After three months of closure, my gym in Vancouver re-opened on June 1st. Even though I’ve been a gym rat since 2013, the pandemic took a huge toll on my physical performance. Six weeks later, my workout capacity hovers around 40% of what it once was.

I see this deficit most clearly on an indoor rowing machine. The treadmill of canoes, rowing machines produce resistance thanks to air flowing through a flywheel. The wheel connects to a chain, and the combination of pushing with your legs and pulling the chain handle spins the flywheel. The faster you row, the faster the flywheel spins and the more resistance it creates. The amount of power you produce — measured in meters, calories, or watts — is displayed on a small screen, giving you instant feedback on each stroke.

Two ways to get the flywheel moving: brute strength or proper technique. In the past, I could muscle my way through at a reasonably respectable pace for someone built for ballet, not rowing. But thanks to a combination of three months off, nagging injuries, mid-thirties hormones, elevated base level stress, and extra glasses of pandemic wine, I have been forced to adjust my strategy. Pulling the handle like all hell just doesn’t work anymore.

Like most things that seem simple, rowing technique is complicated. Arms straight. Head neutral. Shins vertical. Heels lift. Push through the legs, then extend through the hips, then pull the chain. Legs, hips, pull, release, hips, legs. Don’t let the chain slack. Don’t hunch. Don’t lead with the back. Don’t bend the arms too early. Legs, hips, pull, release, hips, legs. Breathe. Legs, hips, pull, release, hips, legs. Repeat.

My goal is not to become a professional rower. It’s to get through the rowing portion of my afternoon workout so I can move onto the next movement. Focusing on every aspect of my rowing technique would be a waste of my time. Instead, I focus on one thing I can do to increase my efficiency: get the handle to the proper starting position, every stroke, every time. Focusing on the handle’s placement guarantees that 1) my stroke length will be as long as possible, which increases speed; 2) positions my back and legs to fire in the right order at the right time, which increases power; 3) keeps my mind zeroed in on one thing rather than 100 things, and 4) distracts me from how awful rowing is.

Why is this relevant to happiness? Because by focusing on one aspect of rowing technique, my power and speed are guaranteed to increase, thereby improving my overall performance. I don’t need to be great everywhere all the time. I just need to be a little bit better, repeatedly. Over time, this will translate into more strength and stamina…without breaking my spirit.

The same theory applies to happiness. It’s not about making sweeping changes and overwhelming the system with hundreds of new processes, only to beat ourselves up for failure. It’s about taking stock of your life and focusing on doing one thing right, every time that will set a stronger foundation for each process that follows.

For me, that one thing is staying off social media. Maintaining that boundary gives me greater emotional and psychological resilience, which means I am able to consume more meaningful information, brush off minor irritations, and more quickly bounce back from major roadblocks.

For my sleep-challenged partner, Justin, that one thing is making sure that he dims the lights in the apartment at least an hour before getting in bed. Keeping the lights down and the candles lit sets him up for a better night’s sleep, which means every aspect of the next day gets easier.

For my mother, that one thing is keeping the house clean. But instead of doing a big clean up once a week and then getting irritated as the week moves on and the mess piles up, she commits to tidying up two things every time she walks in a room. The result? The house is always well kept — in no time at all.

What is one thing in your life, when done right every time, that makes your day easier and lighter? Find it. Focus on it. Do it right. Every time.

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How to Be Great? Just Be Good, Repeatably — blog.stephsmith.io

To create something great, we are told to take baby steps, put one foot in front of other, and take it one day at a time. We’ve heard these platitudes our entire life, but in the moment it can be hard to see how small changes add up to something bigger. We want to be great, now. In this piece, Steph Smith shows us that greatness is a myth. To be great, she argues, just be good enough…over and over and over again.

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Jim Collins – Concepts – The Flywheel Effect

Jim Collins is a researcher focused on business management and sustainability. This excerpt, from his book Good to Great, highlights “the flywheel effect,” which states that in any great creation, there is no single defining action that leads to success. Instead, it is about making relentless, incremental progress until the flywheel gains enough momentum to turn on its own.

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The secret to giving a compliment that makes people glow | — ideas.ted.com

Struggling to find that one thing to do right each day? Try giving one person per day a heartfelt compliment. Educator and TEDx speaker, Cheryl Ferguson, shares how.

Summer months in Vancouver mean endless hours of daylight. At its peak, light emerges around 4 am and does not wane until well past 10 pm. Earplugs, sleep masks, and blackout shades are the only defense against a bungled circadian rhythm, and some mornings—like this morning—it’s particularly hard to get moving.

I stumbled out of bed before 7am, a sliver of sunlight streaming through our northern facing apartment. I sat in silence for 11 minutes, my usual meditation, and found myself on the edge of dozing off. The gong signaling the end of my mediation sounded, and I wrapped myself in a blanket and took a morning snooze on the couch.

