Yes, but according to Irving Kirsch, the benefit of anti-depressants above placebo is very small for anyone who isn't severely depressed, and the observed small effects can plausibly be explained by patients unblinding themselves (due to the presence of other side effects in the treatment group), or by things like publication bias.
I'll add that side effects alone can influence depression scores. Any medication that de- or increases sleepyness will change the score of any questionaire when taken at the appropriate time of day.
In my case, at this very moment, I'm going through antidepressant withdrawal and have random crying spells. Sure, depression might not be mediated by serotonin, but these drugs have an effect on mood. It might be that there's a different mechanism of action.
My guess, without digging into the study itself since I'm on mobile, is that there is no singular cause for depression. Rather, depression is simply a symptom of a wide range of causes, with one possible cause being low serotonin (or a reduced sensitivity to it). Or even, low serotonin is a symptom of the depression.
Not all patients with depression find relief from SSRIs, or medications in general, but some certainly do.
Because psychiatric drugs don't necessarily work by counteracting specific deficits in the brain. That's a myth driven by unfortunate marketing campaigns and surface-level misunderstandings of the science.
This makes intuitive sense to people when discussing other topics. For example, when someone is in pain they don't need to have an "endogenous opioid deficiency" for opioid painkillers to alleviate their pain. They're just in pain, and modulating the opioid system with drugs is one way we can reduce that pain. Or COX-2 inhibitors. Or a number of other substances.
Likewise, modulating the serotonin system with SSRIs is one way we can modulate depression symptoms. People don't need to have a "serotonin deficiency" to see benefits from modulating their serotonin system.
Depression has no common cause or common set of symptoms. I read a paper that likened it to a watershed, with tributaries feeding into a general pool of malaise. The watershed varies from person to person, and affects their internal “ecosystem” differently.
Maybe it’s a bit cute, but with this understanding, I think the headline is not shocking. We will never find the one cause of depression because there isn’t one.
In my opinion, our best bet is more personalized medicine: helping people identify which rivers are filling up their lake of depression. For most people it will be a weighted combination of many things, but I think there will usually be some principal components.
One of them is, yes. There are several, and basically all of them are some variant of "how resistant to giving into despair are you? (as a rat)". Forced swim, tail suspension, light/dark exploration activity. Kinda dark, but this research saves lives, and depression is notoriously hard to study objectively.
> ...two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits.
> ...A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness.
> These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied.
Indeed. The whole profession of psychiatry suffers from poor application of scientific research, to the extent that the National Institute of Mental Health once banned reference to the Diagnostic and Statistical Manual of Mental Disorders (known as DSM-5).
This is completely unsurprising and indicative of how limited our understanding of the brain is.
It reminds me of Pfizer's work on gabapentin. A professor from Northwestern was working on GABA antagonists (by modifying GABA itself) and eventually came up with the drug. It was hailed as a great example of "structure-based drug design".
The drug was approved by the FDA and efficacious for a number of issues like neuropathic pain. The submission documents from Pfizer had all this data on the binding efficiency of the drug to GABA receptors.
Except it didn't work through the GABA receptor at all.
After approval, more research was done and they said it worked through glutamate channels. Then more work was done and it seems most of its effect is through calcium channels.
Do you have links to more info on this? Sort of an armchair pharmocologist and had never heard this about gabapentin. I thought it was a straight up gaba agonist like phenibut. But makes sense that it would be different given its very unusual dose response curve/self potentiation.
(Probably making anyone who actually knows what they're talking about cringe. Take it easy, lol)
Gabapentin was designed as an antagonist (the structure is basically GABA with a big bulky group on it).
You can just google older papers on gabapentin. Just like most drugs it impacts a number of different receptors in the body. We still don't fully understand them all.
Don't get me started on Gabapentin! I just got off of it after 11 yrs (serious spinal cord injury - neuropathy). Initially, after my surgery, I was on 12 different drugs (not all related to my injury). Over the last 5 years I've been slowly weening myself off of them one by one trying to figure out what was causing me so many side effects. It turns out that the last thing I quit was Gabapentin, which was last month. Amazingly, all the side effects disappeared once I stopped. I'll never take it again.
Depression is caused by a shitty life. Most people with depression are trapped in an abusive relationship, though often it is with themselves. They're trapped by fear of admitting failure and making changes.
