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Does magnesium treat depression as well as SSRIs? Despite claims, there’s no evidence

With health care cuts looming, low-cost magnesium a welcome option for treating depression

Our Review Summary

If something sounds too good to be true, it probably is. This news release from the University of Vermont reports on a study showing an association between taking magnesium supplements and a decrease in depression and anxiety symptoms in people with mild-to-moderate depression. The release simplifies and overstates the benefits of magnesium without offering any comparisons (beyond vague statements) with current pharmaceutical treatments for depression. It also ignores any mention of the study’s limitations.

 

Why This Matters

Because depression is a global problem, an inexpensive, easily accessible supplement with no side effects that could be used to combat depression would be widely welcome — but only if it is viable. This release doesn’t make the case that magnesium is the answer for a condition that affects millions.

According to the CDC, almost 8 percent of Americans age 12 and older have depression in any two-week period. There’s  a stigma attached to mental illness, which can prevent some people from seeking treatment. Using magnesium to fight depression is a tempting solution because not only is it low-cost, but it can be bought over-the-counter without the need for a psychological evaluation. Unfortunately, this news release might encourage people to take the treatment of their mental health into their own hands using only supplements, instead of seeing a doctor or psychologist.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Despite claiming the low cost of magnesium supplements as a benefit, the release doesn’t include the cost. A quick google search shows that magnesium tablets can be bought online or in stores for less than $15 per bottle.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

According to the news release, consuming magnesium chloride “resulted in a clinically significant improvement in measures of depression and anxiety symptoms.” But the release made no mention of what these measures were, or how the measurements were taken.

The published study notes that the primary outcome measure was a mental health questionnaire given by phone bi-weekly (the Patient Health Questionnaire-9, or PHQ-9). Like any survey, this method of data collection is vulnerable to bias in the form of self-reporting. In the published study, the researchers said that the results of the PHQ-9 survey are clinically significant if there is a 5-point or more difference between treatment and baseline. The net improvement was a difference of 4.2 points, but when the researchers adjusted for other factors (including age, race, gender, smoking, alcohol use, and treatment adherence), the difference rose to 6 points, making it clinically significant. Importantly, however, the duration of this treatment benefit beyond this brief trial is unknown.

None of these nuances were mentioned in the news release.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release made no mention of potential harms of magnesium supplements although it notes the treatment is safe on two occasions.  The actual results, however, were not quite as straightforward. The authors noted in the published study, “The most common reason for a negative response was that “magnesium did not help mood” (46%), followed by side effects (20%). The most common side effect, diarrhea, was reported by 8 participants. In addition, the published study notes that people with gastrointestinal disorders or kidney disease could not participate in the study since high levels of magnesium are not safe for these patients. 

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The news release provides a description of the study, “an open-label, blocked, randomized cross-over trial involving 126 adults in outpatient primary care clinics.” While this is adequate for an experienced reader, we would have liked to have seen a bit more information about the actual mechanics of the study and the trial limitations included in the release. The authors of the study did an admirable job in discussing the limitations of their design. Unfortunately, these were not carried over to the release.

Among the limitations:

There was no placebo arm of the trial, and while the participants were randomized, the trial wasn’t blinded for either the participants or the researchers. Both of these can lead to bias in the study results.

The study participants took the magnesium supplement for just 6 weeks. There’s no way to know if the slight benefit extended beyond the study period.

The news release doesn’t mention whether the study volunteers were on other medications or treatment plans to help their depression. This could be an important factor, especially if some participants were on prescription anti-depressant medications or in counseling, and others were not.

Does the news release commit disease-mongering?

Satisfactory

No disease-mongering here. The news release called depression an “enormous disease burden.” This is true—depression is a huge problem that affects millions of people. The World Health Organization says more than 300 million people worldwide suffer from depression.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The news release didn’t mention either the funding sources or address conflicts of interest. These were noted in the study and could have been easily included in the release.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The news release makes some statements suggesting magnesium supplements are as effective as SSRI anti-depressants and offer lower cost and fewer side effects. No evidence is offered for this and the study was far too small and too brief to demonstrate magnesium effectiveness. 

The release should have delved into this area more, especially because there are so many current treatments for depression. For example, the release offered no mention of other classes of anti-depressant medications or non-drug interventions like cognitive behavioral therapy.  

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The news release mentioned that magnesium can be found over-the-counter.

Does the news release establish the true novelty of the approach?

Not Satisfactory

The release says that “few clinical trials have studied the supplement’s effects.” It also quotes the lead researcher as saying, “This is the first randomized clinical trial looking at the effect of magnesium supplementation on symptoms of depression in U.S. adults.” 

While this might be the first clinical trial in the US, there have been other studies (which the researchers referenced in their paper) that have looked at the effects of magnesium on depression in adults. Specifically, they mention two observational studies–one that took place in Norway, and one that looked at adults with type 2 diabetes. 