When I mustered the will to peel myself off the cushions, fuel myself with tea, and transform the bedroom from my sleeping place to my coronavirus office space, I opened up The Daily Stoic to read the day’s entry:

“On those mornings you struggle with getting up, keep this thought in mind—I am awakening to the work of a human being. Why then am I annoyed that I am going to do what I’m made for, the very things for which I was put into this world? Or was I made for this, to snuggle under the covers and keep warm? It’s so pleasurable. Where you then made for pleasure? In short, to be coddled or to exert yourself?”

-Marcus Aurelius, Meditations, 5.1

I am awakening to the work of a human being. Aurelius seemed to interpret this awakening literally. He was a Roman emperor, and the demands of the job required the occasional morning pump up. I imagine that woven silk sheets of the imperial palace were significantly more pleasurable than managing 1st century Rome, but as Aurelius said, he was put on Earth to run Roman empire, not whittle the day away in bed. What choice did he have?

But in July of 2020, I am awakening to the work of a human being takes on a whole new meaning. To simply be human is the work. It is all there is and all there ever will be. Six months ago our work was our career, our success, our routine. But when it was all taken away, the real human work remained. The job, the schedule, the life—it’s nothing but a thin coat of paint.

What is the real human work that you were born to do? If you have trouble answering, look issues that have roared their ugly head over the past few months. What makes you angry? What are your patterns? What challenges has the pandemic revealed? And what gifts has it given you? What changes will you take with you?

Get clear on the work ahead, and know that it will not be easy. Deep work never is. But you will be doing the work you were made to for, the very thing for which you were put into this world. Are going to remain coddled? Or wake up, face the day, and get going?

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If You Want to Change the World, Start Off by Making Your Bed – William McRaven, US Navy Admiral — www.youtube.com

I first watched this speech around 2010, after nearly 25 years of refusing to make a bed that I figured I was destined to mess up that night. Since I first watched it, not a day has passed where I haven’t made the bed. Why? Little things matter. And starting the day with one completed task, sets you up to complete the rest.

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BBC – Travel – The unexpected philosophy Icelanders live by — www.bbc.com

Icelandic people know they are not in control; their world is made up of volcanos, bitter cold, and endless nights. Living with the force of nature dwarfs wee human life, leading to the Icelandic phrase,‘þetta reddast’, which roughly translates to the idea that everything will work out all right in the end.

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The Biggest Psychological Experiment in History Is Running Now – Scientific American — www.scientificamerican.com

DISCLAIMER: If you’re exhausted from covid content and/or someone who is easily riled up from covid content, skip this article. But if you’ve got the capacity, glaze over the usual covid terribleness and read this piece through the lens of ‘real human work.’ One line that stands out: “People who believe they can cope do, in fact, tend to cope better.”

Yesterday, I was listening to a podcast with renowned couple’s therapist Esther Perel. She was talking about how couples were coping with the pandemic and said, “You can’t be feeling great in this moment. You can feel relieved. You can feel thankful. You can feel appreciative for what you have. You can feel humble. You can feel thankful to things, but you can’t feel great in this moment, because if you’re feeling great in this moment, you’re detached, you’re disconnected.”

The episode was recorded sometime in late March/early April, about three weeks into lockdown. Had I listened to it at the time, I likely would have agreed. How could someone feel great when the world was but an ominous shell of itself, with an air of fear and uncertainty thick enough to choke even the healthiest of lungs?

But in listening to Perel’s comment now, three months later, my thoughts on the matter are different. Why can’t we strive to feel great in this moment? And why are we encouraged to exchange our own well-being in order to stay plugged in to global suffering?

Because it’s important to stay informed. Because ignorance is dangerous. Because a good person cares about other people. Because it’s selfish to look out for number one. Because the world doesn’t revolve around you. Because people are dying. Because. Because. Because.

Happiness is a most rebellious act. To be happy, especially when others are not, is to break an unspoken human rule that equates thriving with selfishness. The Australians call this Tall Poppy Syndrome, referring to the expectation that a field of poppies should grow together. If one grows too tall, it needs to be cut down. In human terms, this means we celebrate the downfall of high achievers and shun those with enviable qualities. Poppies that stand out for doing well don’t fare much better than those that stand out for doing poorly.

But I feel guilty for being happy when so many people are hurting.

To tear down others for perceived happiness is a fundamental misunderstanding of happiness in the first place. It assumes that happy is a destination rather than a state of existence, and that choosing personal happiness is a callous blow to collective suffering. It is the guilt, not happiness, that emerges as the most selfish act. Guilt is what happens when we take someone else’s pain and make it about ourselves. It does nothing subtract pain, and instead doubles its existence while taking focus away from the issue at hand.

Think about it. How do you feel after a day when you’ve been wracked by guilt or have spent too many hours following the latest on infection rates or political incompetence or unrest? Are you left with the emotional capacity to answer the phone when a distressed friend wants to talk? How do you respond when your kid knocks over an heirloom and shatters it on the floor? What vice to you choose to numb the pain you just witnessed? How does any of this help you and the people around you?

But by pushing guilt aside and allowing ourselves to learn happiness—or strive for greatness—even in a time of anguish, we actually expand our capacity to help others who are suffering. We are able to more freely move between contentment and action, without getting tangled up in a collective web of pain.