Absolutely. The best parts of modern psychology are CBT and finding a better mind state. The drugs sometimes help shake up your mind enough to find that.
I thought it was widely accepted by now that the serotonin thesis was a bullshit story spread, among others, by Al Gore’s wife, maybe in good faith, maybe not.
Edit: Tipper Gore; I did not remember her name (I’m not from the US).
I read she was a big fan of the serotonin theory in a book (whose title I don’t remember at the moment).
Edit #2: The book is: Lost Connections: Uncovering the Real Causes of Depression, by Johann Hari
In chapter 2: The year after I swallowed my first antidepressant, Tipper Gore -- the wife of Vice President Al Gore -- explained to the newspaper USA Today why she had recently become depressed.
Just so that it's clear: I have nothing against Al Gore -- except that he lost the election.
SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time.
The key thing to understand is that serotonin levels don't have to be low for SSRIs to induce positive changes. SSRIs don't just "raise serotonin levels" as many have come to believe, but rather change the dynamics of serotonin in the brain. This produces downstream changes that, over time, can contribute to lessening depressive symptoms in some patients.
This makes more sense if you think about other conditions like chronic pain. Someone suffering from chronic pain doesn't have an "endogenous opioid deficiency". They're just in pain. Opioids are one medication we can use to modulate their pain.
Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field.
I'm not sure what you're suggesting, but SSRIs definitely do change a number of measurable metrics of the serotonin system by prolonging the duration of serotonin in the extrasynaptic space. This is well studied.
The first "S" is for selective, meaning they have minimal affinities beyond the serotonin transporter.
Where do you get that from? SSRIs act on SERT and SERT handles reuptake from the synaptic cleft, not from extracellular space which is ”vacuumed” by MAOA/B and COMT.
I don't think we're disagreeing. Increasing duration spent in one place doesn't change the total count of the molecule. SSRIs don't make the body produce more. That's okay, they work by other means.
The S for Selective actually means it only works on serotonin, compared with say, an SNRI, which works on both serotonin and norepinephrine. Impacting the overall values is in fact pretty much the only thing it does.
> the pop-culture misunderstandings about "low serotonin"
Let’s be clear though, I had an actual licensed psychiatrist say this to me last week. It’s not like people are getting this “pop-culture” information via blog articles…
Or like many practicing medical professionals in many specialties where the patient demand is high enough to fill their week ... they don't have time to keep abreast of current research in their field and since they aren't required to, they just don't. There is usually some required ongoing professional development but that is in no way designed to ensure they keep up with current research consensus, more that they don't continue doing things the old way when we know about newer better ways.
This psychiatrist is either an lazy, an idiot or using shorthand.
Anyone who spent even in a couple hours reading about depression (one of the most common ailments) in the last decade knows that low serotonin is not the cause of depression.
I’d agree with your assessment. It was just an opportune time to mention that they may not be familiar with recent research results. But you’re absolutely right, they should know this one.
Funnily enough the one I used to take (Escitalopram) apparently has been found to begin permanently altering brain function after only a few hours of first ingestion. I was pretty happy with it. No pun intended
Not comment OP but I got off recently after about 1.5 years - still very happy :) Although admittedly I did have some infrequent spouts of rebound symptoms for a few weeks, but those were pretty manageable.
Also, kind of happy to be off it right now honestly, heat is something that doesn’t go along well at all with SSRIs.
For me it was around the same time Mo3 mentioned they took, maybe a bit more than one year and a half. It's been long, so I don't remember precisely.
However I was in a quite sorry state before... I was having several panic attacks a week. My therapy alone was also not working well, I was doing twice a week. After starting it, everything started falling into place. I never had a panic attack again.
I never had any downside whatsoever from taking them (didn't know they don't go well with summer!), including the regular complaints, it wasn't really a burden on me other than having to buy them monthly and take them every day.
I would like to see more discussion of the role of SSRIs in treating anxiety, rather than depression (which always seems to be the default focus). I also suffered from panic that went away completely with SSRIs. I have never had issues with depression, but these medications gave me my life back.
Interestingly the reasoning from my doctor for me taking Escitalopram was that it was good for anxiety, so I guess there's at least some anecdotal evidence from doctors about its efficacy...