Total Score: 3 of 10 Satisfactory

Comments (5)

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Paul Scott

July 3, 2017 at 2:44 pm

Hi. I get the larger critique here and I wouldn’t be in any position to defend magnesium supplements for depression but I would ask whether the following statements are in fact valid or are instead a product of disease mongering: “Because depression is a global problem…” and “According to the CDC, almost 8 percent of Americans age 12 and older have depression in any two-week period. There’s a stigma attached to mental illness, which can prevent some people from seeking treatment.” The stigma surrounding mental illness narrative is problematic, simply because the widespread use of psychotropics suggest otherwise while the narrative functions to disarm all critiques of the medications. It says that thinking critically in our time about SSRI’s and the overdiagnosis of depression is to support stigma, essentially. Moreover, research shows that bio-based framework for mental health functions to increase stigma. More to the point, the CDC data embodied in this is highly suspect. If you follow the citation you learn that “Depression” was “Measured by the National Health and Nutrition Examination Survey (NHANES) using the Patient Health Questionnaire (PHQ–9), a nine-item screening instrument that asks about the frequency of symptoms of depression over the past 2 weeks (9).” The PHQ-9 was developed and is owned by Pfizer, the makers of Zoloft, and is associated with over diagnosis of depression. https://www.ncbi.nlm.nih.gov/pubmed/25201931

Reply

    Harold DeMonaco

    July 10, 2017 at 2:33 pm

    Mr. Scott is certainly entitled to his opinion and I thank him for responding to our review. However, I would take issue with his categorization concerning our “mental health narrative.” Indeed, we referenced the Centers for Disease Control data derived from the NHANES study and the PHQ-9 was the primary instrument. The PHQ-9 instrument was developed by Kroenke and colleagues under a Pfizer educational grant and has been validated on numerous occasions as compared to more complicated instruments such as the HAM-D.(for example see:http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2001.016009606.x/full) It is unclear to me how the CDC data is “highly suspect”
    The authors of Mr. Scott’s cited reference had a somewhat different conclusion from his: “These exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure.” To be clear, the authors noted the exploratory nature of their study and a need for confirmation in other studies.

    It is unclear to me how our “narrative” on the stigma associated with depression in any way “disarm(s) all critiques of the medicines.” The current use of SSRI and other antidepressants has been the topic of research for a number of years. A 2011 article in Time magazine perhaps said it bests: “While some observers complain that antidepressants are being handed out like candy, the data show that patterns of prescription generally adhere to what is known about depression prevalence in the U.S. In fact, the research suggests that depression is consistently undertreated.”(see: http://healthland.time.com/2011/10/20/what-does-a-400-increase-in-antidepressant-prescribing-really-mean/)

    So, to answer the question posed, “yes, the statements are valid.” Depression is a global problem both in terms of diagnosis, access to care, cost of care and long term treatments. The ease of use and the high level of sensitivity and specificity of the PHQ-9 instrument make it an ideal diagnostic tool.

    Reply

      Paul Scott

      July 12, 2017 at 3:26 pm

      I will try to restate my point more clearly. If you look around, there is no other illness advocacy position that posits stigma. Not the AIDS people. Not TB. It’s a standard assertion with depression screening and largely only depression screening, and so the “stigma of depression” in that sense is functioning as a narrative, with all the encompassing baggage. We live in a social context with medicine; stigma and depression screening are part of the context which affects the way we approach how closely to look mental health policy. My point , not very well stated, is that depression screening campaigns routinely posit stigma: there is no assertion of stigma connected to heart disease, or cancer, or diabetes, and yet it remains challenging for critics who take issue with the validity of the screening tools in those illnesses . Now consider adding the message that those who consider the PSQ-9 are stigmatized for considering their need for depression screening, and that adds another layer of social scorn upon any who would fault such efforts. On top of all this, there is no stigma to having depression anymore! The drugs are taken by millions! This is the era of mental illness memoir. The suggestion that depression is a haunting social secret, to be whispered, like cancer in the 1960’s, it is preposterously outdated. Third, actual research on stigma shows the biomedical model is indeed stigmatizing. Meaning if those moving patients towards antidepressants are really concerned about stigma, they would reconsider their model. The idea that Time magazine proves depression is under diagnosed, or even the views of the CDC, is not very convincing. We have such a long way to go to disconnect ourselves from the problems created by Pharma with the literature regarding incidence and nature of mental illness. But my point was really about the PHQ9, which is clearly lacking in sensitivity, and subject to overdiagnosis. I spent only a few minutes finding the study I linked, I will not dig around to find the studies showing its sensitivity is poor. If the fact that it was funded and is branded by Pfizer doesn’t trouble the authors there’s not much more I can add. I will ask just anyone reading this to take the thing. You will all come away officially depressed.

William Conder

July 11, 2017 at 5:16 pm

This criticism of a press release is overblown. After reading the press release, one may go to the research and references to enlarge one’s understanding of the researcher’s rationale for their hypothesis. After reading the press release, one suffering mild to moderate depression may decide to try consuming magnesium supplements and may experience benefit. Since many people in our society are magnesium deficient (a fact that’s been established for many years) there may be other benefits. If there is significant benefit such that one can avoid the doctor’s office and a prescription for potentially dangerous drugs, all the better. Good, accurate writing is important and rare but nitpicking a press release that’s a few paragraphs long about research that tries to grasp a very big problem is counter-productive.

Reply

    Kevin Lomangino

    July 12, 2017 at 9:36 am

    How many readers have the savvy to read and understand the original paper that this news release is based on? How many have the time to do so? I think it’s wrong to put the onus on the reader to research and evaluate unsubstantiated claims in news releases. It’s the news release writer’s job to provide accurate information about things like evidence quality and benefits. Call it “nitpicking” if you like, but we think this is vital information. Institutions like the Association of American Medical Colleges and the National Institutes of Health — who’ve asked us to present our criteria for evaluating news releases at their events — agree that this is necessary and important information to include.

    Kevin Lomangino
    Managing Editor

    Reply