Experimentation is one of the keys to my mental health.

I’ve known this for eight or nine years now, in fact ever since I was diagnosed with bipolar disorder.

One of the biggest problems with any illness is working out cause and effect. There is so much noise going in everyday life that it’s near impossible to separate these things out.

Take medications as an example.  Bipolar is notoriously difficult to treat; it can take several years of trial and error to find a combination that offers a reasonable result. It requires experimentation. If this is formalized in some way there is a much better chance of success.

What used to happen? Once a month I’d visit my doctor and each time the conversation went like this:

“How have you been over the last month?”
“Pretty bad”.
“What in particular was pretty bad?”
“I can’t really remember.”
“How is the new medicine going?”
“I don’t know. It’s hard to tell.”

If you’ve had similar conversations then you’ll know how frustrating they are – for everyone. If only we had a checklist of what works and what doesn’t handed out to us on a silver platter, life would be so much easier*. But the realization that this was never going to be the case opened up the door for me to a way of dealing with my condition proactively: experimentation. Instead of merely telling myself, “Don’t do this or that,” I sought to answer the question, “What will this achieve?”

* Shameless plug: I developed the Optimism apps to help with this specific problem. :)

A couple of years ago I stumbled across Think Try Learn, a website that has been a big help in my goal of living a more fruitful and less stressful life. Dubbed as The Experimenter’s Journal, Edison is the perfect resource for people who adopt the simple idea that “all life is an experiment” and it’s up to us to think, try, learn.

With over 400 experiments and more than 600 users to date, Edison has evolved to become a community of experimenters who have given the TTL method a try and are willing to share the lessons they’ve gained over the course of exploring unchartered territory. Whether it’s learning a new sport, starting a weight loss plan, or growing a plant – all these experiences are documented at Edison.

In my case, there are many and varied things that I’ve found out about myself through experimenting – some of them related to mental health, others unrelated.

• I am intolerant of some foods beyond a threshold. If I binge on one of them I have a big mood swing a couple of days later.
• I am more productive when I select my work tasks randomly by rolling dice.
• I took photos of my food for a week to shame myself into losing weight. (I put on weight.)
• I experience better moods when I sit on an exercise ball for work, than when I sit in a normal office chair.
• My skin reacts to latex dish washing gloves, which isn’t immediately obvious for some time after washing up.

I documented the last 4 of these on Edison, with some feedback and encouragement from others.

As you can see from my own experience, an experiment need not be a grand one to be beneficial, especially when it comes to one’s health. Even the simple discovery that eating sweets makes you stay awake long into the night, or that a certain brand of detergent causes you to break into a rash, is something that you would appreciate knowing. However small a piece of information may seem, if it brings some ease to your day to day living then it‘s worth the effort that you put into finding it.

There is a useful website called BluePages by the Centre for Mental Health Research at the Australian National University. The site isn’t pretty, but the content is very helpful.

The Centre for Mental Health Research has ranked the best treatments for depression according to the depth and quality of evidence supporting them. It is updated regularly as new research is published.

Here is a summary:

Medical

Antidepressants and Electroconvulsive Therapy (ECT) are both ranked highly with strong scientific evidence for their effectiveness. A relatively new treatment called Transcranial Magnetic Stimulation has so far only shown small benefits that disappear after a couple of weeks.

Psychological

Cognitive Behavioral Therapy ranks highest with strong evidence for being very effective. CBT focuses on helping the individual learn and use new thinking skills to modify negative emotions, beliefs and behaviors.

Interpersonal Psychotherapy, Psychodynamic Psychotherapy and Bibliotherapy are all on the next tier. They are supported by scientific evidence as being effective, but the evidence is not as strong.

Studies have found that supportive counselling, in which problems are discussed and the counsellor provides emotional support, is not effective.

Lifestyle & Alternative

Exercise, Light Therapy and St John’s Wort are ranked on the second tier as useful treatments, with good evidence but not as strong as for, say, CBT.

On the third tier there is a large group of other promising treatments with less evidence in support. It includes Acupuncture, Alcohol Avoidance, Massage Therapy, Relaxation Therapy, Vitamins and Yoga.

Many different things are touted as the best treatments for depression, but that doesn’t mean they’re effective. The BluePages is a good place for a quick check on such claims.

Anna & I exhibited Optimism at a recent Sydney conference – the 2nd Annual Rural and Remote Mental Health Symposium. As with other conferences it was exhausting work, but we received keen interest in the apps and were able to catch some interesting presentations.

I gave a summary of why the apps exist in the video below. It’s not pretty, that’s for sure, but my on-the-run comments sum up how we see ourselves fitting into rural and remote mental health.

James Bishop RRMHS from AST Management on Vimeo.

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

CureTogether is a community based health site, where members share their health concerns, symptoms and treatments. It has grown very quickly over the last couple of years, and the “crowd-sourcing” of health data is really starting to bear fruit. Kudos to Cure Together!

In compiling the chart, anonymous information was collected from 944 people in their Depression community.

Perhaps not surprisingly, exercise is rated as both the most popular and effective treatment. For us depressed folk, it is also one of the hardest to start and continue with. Especially when we need it most. Maintaining good sleep habits was also found to be popular and effective. Again one of the first things to depart with the arrival of depression.

I think it’s odd that people consider caffeine to be a treatment, even if a less helpful one. Odd, because in large quantities caffeine acts as a depressant; it releases stress hormones like adrenalin. I’m acutely aware of this. My addiction to strong, freshly roasted Australian coffee is incompatible with bipolar, at both ends of the spectrum.

Cure Together also released an ebook a week ago, called “The CureTogether Guide to Depression” and subtitled “How to Find a Treatment That Works: Research Results and Practical Advice”. I haven’t purchased it yet, but for $10 it sounds like a bargain. This is exactly this kind of patient centered research that has real potential for improving the body of knowledge, influencing the direction of clinical research, and ultimately improving health outcomes. (To be clear, I don’t have a relationship with Cure Together and no financial interest in promoting this book).

Another similar but much older resource can be found at the Australian National University’s Blue Pages site. Its survey of treatments is based on clinical, not patient-generated research, but the results dovetail nicely.

On a related note, many people who use our desktop and online applications have authorized the anonymous use of their data for scientific research. The proportion opting in has been exceptional – somewhere between 40% and 50%.

Later this year we will have sufficient data to start analyzing correlations between the items being tracked. The results will be freely available. It is my fervent belief that the Optimism community will also make a helpful contribution to the body of knowledge on mental health.

The research will be done in collaboration with a well regarded U.S. university, in addition to a more formal study on how the apps can change a person’s relationship with their physician and the quality of their treatment.

Watch this space! :)

“Wikipedia articles appear in the top 10 results for more than 70 per cent of medical queries in four different search engines…

…Even more disconcerting is that 50 percent of doctors turn to the user-generated Wikipedia for health info.”

Read the full article at New Scientist.

I wrote a post 18 months ago about using search engines, more specifically Google, to search for health information. Nothing much has changed. The distinction between content and advertising is blurred, and it’s all too easy to end up on a dodgy website.

So who can you trust for reliable information?

A good place to start is to look for the HONcode icon at the bottom of a web page. You will find it in the footer of pages on reputable sites – see for example Psych Central, the Depression and Bipolar Support Alliance and the Black Dog Institute. The icon indicates that the site has gone through a certification process for the reliability and credibility of its information. It has become the industry standard for reputable health sites.