Escitalopram is specifically prescribed for anxiety disorder at least in my country of residence. I think it’s considered one of the top options for GAD/panic disorder generally.
Source? Im not aware of research that shows “permanent” alterations from a single dose, unless someone is really stretching the definition of “permanent”
Pointing to alterations isn’t really helpful without context. An anti-depressant should induce long-term helpful alterations in order to alleviate symptoms.
> Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field.
The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that his training explicitly made this claim, that his textbooks make this claim, and that he himself was later passing it down to other students.
Other sources quoted by the news article are similar to your own claims. Overall, it sounds like there are camps in psychiatry that have indeed long abandoned this theory, but others who still hold onto it.
Furthermore, the meta analysis being talked about in the article does make the additional claim that SSRIs are perhaps not necessary for the treatment of depression. I don't believe they are right, but it's also misleading to suggest that theur research is entirely in line with psychiatric orthodoxy.
To be clear: The serotonin deficiency hypothesis has been floated for a long time as one of the possible underlying changes involved in depression etiology. It’s not even a stretch, given that we can find upregulations of the serotonin transporter in response to chronic unpredictable mild stress, the fact that 5-HTP (serotonin precursors) supplementation can boost mood, and the fact that many drugs of abuse operate through serotonin receptors to alter mood.
However, like I said in my post above, we’ve know for decades that it’s not the explanation because SSRIs boost extrasynaptic serotonin levels within hours but their therapeutic efficacy is famously delayed by weeks.
I suppose it’s possible that the author had some weird textbook that misrepresented the state of research, or that he misunderstood the relative confidence and significant of each theory presented. However, the state of research didn’t even believe that the serotonin hypothesis of depression was the full, accurate explanation when SSRIs were introduced for the reasons I stated above and more.
I've tried lots of natural anti-depressant remedies. Background: I've suffered with major depression my entire life with frequent suicidal ideation and several near-suicides. It's fairly seasonal and wile it happens throughout the year the worst time is in the winter near the solstice. I've also struggled with difficulty falling asleep since very young childhood, though that has gotten somewhat better with age (over 50 now).
** warning **
If you are on any prescription anti-depressants, don't stop taking them or modify your routine without talking to your doctor first.
5-HTP: nasty side effects from unwanted metabolism in the gut and excess serotonin levels in the brain that border on serotonin syndrome sometimes. After the initial 8 hours or so of bad side effects the anti-depressant effects last for about two days followed by a very hard crash on day 3. During the 2 "good" days the quality of the effect is a bit "off" and gives me an unusually "comfortable feeling" that is while much better than depression is not the most productive or normal feeling (see melatonin below for contrast). Be extremely careful with 5-HTP, serious serotonin syndrome can easily develop, especially if you are on other anti-depressants and can be fatal. I don't take 5-HTP anymore because of these side effects and better options (below).
THC: Very effective during use (edibles = 4-6 hours), but tolerance levels build requiring higher doses. mild anti-depressant effects trail off gradually after day or two and quality is generally good. Of course cannabis has some side effects: short term memory impairment, general slight cognitive reduction but I have found these side effects can be virtually eliminated with L-Dopa (see below)
L-Dopa: Taken with vitamin B-6, this is one of the few things I have found that enhances the cannabis experience rather than taking away from it. This increases dopamine levels in the brain which enhances the high and for me also seems to miraculously eliminate the side effects of cannabis (maybe this is due to offsetting dopamine depletion by THC?). I have also found that L-Dopa even seems to increase general cognitive functioning beyond undoing the effects of THC (maybe reversing age related degredation? It makes my brain feel like it did when I was 18). L-Dopa does have serious side effects however: It dramatically and seriously increases anxiety/paranoia for several hours so I only take it with cannabis edibles and even then not every time, no more than once per week. It's very important to know how to manage paranoia since THC also frequently triggers paranoia and the L-Dopa seems to amplify that. My method is to consciously and affirmatively "acknowledge and disregard" any paranoid or anxiety related thoughts. I have found that once I consciously identify and acknowledge certain thoughts are caused by the drugs/supplements and are not real (or as important as they seem), they disappear and everything is ok.
