

We have actually factored this in and that is what we meant by our Bayesian adjustment. The best way to explain is to show you the unadjusted chart next to the adjusted one. I’ve uploaded an image that shows this at http://www.curetogether.com/images/depression-bayes.png (note that the dots are unlabeled and the image is a few days newer and has a bit more data, so some of the dots may have shifted slightly).

You can see that, prior to adjustment (chart on the left), some treatments that are tried by only a small fraction of people (e.g. light therapy with 20% popularity and over 0.9 effectiveness) initially appear to have extraordinary efficacy – even more than CBT and exercise!

But when we adjust for the fact that fewer people have responded for those treatments (and that we therefore have less confidence in the rating), it preferentially brings the points on the left side of the chart toward the center (more formally, toward the average effectiveness of all the treatments for that condition). You can see this correction in the right chart, which is the one we originally published.

And even after this adjustment, those treatments we labeled as “surprisingly effective” are above average in effectiveness and below average in popularity.

So you would be absolutely correct (and impressively perceptive) if what we had published was the uncorrected data – but it is not, as I hope I have adequately explained.

Hi Alex,

That’s an interesting and I imagine quite useful graphic.

I’ve been getting ever more skeptical of the use of statistics in understanding the human condition (I’ve been reading “The Black Swan: The impact of the highly improbable” lately), but I’m not at all yet ready to dispense with the notion of learning from other people’s experiences. So, I’m all for efforts such as this table, that help us to make sense of tons of disparate data.

I didn’t understand the niceties of the issues raised by Anne Marie or Daniel’s response. But, as a lay person, I wonder if the y-axis could simply be “Rated Effectiveness”, without any fancy Bayesian adjustments. I think we can see for ourselves that treatment XYZ has been rated as highly-effective but only a few people have tried it, and make up our own minds whether it is something we’d like to try. As Jeremy Johnson commented, we (individuals) really care about what might work FOR ME. We’d like to know if something has proved very effective for even a small group of people, if those people are somehow like me. So, it would be nice if you could provide any insights into what was common amongst the people involved for all the treatments that were rated highly effective.

Hi Rajiv,

Thank you for your comment! To clarify, the effectiveness was adjusted to prevent overestimating a treatment’s effectiveness given its small sample size – for example if treatment A was rated very highly by only 10 people, that’s worth less weight than treatment B that was rated very highly by 100 people. Does that make sense?

Anyway, I definitely agree with your idea to increasingly personalize the information, in which case seeing what 10 people LIKE YOU tried without any adjustments would be very interesting. As we collect more data, we can dive deeper into this kind of analysis.

Be well,
Alexandra

[...] by George Van Antwerp in Consumerism, Healthcare, Social Media, Technology. trackback I just came upon this infographic based on information from almost 1,000 people in the depression community on [...]

Thank you, Rosalind! I’m glad to hear you find it helpful and thought-provoking, and I hope it helps your clients as well.
Be well,
Alex

This is a great graphic – very clear! It parallels what my doctor told me. (He said, rather humorously, that the sure recipe for enhancing depression was to stay sedentary, in a dark room, alone, and listen to Leonard Cohen songs!)

I’m surprised that Cognitive Behavioral Therapy is not on here; there are certainly evaluations showing its effectiveness; it also worked for me.

One of my own favorites is gardening – I suspect it’s effective because it combines exercise and light, and then throws in flowers for good measure.

Thanks for sharing this fascinating infographic on treatments for depression. It is inspiring to see how the sharing of data combined with infographics can be used to reveal the efficacy and popularity of treatments. There is a lot we can learn by sharing data and presenting it through beautiful, intuitive designs. One of our feature stories Decoding Data (http://www.healthymagination.com/stories/decoding-data/) looks at how data visualization can be an incredibly powerful tool for interpreting large quantities of shared information. We think data visualization coupled with crowdsourced data has great potential to transform the way we interpret and respond to health information.

[...] 6 Surprisingly Effective Treatments for Depression. Categories: Culture, Science Tags: Depression, Health, infographics Previous post: The World Cup Predicted Leave a Comment [...]

On checking out the amount of vitamin D3 used as a basis for rating, I find it is only 4000IU daily.

Dr. J. Cannell, at http://vitaminDcouncil.org is now recommending 10,000 iu of vitamin D3, ( NOT VITAMIN D2! ) daily, for depressed people.

The Vitamin D Newsletter: April 21, 2010: More letters: “Vitamin D deficiency is but one cause of major depression; there are lots of others. However, I now recommend that anyone struggling with depression should take at least 10,000 IU /day with frequent 25(OH)D blood tests to assure levels of at least 100 ng/ml and to monitor for toxicity”.