So grow tall, break the rules, rebel with happiness. The world may not understand you, but now more than ever, it needs you.

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Viktor Frankl on the Human Search for Meaning — www.brainpickings.org

The Australian psychiatrist and Holocaust survivor said of his experience in Auschwitz: “Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

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Consciousness Isn’t Self-Centered – Issue 82: Panpsychism – Nautilus — nautil.us

Humanity has convinced itself that consciousness is an inherently human trait. But what if it isn’t? This is a fascinating read that focuses on the scientific search to determine all things—plants, stones, a fork—have consciousness.

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Dealing with the guilt of privilege — www.rappler.com

I love the last line from this excerpt:

“The guilt that many have begun experiencing in this pandemic may be attributed to increased self-awareness of their advantaged position. As with any emotion, the feeling of guilt is valid and normal in light of a realization like this, but it is just as important to realize that being privileged, in itself, is not wrong. Privilege is often something that is given, not something that is chosen. However, what can be chosen is what to do with privilege.”

The following was originally published in my newsletter, Happiness Is A Skill, Issue #01. 

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The past few months have gifted us with an opportunity for deep reflection. While the world changes at a breakneck pace, we’ve all been stuck inside, left with nothing but the life we’ve created for ourselves and the emotions that come with facing it.

Turning inward has forced me to take a hard look at how I want to move forward, both in my personal life and public one. Between winning Chopped and having an impactful mental-health piece published in the Washington Post, I’ve turned into the world’s most wee public figure. With my memoir on antidepressant withdrawal now out for submission (which means publishers are considering whether or not they want to buy the manuscript and publish the book), I put myself under considerable pressure to produce on social media in order to tantalize publishers.

The problem, though, is that social media is notoriously awful for mental and emotional health. After four years of doing the deep work to get myself off of antidepressants and out of a decade and a half of depression, three weeks of Twitter sent me back into psychological hell. About 10 days ago, I broke. Social media is simply filled with more pain than I am currently able to carry on my shoulders, and I made the choice to step away. The apps are off my phone, blocked on my computer, and I’m turning to print (gasp!) for news.

Our society is filled with all sorts of viruses. Biological, political, racial, cultural, systematic—they all seep into our cells, etching themselves into our physical and emotional makeup. Unplugging from social media may seem nuclear, but consciously and constantly exposing myself to other people’s pain—which I can neither fix nor control—is the emotional equivalent of licking a bathroom stall at LAX. Why do that to myself? Who benefits from making myself sick? Not me. Not you. Not my community.

I believe that happiness is a skill that must be learned, practiced, and maintained. We aren’t born with it any more than we’re born with the ability to run a marathon or complete a PhD. Some of us may come in with runner’s legs or photographic memories, but the mere presence of aptitude does not guarantee success. The work is the work. In continuing to put myself in the line of social media fire, I was consciously working against the happiness practice I built. And I refuse to do it any longer.

Instead, I am funneling my former social media efforts into a new newsletter dedicated to helping people who want to wean off their antidepressants, recover from depression, and learn the skill of happiness. You can expect everything from relevant articles to inspiring figures to actionable practices to musings on Stoic philosophy. Some weeks may make you laugh, others may make you think. All of it is designed for people who are ready to do the work.

So many of you have stuck with me for so long. Know that I appreciate you, and I hope that each week it brings a little extra value to your life…without the toxicity that comes with so much of the internet. In this space, you won’t find any ads for toenail fungus cream, political bloodbaths, or cruelty. Just little morsels of strength and light in an otherwise dark world.

It’s hard to celebrate anything right now. Yesterday, after a much needed few days entirely off the grid, I came back to a digital shitstorm. The specifics are irrelevant, but what was important was that in the middle of getting real mad and doing a whole hell of a lot of ugly crying, I realized I was having a moment of clarity. After months of fighting to get my work heard, I’d finally hit the end of my rope. I was done.

The exact words out of my mouth were, “I don’t know what this means moving forward, but I refuse to keep doing this to myself.”

It took an accident of an event for me to surrender, but understanding what was happening took a boatload of self-awareness. In order to recognize that I needed to make a change, I had to trust in myself to:

I didn’t develop any of these skills in the past 24 hours. They are all a result of hard, deep self-work I’ve put in over the past 4 years. Had I not spent those years actively cultivating these skills, I would have melted down yesterday without recognizing the value of the meltdown. Anger, tears, emotion—it’s all a bright flashing sign pointing to an issue that needs to be fixed. And yet we never teach people to recognize an emotion as such, and so we end up in a feedback loop of our own personal hell.

Happiness is not a given. Nor is it doled out to some but not others. It is something that must be cultivated and learned through trial and error. When you’re depressed or struggling though, it can be impossible to think you can help yourself. I know that during my 15 years of depression and year of antidepressant withdrawal, every time someone suggested a gratitude journal, I wanted to punch them in the face. Gratitude works when you want life. It mocks you when you want death.

My goal is to teach people the skills that I’ve learned so that they can take control of their own life. After yesterday’s moment of clarity, I’ve realized that I have to try a different strategy. What I was doing simply wasn’t working for me. It had me working against my own ethos, and that is a recipe for malcontent. The good of others is no good if it’s not good for me, too.