Melatonin: This is by far the best anti-depressant I have ever used. Essentially no side effects other than putting you to sleep 30 mins after use, which when taken before bed is a huge plus (I have had difficulty falling asleep my entire life). Anti-depressant effects last for a few days, gradually trailing off without the hard crash of 5-HTP. The quality of the effect is also excellent (much better than 5-HTP). The best way I can describe it is "feeling healthy, energetic yet relaxed, and normal" most of the time. It's like a miracle drug, at least for me. I take 5mg every 3-4 days as needed.
Thanks for your post, and thanks for whoever vouched for this. I have a similar background to you, including age, living in a northern latitude with short winter days, long term sleep issues, and suicidal ideation.
5-HTP - There seems to be wide variation in the formulations available from manufacturers. Some have given me no issues at all, another brand, of the same strength, consistently leads to intense nausea and vomiting, followed by a significantly altered mental state. Almost tripping, and yes, I'm familiar with that.
THC - agree with your comments, but by far the biggest advantage for me is that it enabled me to completely quit drinking. Alcohol is terrible in that it will temporarily shut those intrusive thoughts off, but then they seem supercharged them when they inevitably return after a few hours. Drinking definitely exacerbates my actual depression even if it masks some symptoms.
I do use melatonin occasionally/as required but not super often. It's very effective as a sleep aid, but I have not noticed any antidepressive effects in myself. Valerian is also an extremely effective sleep aid for me. Will have to research L-Dopa.
Consider trying Sceletium Tortuosum extract (Kanna). It has been commercialized as "Zembrin" and is available in OTC supplements. There are peer-reviewed studies indicating that it is safe and effective, and personally, I've found it to noticeably effective against anxiety, less so for depression. As supplements go, it's inexpensive.
Finally, psilocybin has been revolutionary for managing my mental health, and specifically depression. I found microdosing to be ineffective. A full trip sets me right for several weeks, to the point where it is startling when the intrusive thoughts start up again.
Have you ever tried 5-HT2A antagonists or inverse agonists like trazodone, mirtazapine, or the dozens of atypical antipsychotics that are indicated for depression? I ask because I wonder if the rapid tolerance at 5-HT2A is responsible for the therapeutic response you get from psychedelics, and if antagonists or inverse agonists can emulate that tolerance in a sustainable way that doesn't require regular psychedelic experiences. Those experiences can be great, but the potential for bad experiences might be a Faustian bargain.
The uncomfortable feeling you get from 5-HTP can be from activation of parasympathetic serotonin receptors, as well as activation of 5-HT2C in the brain. You're essentially going through the initial two weeks of SSRI use, where 5-HT2C gets activated but hasn't downregulated yet, which is a hypothesized source of increased anxiety and suicidality from initial SSRI use. What would be interesting is to see if that discomfort would dissipate after 2+ weeks of chronic 5-HTP use, with the goal of blasting 5-HT2C until it's desensitized, which is what happens with chronic SSRI use. I don't like the idea of 5-HTP because of the potential for higher levels of serotonin in the blood potentially activating 5-HT2B in the heart, potentially leading you to need a heart valve replacement.
Regarding L-Dopa, from what I'm aware of, L-Dopa gets metabolized before it makes it to the brain, so much of the L-Dopa gets metabolized into dopamine and norepinephrine outside of the brain and then those neurotransmitters activate the parasympathetic nervous system, resulting in increased anxiety, paranoia and physical discomfort. That parasympathetic activation can increase feelings of alertness and wakefulness without ever having L-Dopa enter the brain. Another interesting thing to see is how L-Dopa would fare when taking it with an inhibitor that would allow it to successfully enter the brain a la Carbidopa for Parkinson's patients.
Obviously don't do this, I'm just thinking out loud and fucking around with your body like this can have serious consequences if you aren't doing so under the supervision of your own doctor.
Finally, regarding THC, if anxiety and paranoia are problems for you, like you allude to when talking about L-Dopa, try delta-8-THC. I find it to be much more therapeutic than delta-9-THC. I get no anxiety or paranoia from delta-8-THC, but I do get the full therapeutic effect I got from normal THC when it comes to antiemesis, mood, pain, etc. It also has less of an intoxicating effect, and doesn't mess with my memory of motivation as bad as delta-9-THC does. I haven't used normal THC in years despite it being legal and readily available.