He advises that the cofactors required for optimal absorption and utilisation are good levels of magnesium, zinc, boron, and vitamin K2. 59% of Americans are deficient in vitamin D3.

Those with the lowest levels are 11 times more likely to be depressed (www.mercola.com – Dr. Mercola recommends 5000IU – 8000IU daily for most healthy people, if getting minimal vitamin D3 through the action of sunlight on exposed skin, although some people need much more; view http://articles.mercola.com/sites/articles/archive/2008/12/16/my-one-hour-vitamin-d-lecture-to-clear-up-all-your-confusion-on-this-vital-nutrient.aspx ).

A deficiency in calcium can also cause depression; vitamin D3 is needed so it is utilised, and good levels of magnesium ensures it is deposited on bones, (preferably with some weight bearing exercise) where it belongs, rather than in blood vessels.

So basically, getting more sunlight is what works best?

[...] Published The Collective Well » Blog Archive » 6 Surprisingly Effective Treatments for Depression. [...]

whats with the unnamed dots?

[...] The Collective Well » Blog Archive » 6 Surprisingly Effective Treatments for Depression. var a2a_config = a2a_config || {}; a2a_config.linkname="6 Surprisingly Effective Treatments for Depression"; a2a_config.linkurl="http://www.spencersmith.co.uk/wordpress3/2010/05/6-surprisingly-effective-treatments-for-depression/"; [...]

Is there an interactive version of the depression chart or one that labels all the dots? For instance, the second most effective treatment, rated so by 65% and used by less than half, is not labeled. Those of us who need to leave no stone unturned in a search for help would like to have these dots labeled in the chart or at least in a legend/sidebar. Thank you.

Awesome. Crazy how exercise is the greatest remedy, but can be the hardest thing to do!

Thanks Chris! And to answer your question, Warner, you can see the latest interactive version of the chart here, where you can hover over all the dots to see what they are – http://curetogether.com/depression/ig/treatment-effectiveness-vs-popularity

Alex

hi i used chocolate
but the best for me is the sudarshan kriya and silva method ….
excellent post

While presenting bayes-adjusted factors is good, it would still be nice to see error bars on these dots. I’m not sure how one does bayes-adjusted errors, but at the very least you could present the pre-bayes 95% confidence intervals as they originally were, with the dots in their bayes-adjusted positions (ie, no longer in the middle of the error bars, but shifted toward the mean). This would give us some sense of how different the more and less effective treatments really were (pace all the more serious problems with treatment self-selection).

Hi Colin,
Thank you for your comment! I’m very impressed at the level of self-knowledge you have, and appreciate you sharing your helpful insights. You’re right that as CureTogether grows, it would be great to be able to get into more specific examples of exercise, meditation, drugs, etc, and see how different categories compare to each other.
Personally, I find both intense and gentle exercise to be helpful, depending on the time of day and my mood. I think as people develop their own intuition and understanding about their specific bodies, they can tailor exercise and lifestyle programs to how they are feeling in each moment or day, pulling out the right tool from the treatment toolbox to fit the situation.
As for the SSRI’s, it’s a great question, and one that we noticed too – we’re running some queries to see if we can figure out what’s happening there.
Thanks again and welcome to the community!
Alex

[...] Research Findings found that exercise is one of the most effective depression treatments. A shocker I know. [...]

Thank you for presenting this information. As a sufferer from depression I learned something new and useful. However, I have some criticisms of how you have presented it. I hope you don’t mind me putting in my oar. Steel yourself for some frank complaints.

The whole thing is not simple or efficient or clear. We depressed Stumblers do not have much patience you know.

It is very confusing to be told what you thought would be popular. No offence, but we don’t care. We just want to know what works. Leave us to be surprised or not about the popularity of something. It would be better to make the explanatory text relevant and helpful.

The infographic may look beautiful to you, but it is too complicated and difficult to understand. It took me quite a while to figure it out, and I’m trained in mathematics. The orange and green rectangles look like part of the graph at first, and just mess with my head. The cut-off points should have been left out in my opinion. As it is, they seem arbitrary, and chosen by you, and they just confuse everything. I think you should forget about “quadrants”. I can’t even be bothered to try and understand most of the key at the bottom of the page. Oh – I just did – and I wish you hadn’t.

Even now I think I have it figured out, I am still unwilling to refer to it for advice. It is just too crazy to look at. This is a shame because I am sure that I could learn more from it.

You can tell I don’t have a job, can’t you? Time on the old hands. I do care about this matter though, because the information is important to some people.