And so I move forward, my way, this time.

“Iatrogenic comorbidity” is one of those jargon phrases that makes me want to run far far away from research.  To me, it’s code for this is an article for those who have letters after their name and if you don’t you’re too plebian to understand. For regular folk, it’s a term that’s difficult to remember, impossible to pronounce, and seems to have something to do with death.

It has nothing to do with death. In layman’s terms, iatrogenic comorbidity is illness or disease caused by medical treatment which results in two or more simultaneous conditions in a patient. It is also one of the most important (and overlooked) aspects of treating depression and prescribing antidepressants. If more patients understood what it meant, perhaps more doctors would be forced to take it into consideration.

Iatrogenic is an adjective that means, “relating to illness caused by medical treatment or examination.” For example, if a woman has heart surgery and the stitches get infected, the infection is an iatrogenic effect. If the stitches never existed, she wouldn’t have an infection.

Comorbidity means the “simultaneous presence of two or more chronic diseases or conditions in a patient.” For example, an elderly person could have osteoporosis (brittle, porous bones) and dementia at the same time.

Putting the two words together, iatrogenic comorbidity is what happens when medical treatment or examination causes two or more chronic diseases or conditions. In the case of our heart patient, let’s say that she was given antibiotics to fight against the iatrogenic effects of the infected stitches, but that she didn’t know she was allergic to the particular antibiotics. When she takes the drugs, she goes into anaphylaxis. Now, the heart issue, the infection, and the anaphylaxis are all comorbid conditions. A good physician needs to carefully understand what caused what issue in order to properly treat it, otherwise, he might misdiagnose and mistreat.

I am not a doctor, but I imagine it’s generally easier to trace iatrogenic comorbidity in physical illnesses. The heart surgery results in infected stitches which results in anaphylaxis. It’s an unpleasant outcome, but the progression is clear. Mental health, on the other hand, is inherently fuzzier. It is not uncommon for patients to present with comorbid conditions, like depression and anxiety. When medication is administered and more conditions show up, like suicidality, there’s no real way to know what caused what. Did the medication cause the patient to want to kill himself? Or would the urge have developed had the medication not been given? Was it the chicken? Or the egg?

There is a growing faction of psychiatrists and researchers who are calling for a drastic overhaul of the way we prescribe antidepressant and antianxiety drugs because of the risks of iatrogenic comorbidity. General practitioners, in particular, are being called out for defaulting to prescription antidepressants rather than recommending therapy. The argument, essentially, is that general practitioners are well…generalists. They are the traffic control of healthcare, designed to guide people down the appropriate specialist highway so oncologists don’t get bogged up with common colds. In theory, this means that GPs should refer someone suffering from depression to a psychologist for further evaluation. In practice, what often happens is that GPs prescribe an antidepressant (or multiple antidepressants) and send the patient on their way.

To put this practice in perspective, I lived in New York City for eight years and never once saw a psychiatrist for my Effexor XR and Wellbutrin XL. Furthermore, my GP only required that I see him once every 12 – 18 months, for a five-minute appointment. So over the course of nearly a decade, I got about thirty minutes of face time with the man who prescribed me daily psychiatric drugs. That’s fucking absurd.

So why is this happening? A general practitioner would never give a patient a script for chemotherapy, so why is it a widely accepted practice when it comes to depression and anxiety?

I would argue that a major factor is the fact that the iatrogenic comorbidity of chemotherapy is much more obvious and well-studied than it is with antidepressants. We know that chemo is a hell of a drug because it quickly makes most people vomit, turn grey, and lose all their hair. The iatrogenic effects of antidepressants though, do not develop in a common, linear way—if they develop at all. The same drug presented to four people with similar symptoms, background, and genetic makeup can produce four very different effects. One person may gain weight and develop insomnia. The second might sleep well but experience PSSD (post-SSRI-sexual-dysfunction.) The third may lose weight and have suicidal tendencies. The fourth may flourish for a few months, but show symptoms of bipolar disorder years later.

In all of these cases, when the patient goes back to their general practitioner because they’re not sleeping well or their weight has changed or they’re suddenly manic, what’s likely to happen? They get a sleeping pill or they’re put on a diet or they add a Lexapro back to their Celexa. Now they’ve got additional medication in the mix, which creates the potential for even more iatrogenic effects. And so on and so forth, until the patient is drugged up to their eyeballs and their system has gone haywire.

Does this happen every time? No. But it happens enough, and it’s avoidable if protocols are put in place to make it more difficult to prescribe antidepressants. I’m baffled by the fact that a course of some sort therapy is not considered a pre-requisite to prescribing antidepressants, especially given that research indicates that over the long term, therapy is just as, if not more, effective than antidepressants. Additionally, the positive effects are more likely to endure and there is little risk of iatrogenic comorbidity.

