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One of my longtime patients came into my clinic. He was feeling down for months. But this depression was worse than usual. He stopped having the energy to go to work and ended up losing his job. He started smoking cigarettes a lot more. And he wasn’t eating right; all he had were soup cans.

I read the book like you told me to,” he uttered, panting in between breaths.

Psychiatrists may be known for just “prescribing medications,” but a psychiatrist can do much more than that. We do talk therapy, arrange group classes, and even recommend books to read. And in this case, he was talking about a cognitive behavioral therapy book, Feeling Good, written by a Stanford psychiatrist. That book, even though it’s been around for almost two decades, was something we still talked about and recommended.

What about the app I asked you to try out?,” I then asked.

A lot of us doctors talk about apps to download. Even Internet sites to read. There’s so much buzz about apps promising to revolutionize mental health now.

But what we don’t hear a lot about are the side effects.

I’ve been thinking about these sorts of things a lot more lately. My colleague, John Torous, is a physician at Harvard who evaluates technology and thinks about new ways to use it for mental health. One day, he came across an app for bipolar disorder that he decided to test. He was shocked to see that it recommended that he start drinking alcohol if he feels a bout of mania—revved up out-of-control energy—coming on.

Have you ever heard of a doctor recommending that someone drink more alcohol? Almost never!

The side effects of apps

Any good doctor will recommend, discuss, and prescribe what they think would be most helpful. Medicines come with these benefits, and they also come with risks. These new, cool technologies come with side effects as well. Here are two that can come with apps:

Side effect #1: Inflated expectations of an app or technology could lead to ultimate disappointment and frustration

Samsung recently hyped its most powerful smartphone—with a better processor, better camera, better screen—all in the Galaxy Note 7. With its marketing machine in gear, Samsung manufactured these phones and pre-sold them to customers worldwide.

Unfortunately, Samsung didn’t do enough quality testing. Reports of hardware issues have led to the manufacturer doing an unprecedented recall of its 2.5 million smartphones. This—plus government and airline bans on the device—are frustrating lots of people. Customers expect a device that works!

The marketing behind some apps, tech, and devices can frustrate people as well. Fitness trackers, for instance, encourage and set the expectation that a person should exercise more and lose weight. But there’s not as much talk about recovering from failures. In fact, a study released this month from the University of Washington talked about the frustrations people had with Fitbit, surveying over a hundred people who stopped using the device.

Jennifer Langston reported in UW Today that,

“Half of these Fitbit users described feeling guilty about their lapsed Fitbit use and nearly all of those said they would like to return to activity tracking. Twenty-one said they got no value out of tracking, found it annoying, or struggled to connect the data to behavior change.”

The good news for these Fitbit users is that there exists a whole culture and industry that supports fitness, exercise, and diet. With mental health, the culture is much weaker and more hush-hush, due to the higher stigma surrounding mental health.

This makes the mission behind mental health apps—to improve people’s mood and well-being—much more challenging. We want the mental health apps to work. It is a new and promising frontier. But, if these apps are frustrating to use or lead to disappointing results, they may discourage people from trying this new medium again.

Side effect #2: Some apps and devices aren’t thoroughly vetted or researched. So there’s a risk that an app comes with bad advice that could worsen your condition

That phone we talked about earlier, the one with battery issues? It turns out that if you bought into Samsung’s marketing message and bought the phone, you put yourself at risk of harm. As of this writing, there are at least 36 reports of the phone exploding and setting children, buildings, and automobiles on fire.

Similarly, the criticism behind The Dr. Oz Show is that it is all for, well, show. Researchers from the University of Alberta and University of British Columbia found that about

“half of the recommendations have either no evidence or are contradicted by the best available evidence” and “[t]he public should be skeptical about recommendations made on medical talk shows.”

I remember how my colleague, Dr. Torous, also found an instance of a smoking cessation app that would keep track of one’s smoking habits, that actually ended up leading to even more smoking in people who used the app. Similar issues have been found in which some smoking cessation apps do not adhere to science-based practices and guidelines. There are also lots of bold claims and promises made by companies peddling heart-rate checking apps, skin-checking apps, and smartphone-light phototherapy that are utter hogwash.

The bottom line

So what’s the bottom line? Be skeptical. Until there are good data and research behind a product, the app or device or technology may come with a lot more side effects than you bargained for!

These gadgets and apps are just new tools in our treatment arsenal. Just like there are good and bad books, good and bad medicines, and good and bad nutritional supplements, there are also good and bad apps.

Remember my depressed patient earlier? I recommended to him that he try using a medication, a book, and an app. It turned out that he never used the app at all. He couldn’t figure out how to download it!

So, while we talked about these side effects, I showed him how to open the App Store to download the app.

It’s all part of the treatment plan.

Steven Chan, MD, MBA (@StevenChanMD)
Dr. Chan is a Clinical Informatics fellow at UC San Francisco (UCSF)'s Division of Hospital Medicine, serving as editorial boardmember for the Journal of Medical Internet Research (JMIR) Mental Health, and develops cutting-edge research in the areas of digital mental health, with applications for cultural psychiatry and underserved minority health. Steve's ideas, thoughts, and research have been featured in JAMA, Healthcare, JMIR (Journal of Medical Internet Research), Wired, PBS, and NPR Ideastream. Steve serves as Vice Chair for the Workgroup on Mental Health & Psychiatric Apps at the American Psychiatric Association (APA), a part of the Committee on Mental Health Information Technology.

1 COMMENT

  1. That is a very good tip especially to those new to the blogosphere.

    Brief but very accurate information… Many thanks
    for sharing this one. A must read post!

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