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.

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”

When people describe legitimate research, they tend to preface it with the term “peer review.” Because peer review is a critical part of scholarly publishing, it’s worth taking a few hundred words and diving into its meaning.

Peer review is exactly what it sounds like: academic peers review an individual’s work in order to determine if the research is strong enough to publish. All articles published in legitimate research journals are peer-reviewed, which is why scholarly journals are deemed a reliable source of information. This is also why predatory journals are a problem. They don’t follow the peer review protocol, which means there aren’t any gatekeepers to stop unethical or fraudulent research from getting out into the public.

Peer review follows a standard process:

If you find research in a reputable journal, the article has been peer reviewed. However, sometimes researchers bypass the peer review process and instead submit research directly to their university or for use at an industry conference.

Having watched Justin go through multiple rounds of article submission, I feel the need to highlight the difficulty and glacial pace of publication. This shit is hard and slow. Justin has work he finished years ago that has only recently been accepted. It’s not that it takes all that long to read a paper, but because reviewers aren’t paid and they have other things to do, sometimes the work gets lost in the slush.

One survey suggested that 50% percent of articles are ultimately published, but only 9% are accepted without a revise and resubmit. While 50/50 odds aren’t the worst, the competition for publication in top journals is vicious. The journal Science only accepts 8% of submissions, while the New England Journal of Medicine publishes just 6%.

In short, no. Critics of the peer review system say it’s slow and expensive, inconsistent and subjective, and often filled with bias and abuse. However, with no viable alternative, both researchers and the general public must continue to believe in the system. The irony of course, as summed up by peer review critic Richard Smith: “How odd that science should be rooted in belief.”

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.

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