I was scrolling through Twitter when I came across a tweet by Michael P. Hengartner, PhD that read, “In my new open access paper, I critically discuss whether long-term antidepressant use has prophylactic effects, ie., whether long-term use effectively protects against depression relapses and why we must consider withdrawal reactions…”

Hengartner is one of my great new finds on Twitter. He’s a senior lecturer and research in evidence-based medicine with a focus on public health and social psychiatry. He is openly critical of the modern psychiatric system and its practices not because he’s anti-psychiatry, but because he’s pro-drug safety. His initial research on depression raised questions regarding treatment rates and long term outcomes, which combined with his research around selective reporting and flaws in the scientific process, led him to realize that antidepressant efficacy is likely overestimated and that the negative side effects have been underreported and minimized. Effectively, he’s stumbled across what many patients (including myself) have said all along.

But the difference between Hengartner and a huge faction of researchers and psychiatrists is that he isn’t’ turning his findings into an Us vs. Them debate. Instead, he’s acting like a fucking scientist and questioning our existing assumptions which is the whole point of science and advancing medicine in the first place. Questioning, analyzing, and building upon existing research is how we move forward. It is not anti-psychiatry or anti-antidepressants. It’s asking tough, critical questions to make sure that we are doing right by patients.

Though Hengartner is doing meaningful work that might actually change something, I still find myself scratching my head at some of his tweets. His audience, I assume, is mostly psychiatric professionals, so he has no reason to dumb down industry language for laypeople like me. A world like “prophylactic” makes me want to run to the nearest Buzzfeed listicle that provides about as much intellectual value as a bag of stale rice cakes. Still, I am trying to gain a deeper understanding of psychiatric and pharmacological research, so down the prophylactic rabbit hole we go.

pro·​phy·​lac·​tic | \ ˌprō-fə-ˈlak-tik also ˌprä- \

adjective

noun

I’m having flashbacks of someone referring to condoms as a prophylactic, so I guess I should have put two and two together…moving on!

In the case of pharmaceuticals, prophylactic drugs are medications or treatments designed and used to prevent a disease from occurring. Antibiotics taken to prevent infection before surgery are a good example, as well as drugs taken at the first sign of a migraine that keep debilitating symptoms at bay. Hengartner’s recent article examines the prophylactic use of antidepressants for depression, presumably in response to Saeed Farooq’s systematic analysis claiming that using antidepressants as a pre-emptive measure could help to prevent depression.

Hengartner’s interprets the existing research differently. He points out an often overlooked aspect of antidepressant discontinuation studies: antidepressant withdrawal. Withdrawal symptoms can appear erratically and don’t manifest universally across all patients. They are often confused with relapse, which according to Hengartner, compromises the validity of discontinuation studies.

He says, “It is difficult to quantify the extent to which events recorded as depression relapse in maintenance studies are related to withdrawal reactions, but different estimations suggest that it is presumably the majority.”

In short: We can’t know whether or not antidepressants could be considered prophylactic (or rather, the condom of mental health) because a relapse in depression and side effects of antidepressant withdrawal is often confused, misinterpreted, and misdiagnosed.

The more you know. Ding ding dong!

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Click here for Hengartner’s article, “How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding”

Click here for Part One of Where to Find Scientific Research Papers (and How to Know if They’re Legit).

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Yesterday, I wrote about predatory journals. I suppose I shouldn’t have been surprised to learn that there are shitty people in the research world who get off on exploiting academics and undermining science, but I was. Blame my mother. She raised me in a world where all people, on some level, are good. I never quite bought it, but I also didn’t learn to look at everything and everyone with skepticism. I tended to assume that people were just doing the best they can. They may be severely annoying in the process, but ultimately it was all with good intention.

The internet has shattered that illusion. People are fucked.

And so the burden falls on to the individual to see through the bullshit. Historically, we’re not great at that, but when it comes to sussing out whether or not a research paper is legitimate, there are a few quick and easy ways to verify your science.

Google Scholar is one of my favorite ways to source research, but because Google Scholar is a search engine and not a curated database, articles published in known predatory journals may pop up in your search results.

The quickest way to determine if the article is legit is to check the “Cited by” number at the bottom of the search. If an article has multiple citations, it means other researchers are referring to the research in their own articles, which indicates legitimacy. It’s rare that articles are cited hundreds of thousands of times like Eugene Paykel’s excellent study in the photo above. (Paykel’s study is the research equivalent of a New York Times bestselling book.) According to my smarty-pants academic boyfriend Justin, even mid-single digits is enough to assume the research isn’t bunk.

While citations are a great place to start, they benefit from time in the system. Paykel’s article has been around since 1976, which means it has nearly half a century of research built upon it. New research won’t come with shiny citations, so you need to look at the journal it’s published in to see if it’s legitimate.

Academic journals are ranked for impact and quality. Think of it like the college system. Harvard isn’t the same as Iowa State, but that doesn’t mean that Iowa State isn’t capable of producing damn good citizens (and we all know question marks who graduated from top tier universities.) The top journals produce great work, but there is still plenty of meaningful work to be found in smaller journals.

Find journal rankings by googling the name of the journal and the word “ranking.” The Scimago Journal & Country Rank (SJR) should be the first result, and that will take you to a list with the journal in question buried somewhere in there. The rank is determined by the H-Index, the details of which I don’t entirely understand. The H-Index is determined by the number of publications and citations, and higher H-Index indicated a higher ranking. However, the H-Index is not standardized across subject areas, so you can’t cross-compare.

