SGEM#341: You Make Me Feel Like a Natural Treatment

Reference: Li, T., & Gal, D. (2023). Consumers prefer natural medicines more when treating psychological than physical conditions. Journal of Consumer Psychology 2023, Date: February 23, 2024 Guest Skeptic: Ethan Milne is a Marketing PhD student at the Ivey Business School (Western University). He researches how moral outrage and status-seeking personalities motivate social media aggression, and how retribution can motivate consumer donations. Case: A 20-year-old male presents to the emergency department with palpitations. After a good history, directed physical examination and appropriate investigations you suspect he is suffering from a major depressive disorder (MDD) with a comorbidity of anxiety.  He is not a threat to himself or others and wants assistance. You arrange for him to be followed up by his family physician to discuss possible treatment options which include medications. He expresses concern that taking a synthetic drug to treat his depression wouldn’t allow him to be his authentic self. Background: Major Depressive Disorder, commonly known as depression, is a significant mental health condition. Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It affects an estimated 5-10% of the population at any given time, with variations depending on demographic factors such as age and gender. It is generally more common in women than in men and can occur at any age, although it often first appears during late adolescence to mid-20s [1]. The National Institute of Health (NIH) estimates that around 8.3% (21.0 million) of US adults over 18 have experienced a major depressive episode in the last year. Various factors can increase the risk of developing MDD, including genetic predisposition, personal or family history of depression, major life changes, trauma, stress, and certain physical illnesses and medications. Depression has been reported to be most prevalent among young women aged 12-17 (29.2%) [2]. The current diagnostic criteria for MDD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). These criteria serve as a guideline for clinicians to diagnose depression. To be diagnosed with MDD, a person must experience at least one of the two symptoms for at least two weeks: Depressed Mood: Most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Loss of Interest or Pleasure: Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. The person must also have five or more of the following symptoms during the same 2-week period, and these symptoms represent a change from previous functioning. Significant Weight Loss or Gain (or decrease or increase in appetite nearly every day) Insomnia or Hypersomnia: Trouble sleeping or sleeping too much nearly every day. Psychomotor Agitation or Retardation: Noticeable by others, not merely subjective feelings of restlessness or being slowed down. Fatigue or Loss of Energy: Nearly every day. Feelings of Worthlessness or Excessive or Inappropriate Guilt: Nearly every day, not merely self-reproach or guilt about being sick. Diminished Ability to Think or Concentrate (or indecisiveness, nearly every day) Recurrent Thoughts of Death: Recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. They must not be attributable to the physiological effects of a substance or another medical condition. Also, the occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. There are several treatment options for MDD and often patients will do a combination of things. It can be a challenge to treat depression effectively and the evidence to support different treatments varies. Lifestyle and Home Remedies: Regular exercise, maintaining a healthy diet, getting enough sleep, and avoiding alcohol and drugs can help manage symptoms of depression. Psychotherapy: Cognitive Behavioral Therapy (CBT): This is a highly effective form of therapy that focuses on identifying and changing negative thought patterns and behaviours that contribute to depression. Interpersonal Therapy (IPT): IPT focuses on improving interpersonal relationships and communication patterns. Psychodynamic Therapy: This explores how unconscious emotions and past experiences contribute to current feelings and behaviours. Medications: Antidepressants: These are the most commonly prescribed medications for depression, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). It may take several weeks to notice the benefits of these medications, and they may have side effects. Other Medications: In some cases, doctors may recommend other types of medications, such as mood stabilizers or antipsychotic medications, especially if symptoms are severe or if the person has a co-occurring mental health disorder. Other Non-Pharmaceutical Treatments: Techniques such as meditation and mindfulness can be beneficial for some individuals when used in conjunction with traditional treatments. Hospitalization: In severe cases, especially where there is a risk of harm to oneself or others, hospitalization or participation in an intensive outpatient program may be necessary. Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS): For severe depression that hasn't responded to other treatments, ECT can be effective. TMS is a newer treatment that uses magnetic fields to stimulate nerve cells in the brain and can be an option. While the prevalence of depression has increased [3], the market for herbal supplements and other natural remedies has also grown with an expected industry value of $8.5 billion by 2025 [4]. The “natural preference” is a pervasive and culturally universal phenomenon [5]. It is defined as when consumers have a favourable attitude toward natural products [6,7]. The Food and Drug Administration (FDA) has not formally defined the term “natural” for labelling purposes. The FDA allows the term “natural” to be used when a food does not contain anything artificial that would not typically be expected in that food. Clinical Question: They had four questions or hypotheses they were testing in this publication. Consumers demonstrate an overall preference for natural drugs over synthetic drugs. Consumers exhibit a general reluctance to treat psychological conditions compared with physical conditions. The relative preference for natural drugs over synthetic drugs is stronger when consumers are treating psychological conditions than physical conditions. The concern that synthetic drugs are more likely to alter the true self than natural drugs serves as a key mechanism connecting the type of health conditions and the preference for using natural drugs. Reference: Li, T., & Gal, D. (2023). Consumers prefer natural medicines more when treating psychological than physical conditions. Journal of Consumer Psychology 2023, Population: Participants were recruited from MTurk, which is an online platform owned by Amazon that allows anyone to sign up and begin completing surveys, experiments, or other tasks in exchange for monetary compensation. For a detailed breakdown of MTurk demographics, see Huff & Tingley (2015). Intervention: Synthetic drugs for psychological or physical conditions Comparison: Natural drugs for psychological or physical conditions Outcome: Primary Outcome: Preference for synthetic vs. natural drugs Secondary Outcome: Process evidence for true self-concern as the mediator Type of Study: Online survey Authors’ Conclusions: “while consumers have a general preference for natural drugs over synthetic drugs, this preference is stronger when the goal is to treat psychological rather than physical conditions. Process evidence indicates an important mechanism that explains the amplified natural preference for treating psychological conditions: Consumers are more concerned about their true selves being altered when treating psychological conditions, and they perceive natural drugs to be less likely than synthetic drugs to affect their true selves.” Quality Checklist for Reporting of Survey Studies (CROSS): Results: This paper was comprised of seven studies. Study 1 was an archival study, and the remaining studies were experimental. Study 1: In this archival study, the researchers identified a set of 10,158 individuals (out of 34,525 total respondents) who reported using at least one type of CAM treatment in the past year. Participants were asked if they pursued CAM because it was natural or not. The researchers then categorized the different illnesses participants identified using CAM to treat as either psychological (e.g., depression, senility, etc.) or physical (e.g., arthritis, diabetes, etc.). Rates of endorsement for using CAM due to “naturalness” were compared between psychological and physical conditions. Study 2: In this experimental study, the researchers employed a 2 (drug type: natural vs. synthetic) x 2 (condition: psychological vs. physical) mixed design.