Wrong on almost every level

It's not common to find a newspaper that's wrong on almost every level, but there's one here:

Gloom lifts as Sad affects fewer people. Aberdeen Press and Journal (13/1/11).

 

It reports on the number of people being diagnosed with Seasonal Affective Disorder (SAD) in Aberdeen, and comments that: "The dark nights are taking their toll on fewer people in the north-east, it emerged yesterday." This assumption comes from the finding that fewer people are being diagnosed with SAD than a few years ago.

 

Of course, the number of diagnoses doesn't mean that people no longer have the disorder since a diagnosis doesn't necessarily occur in everyone with a particular condition. Also, one often finds that it's only a small number of specialists who might make regular use of a SAD diagnosis. Many psychiatrists might make a diagnosis of major depression rather than SAD. Same suffering but different diagnosis. In DSM-IV, SAD is not a unique diagnosis - it is a 'specifier' of major depression. SAD doesn't have a unique diagnostic category in ICD-10 either - there are provisional criteria but it would normally be diagnosed with the same code as the majority of depression.

 

So, reductions in rates of diagnosis may reflect nothing other than variations in the use of certain diagnostic codes, or a reduced preference for specifying descriptors such as "seasonal affective disorder".

 

"The health board said the drop was a reflection of increased awareness among GPs." Awareness of what, exactly? If GPs are now more aware of SAD, then they should be more alert to the symptoms and making the diagnosis more frequently. This isn't the case, according to the information coming from the Freedom of Information request. So, can we assume that GPs are more aware of the condition, but making fewer diagnoses?

 

Apparently not. NHS Grampian would like to believe that "...patients may be 'self-diagnosing', after becoming aware of the symptoms and taking action to treat themselves". Even if patients aren't treating themselves, NHS Grampian "has a supply of light boxes which can be loaned to patients for the winter. The lamps are designed to give natural light indoors, helping to reduce hormonal changes." Nice idea, but there's not much evidence of light effects on specific hormonal levels (Full-Spectrum Fluorescent Lighting Effects on People: A Critical Review.) We don't know either whether more people are using the light boxes.

 

The article goes on to say that: "Other ways to alleviate Sad symptoms include herbal remedies such as St John’s wort, light exercise and eating whole grain foods, root vegetables and fresh fruit. All of these help to give sufferers energy." Unfortunately, the combination of 'Seasonal Affective Disorder' and 'vegetables' or 'fruit' or 'grain' in PubMed doesn't identify any articles. There are a few studies that involve exercise AND light therapy, but "...only weak preliminary evidence exists for use of SJW in SAD". This statement came from a paper in the Journal of Alternative and Complementary Medicine in 2009. When an alternative therapy journal is saying there's not much evidence for St John's Wort in SAD you can be pretty sure there's no evidence. So, there's minimal to no evidence that any of these things are of much benefit in treating SAD.

 

Finally, we've got a comment from Mary Scanlon, the health spokeswoman for the Scottish Conservatives: "It is also encouraging that methods are being used which reduce the prescription of antidepressants." She is clearly clueless when it comes to understanding the figures or the treatment of depression. The number of antidepressants saved by not giving them to a dozen fewer people with SAD (many of whom wouldn't have had them in the first place) is not going to make much dent in the Scottish Government's asinine attempt to reduce antidepressant prescribing. The antidepressant HEAT target is now a psychological therapies access target, so perhaps it's only Mary Scanlon who thinks it's important.