For our purposes, the H-Index doesn’ matter too much. In Justin’s words, “A low ranking isn’t necessarily a problem. No ranking is a problem.”

If the journal article doesn’t appear on the SJR, your predatory journal spidey sense should go off. Cross-reference the journal against Beall’s List, an archive of predatory journals created by librarian Jeffrey Beall. The sheer number of journals listed on Beall’s List is astounding, and it’s easy to see how naive readers could be duped.

A note from Brooke: This post is taking longer than anticipated, so I’m splitting it into two parts. This post will focus on where to find relevant research papers, while Part II will focus on the quality and legitimacy of those articles.

For most of my life, I struggled with the assumption that people with letters after their name are not only smarter, more powerful, and more successful than me, but that the research they create is gospel. I’m not sure when or how this load-of-crap seed was planted, but it’s lead to a lifelong feeling of inadequacy—especially throughout my twenties. Doctors and scientists were busy saving lives and stumbling across eureka. Meanwhile, I made stupid cupcakes for a living and couldn’t afford health insurance.

My assumption that all doctors and research belonged on a pedestal is part of why I so easily accepted their mental health diagnosis. I knew I was depressed, but what did I know about how to fix it? A doctor told me that my brain was broken and that the pills I was taking did not have any major side effects. Who was I to question someone who spent 12 years learning how to identify and treat my exact problem?

It is only since getting off the antidepressants that I’ve begun to understand how complicated, political, and often corrupt the medical and research system actually is. And this isn’t conspiracy. Bad science is everywhere—The Guardian even has an entire vertical dedicated to it.

While researchers are adept at sorting out bad science from the good, regular folk rarely known the difference, which can lead to a plethora of misinformation and ill-informed opinion. But I’ve learned a few basic strategies to help us plebians suss out the good from bad. This is by no means foolproof, but it’s a start.

PubMed is a free search engine that primarily accesses the MEDLINE (Medical Literature Analysis and Retrieval System Online) database of research on life science and medical topics. It allows you to sort by a variety of matches, including author, publication date, and journal. It also has a nifty search feature that will only give you results that include free full text. Unfortunately, the full text of many research papers are hidden behind paywalls, which leaves the average person stuck with nothing but abstracts.

Google Scholar is…well, the Google of research. Whether you’re looking for research on antidepressants or conifer trees, Google Scholar is the grand poobah of scientific information. However, because Google Scholar is a search engine and not a subject-dedicated database (like PubMed), Google Scholar strives to include as many journals as possible, including junk journals and predatory journals. These predatory journals are known for exploiting the academic publishing business model, not checking journal articles for quality, and pushing agenda even in clear cases of fraudulent science.

All this to say that before a paper is read, the reader needs to do a bit of due diligence to make sure that what they’re reading is legitimate. Even then, we can’t be 100% sure. Case in point: Andrew Wakefield’s fraudulent research claiming that vaccines cause autism.

I know, I know. The number one rule in research is: don’t use Wikipedia as a source. Any old geezer (including you) can log on to Wikipedia and change an entry (any entry) to say anything and everything, which means that Wikipedia is riddled with errors and should not be referenced as truth in a research paper or reported article. But since we’re not reporting for the New York Times, Wikipedia is a good place to start because of the references listed at the bottom of each Wikipedia entry. The Wikipedia page on Antidepressant Discontinuation Syndrome, for example, links directly to 27 different sources on the topic. Whether or not all these references are legitimate is another issue entirely, and one that I will get into tomorrow when we explore Part II: How to tell if a journal article is legit.

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As always, please keep in mind that like you, I am learning as I go. These are complicated topics that even experts don’t agree on. We’re all doing the best we can.

Part of the reason why I’m able to learn what I’m learning is that my partner, Justin, is an academic. He’s built his career on reading, writing, and analyzing journal articles, which means he’s my first stop on the understanding research train. This is both great and terrible for me. On the one hand, I have an expert at my disposal. On the other hand, I have an expert at my disposal. What I think are straightforward questions turn into twenty-minute tirades that leave me more confused than before. No answer is ever simple, and I’ve been forced to accept that “it depends” is a valid conclusion.

“The more you research you read the more you’ll understand that every single study is fundamentally flawed,” he said to me yesterday. “Be careful about assumptions, because research studies are full of caveats and exceptions. They’re looking at one little sliver of one thing, and there’s no easy way to accurately translate that into something digestible and catchy for the media.”

All this because I asked him what n meant in a paper.

I assumed the n operated like it does algebra, standing for a constant throughout the entire paper. As it turns out, that is entirely incorrect. There are big Ns and little ns. The big N typically stands for population size while the little n stands for some sort of value. For example, if there are 1000 people in a school but only 200 of them were chosen for a study, N=1000 and n=200.

