By SUHANA MISHRA
When we talk about treatment outcomes, we typically talk about dosage, compliance, and access. We rarely talk about algorithms.
However, when I began working on a scoping review examining misinformation and disinformation in mental health with a team from the Royal College of Psychiatrists led by Dr Subodh Dave, I realized that some of the most powerful determinants of patient outcomes are not limited to clinics. They live in comment sections, short videos, and anonymous threads that shape people’s opinions on what the “truth” is. In fact, the New York Post says, “more than half of TikTok’s top mental health videos contained misleading information.”
I chose to do this research because I have seen how a single online post or video can change the way someone thinks about their own mental health. I have witnessed members of my own family being discouraged from following a treatment plan due to an inaccurate post sent in a WhatsApp group chat. By examining misinformation in collaboration with experts, I hope to identify practical strategies to help clinicians and public health professionals address its hidden determinants of mental health outcomes.
One of the most surprising lessons I’ve learned is that misinformation in psychiatry doesn’t always look like a conspiracy. It can often seem like a comfort. According to a Cornell University ArXiv Studypeople adopt misinformation because it satisfies psychological and social needs rather than accuracy goals.
A viral post on a Reddit r/antipsychiatry thread that claimed antidepressants “numb your personality” may have its roots in one person’s difficult experience. A video on Tiktok circulating discouraging medication in favor of “natural rewiring” may promise autonomy in a system that feels impersonal. These narratives spread not because they are outrageous conspiracy theories, but because they truly resonate with people.
That resonance has consequences.
In the literature we have reviewed so far, exposure to misleading mental health content was associated with lower treatment adherence and higher skepticism toward doctors. When patients arrive at appointments already convinced that psychiatric medication is inherently harmful or that diagnoses are fabricated labels, trust in the system is ultimately lost. Trust, arguably the most essential component of psychiatric care, must be rebuilt before treatment can begin.
Misinformation further complicates this. Unlike misinformation, which is often shared without intent to harm. Misinformation is strategic. Uncertainty exploded. Amplify rare events as if they were common. Rethink evolving guidelines. In doing so, it erodes trust in treatment, institutions and healthcare workers. A clear example was when the US Food and Drug Administration required a boxed warning in 2004 about a Small increase in risk of suicidal thoughts in adolescence. When starting SSRIs, the guideline was intended to promote adherence, without suggesting that antidepressants cause suicide in general. However the NIH As it turned out, certain advocacy websites and online communities strategically reframed that warning as evidence that “antidepressants make people suicidal” in general.
Mental health already carries stigma and vulnerability. A person suffering from depression who reads hundreds of comments insisting that antidepressants “erase your soul” may interpret a temporary emotional change as confirmation of damage. Someone with anxiety exposed to “dependency-creating” viral warnings may avoid support that can help them stabilize.
What makes this crisis so unique is its scale. Social platforms reward this emotional intensity and certainty. A 45-second TikTok warning about “hidden dangers” spreads faster than a peer-reviewed meta-analysis. Algorithms relatively favor precision. Personal testimony, although valid and important, conflicts with medical truth.
This research has made me confront the realization that treatment outcomes are no longer determined solely by what happens in a consulting room. They are influenced by what happens when a patient passes midnight, what they read in a comments section, and what a viral video frame is. When a doctor discusses risks and benefits, a parallel narrative may already be ingrained.
If we want better adherence, better engagement, and better outcomes, we must address not only the symptoms, but also the stories patients absorb about those symptoms. In a world where false information can spread faster than evidence, it is important to safeguard credibility. And that starts with recognizing the algorithms that remain silent in the exam room.
To address this issue, it is imperative that we treat exposure to misinformation as a clinical determinant of health: clinicians should proactively discuss online mental health content during visits, public health organizations should partner with platforms to elevate evidence-based information through algorithmic transparency and credible creator collaboration, and medical education should train providers in digital health communication. Improving outcomes will require not only prescribing treatments but also actively competing in information environments where patients form beliefs long before they enter the examination room. Ultimately, the future of mental health care depends on meeting patients where they are, which is often online and in the stories they believe, ensuring the truth travels faster than a tweet.
Suhana Mishra is a high school researcher and public health advocate from California’s Central Valley.