However, the n does not necessarily refer to human subjects and the meaning of that n can change with context. Using the paper from yesterday’s post as my example, we can see that there are a variety of values for n throughout different parts of the article. The first shows up in the abstract, n=16:

Reading the sentence before it, “antidepressants were significantly better than placebo in trials that had a low risk of bias,” this little n refers to the number of studies analyzed that had a low risk of bias (16 studies.) Why they can’t just say, “In the 16 trials that had a low risk of bias…” I don’t know.

Further down the paper, n shows up again:

To understand what these ns represent, we need to read for context. The previous page states, “The literature searches from databases and additional resources identified 2890 relevant titles.” In this case, n has to do with the number of studies analyzed, and the chart breaks down how the researchers began with 2890 studies (2864 records identified through database searching + 26 records identified through other sources) and whittled their relevant studies down to the 28 included in the meta-analysis.

To sum up: An n is not an interpretation of the data but instead communicates some sort of numerical value. That value changes depending on what it’s referring to, so it’s always necessary to read for context.

When I first began speaking openly about long term antidepressant use and antidepressant withdrawal, it didn’t take long for me to be faced with a wall of academic journals and research papers. At first, my instinct was to read the abstract, get the gist of what I was trying to understand and move on. But much like sourcing all your information exclusively from Fox News, that approach left me a dangerous kind of dumb. I had just enough information to confirm my bias but zero original thoughts surrounding the source, scope of work, journal reputation, limitations of the study, and industry response.

When it dawned on me that just reading the abstract was no better than just reading sensational news headlines and deeming yourself informed, I began to read the studies in full. At least, I tried. For those of us who haven’t spent their entire adult lives in research and academia, these papers are a nightmare.

While I understand that there are longstanding reasons why academic papers are written the way they’re written, it bothers me that only people with a PhD are taught to comprehend this sort of work. How can the individual be expected do their own research and make their own decisions for their own wellness if they can’t understand the research that policy and marketing is built upon?

Which brings me to the first installment of How to Read a Scientific Paper. I’m tired of taking other people’s word on research as gospel, so I’m going to learn how to do it myself and chronicle the journey here. Hopefully, I can beef up the entertainment factor, because damn these articles are dry.

I’m going to begin with a recent article spearheaded by psychiatrist Saeed Farooq and published in the Journal of Affective Disorders, entitled, “Pharmacological interventions for prevention of depression in high risk conditions: Systematic review and meta-analysis.”

I first found out about the study thanks to a Keele University tweet that said, “The study, led by Professor Saeed Farooq, found that using antidepressants as a pre-emptive measure could help to prevent depression in patients considered to be at high risk of developing the condition, for example following stroke or heart attack.” The tweet linked not to the article, but an in-house blog post that feels a bit too much like propaganda. The fact that we’re even considering doping people up on antidepressants before they become depressed deeply concerns me, so I want to learn more about it before I go full oh no you di’n’t! on the topic.

In reality, this was not a research study or clinical trial, but a systematic review and meta-analysis. And for us to learn to read journal articles, we must understand the difference.

A research article is a study designed and performed by the paper’s author or authors. It will explain the methodology of the study—or rather, the methods and systems used to conduct the study—and clarify what the results mean. All of the steps are listed in detail in order to allow other researchers to conduct similar experiments.

One of the best ways to tell if you’re reading a research article is to look for phrases like “we found” or “I measured” or “we tested.” This indicated that the authors who are writing the article are the ones who also conducted the research.

Next, look at the formatting of the article. Research papers include sections that are listed in a particular order: abstract, introduction, methods, results, discussion, and references.

Review papers do not include original research conducted by the authors(s). Instead the author(s) give their thoughts on existing research papers for the purpose of identifying patterns or forming potential new conclusions based on a variety of research studies. For example, a researcher may look at a study performed in 1980 and compare it to a similar study from 2010 in order to provide an overview of the topic as a whole.

Reviews are particularly useful for people looking to get background information on a topic before diving into detailed or technical research papers. However, there is no formal process to dictate which articles must be included in a review, which gives authors the freedom to overlook existing research that may not fit their agenda. Thus, it can be difficult to determine if the author’s conclusions are biased.

Systematic reviews were developed to eliminate that bias by requiring multiple authors to track down all available studies on a particular topic and execute high-level analysis of existing research in order to answer a clearly defined, clinical question. Systematic reviews can take months or years to complete, whereas standard reviews may only take a few weeks.

Systematic reviews contain a lot of data and to the untrained eye, can look a lot like original research. Systematic reviews are held in the same echelon as original research and are often presented to the public as if the research was new (like in the Keele University tweet.) This strikes me as potentially misleading, not because the research isn’t valid or useful, but because of the language used to promote the research.

For example, Farooq’s article concludes that based on his analysis, “Prevention of depression may be possible in patients who have high-risk conditions but the strategy requires complete risk and benefits analysis before it can be considered for clinical practice. However, not a single clinical study has been conducted to support or disprove that statement and the tweet says nothing about that and instead presents the research as if it were a new, exciting discovery.

Meta-analysis is a research process used to manage and interpret all the data for a systematic review. In layman’s terms, meta-analysis is how researchers make sense of the data in hundreds or thousands of individual papers. After extracting the data, analysts use a variety of methods to account for differences like sample size, variations in study approach that may affect the overall outcome of the systematic review, and overall findings.

Frankly, I don’t understand a lick of how meta-analysis works. But, I’ve learned that I don’t have to understand it as long as I understand what role it plays in research: meta-analysis pools the data sets from different studies into a single statistical set of data in order to analyze it and come to a single conclusion.

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For or those of you who like visuals, check out this article by Concordia University that visually breaks down the structure of various journal articles so you can recognize what you’re reading.

I’ve said it before and I’ll say it again: I am not a doctor. I am also not a researcher, pharmacist, or psychologist. I don’t have a PhD. Or a Masters. My Bachelor’s degree is in history. Not a specific part of history, but of all time. I’ve also got a culinary degree that ultimately led me to compete on—and win—Food Network’s “Chopped,” as well as an XPT Life certification that allows me to coach movement and breathwork.

All this to say: On paper, I’m no psychiatric expert.

But life has a funny way of shoving us down unexpected paths, and despite a resume that suggests my time is best spent in the kitchen or the gym, I now find myself as an emerging voice in the fight against the depression and antidepressant epidemic.

I would be lying if I told you that I was happy to hold this torch. But like an avalanche that can’t be stopped, I sealed my fate when I tipped a snowball over the mountain back in July of 2017 and agreed to write a memoir about my year of international travel. The book was to be called Ladyballs, and it would have a snarky, boss bitch attitude about leaving a shitty life for one full of global adventure. Eat, Pray, Love for disillusioned millennials.

Disgusting, right?

Like most work that overleans on sarcasm, the book’s irreverent attitude was a coverup for the story I was still too ashamed to tell: I’d spent half my life on antidepressants, and after a hell year of getting off them, I had no idea who I was or what I was supposed to do with myself.

Ladyballs ultimately fell through, leaving me with nothing but a shitty first draft of a book no one should ever read. But thank God for that shitty draft, because buried in it was nuggets of the real story, the story of what happened after I booked a one-way ticket to Malaysia and got off fifteen years of antidepressants, one by one by one by one by one. As of today, my memoir May Cause Side Effects is out for submission.

Which brings me here. I spent the last two and a half years writing May Cause Side Effects, with no guarantees that it will ever get published. While my agent is busy doing her job, I am tasked with pivoting away from my image as a chef and to what they call, a “recognized expert” in the field. And since I don’t have letters after my name that automatically deem me an expert, I’ve got a different sort of work to do.

For years, I’ve been thinking about how I can use my experience to add value to the conversation surrounding antidepressants without making black or white statements, alienating other people’s choices, or getting overly political. Now that I’ve been published in a major news outlet, started seriously tweeting, and given a few speeches on the topic, I’ve come to the solemn understanding that there’s no undivisive way to enter into the conversation about antidepressants. Like climate change and income inequality, depression and antidepressants are inherently political. The message consumers are presented with is born in a profit-driven marketing machine fueled by researchers who depend upon government money to conduct narrow studies that result in limited data extracted by pharmaceutical companies who funnel billions of dollars into government policy and television commercials in order to convince you that your problems are all in your head.

Did your eyes glaze over a little bit during that sentence? Don’t worry, it’s not your fault. You and millions of other people have a mental illness, just like millions of people have diabetes! The brain is an organ, just like the pancreas. Diabetics take insulin for a faulty pancreas, so why not take antidepressants for a faulty brain?

Except despite a few decades of rampant and rising antidepressant use, depression and suicide rates continue to rise, so much so that psychiatrists from Keele University just published a review hypothesizing that prescribing antidepressants before someone becomes depressed might lower their chance of developing depression.

That’s like giving healthy people chemo just in case they get cancer.

Which brings me to why I’m here. My work over the past few years has led me to believe that without a (highly unlikely) overhaul of our entire mental health and healthcare system, the onus is on the individual patient to do the research and take their treatment, therapy, and healing into their own hands-or face the consequences of unknown, unsubstantiated long term antidepressant drug use. This means that people need to think for themselves, learn how to do their own research, and unscrew the notion that we have any real understanding of what causes depression. Because we don’t. And I don’t see us cracking that code anytime soon.

That said, I want to emphasize the following: Since getting off all my antidepressants, I have been honored to work with a variety of outstanding medical professionals, from psychologists to researchers to psychiatrists. There are solid humans out there working to help people truly get better. This is a stark contrast to the psychiatric and psychological experiences I had as a young adult, and I regularly wonder whether or not my life would have taken the same course if I hadn’t had shit psychiatric luck so early in my life.

But I did, so here we are.

My goal is to take readers through my own process of learning, uncovering, and understanding this complex issue. I reserve the right to question what I’ve been told, to change my mind, and to make mistakes. I can’t promise that I’ll always be right. But I can promise to admit when I’m wrong. Because the only truth I know is the one I experienced, and that’s not enough for me.
If you’ve made it this far and you like what I’m doing, I’d appreciate it if you could give me a follow on Twitter or share my work with someone who might appreciate it.

Thanks for sticking with me,
Brooke