"Low serotonin" was a marketing simplification at one point a decade or more ago. Whether companies were the source of that simplification is up in the air, but they certainly leaned into it in their marketing.
I think you’re throwing the baby out with the bath water here. Sure depression may not be linked to low serotonin levels but it almost certainly some chemical imbalance of some variety.
Metabolism and stress hormones both seem to play a role. It's going to be a very complex thing - the best treatment for a lot of brain conditions is just exercise.
The key word when using exercise to treat stress is that it need to be voluntary (ie, something that the person want to do). Forcing oneself to exercise has the opposite result with increased corticosterone levels. Exercise is great if and only if the individual is doing something they enjoy.
Drowning or having your leg cut off are not chronic conditions. I think it makes a lot of sense to analyze chronic problems in the brain through the chemical lens.
>I think it makes a lot of sense to analyze chronic problems in the brain through the chemical lens.
Thats the basically the point I am taking issue with. Myopic focus on chemistry can be terribly misleading. There will always be a chemical component because we are beings made up of chemical components.
a chemical imbalance is by definition always going to be part of the problem. That does not mean it is always the best point of intervention, and certainly not the exclusive focus when trying to understand the problem.
There really isn’t a lot more going on in there though based on our current understanding of the brain. It’s neurons and synapses and all the neurotransmitters that regulate it all. What exactly are you suggesting could be the problem?
This is the perfect example of myopic thinking coming from the chemical Focus
If your only tool is a hammer then every problem looks like a nail.
The brain is a lot more than chemistry, and that's not even looking at the human being and their interactions with the environment.
there are patterns encoded in the structure and biology of the brain. There are psychological feedback loops and complicated interactions between a human and their environment.
Saying it must be a chemical imbalance is akin to debugging a malfunctioning computer and saying it must be a signal error from a loose wire. It ignores programming sending signals on those wires and it ignores the input to the machine from the environment
Perhaps it's not a literal imbalance but more of a flow problem, neural pathways fail to deliver and a portion is lost along the way. There are so many ways this could be going wrong, we have absolutely no clue unless we devise proper tools and methodology for data-mining everything up to a satisfyingly objective level.
To add to this, SSRI onset efficacy corresponds with the downregulation of serotonin receptors in the brain. "Low serotonin" isn't what's being treated or changed, but the number of receptors and their activation rates. SSRIs can reduce emotional lability, which makes sense when you figure that downregulation and increased activation of serotonin receptors is a relatively stable system compared to an unmedicated brain with many receptors and widely fluxuating activation rates and lowered activation periods as serotonin gets recycled quickly without its transporter being inhibited.
Sertraline suplementation wiped out depression almost completely from my system within two months. I had been depressed earlier for half a decade. Its been nearly 8 years since I took sertraline (stopped within 3 months) and I haven't had a depressive episode since.
It was likely a combination of several things. I had moved to a new country after high school for college. The college also happened to be in an extremely cold part of the country, and I joined in the winter semester.
Culture shock, being alone in a new country, seasonal affective disorder (I come from a warm tropical country), being in a long distance relationship - they all likely contributed.
I also made some pretty bad career moves immediately afterwards, which likely didn’t help.
I'm pretty sure I'm hell banned, but forget about all the chemicals of the brain.
Read anything by Irving Kirsch.
He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All.
He found they basically don't work better than Placebo.
Personally, I think the "Happy" drugs have been the biggest con job the American suffering have ever endured. At least we know opioids work--for awhile. Antidepesssnts just make Dr. Wealthy more wealthy.
My hope is most of these wonder drugs are sued into history, along with those mandatory doctor office visits.
Ask yourself this--why do Psychiatrists have the highest rate of suicide if these drugs work?
I'm glad we have residents whom picked an easy speciality upon graduation, but these drugs have such low efficy rates they should be illegal, or over the counter, with the exception of a few. Trazadone can be nasty. A bad reaction is cured by a needle to the middle part of the brain.
Most are easy on the body, but don't do anything besides make an Artist (Medicine is an art, and Psychiatrists are the milking to the bone.) wealthy.
Only for severe depression, if you take into account all clinical trials - including the ones buried by pharma companies. This is the work by Irving Kirsch being referenced here, and it's excellent.
Spraying water on your house usually doesn't accomplish very much unless your house is on fire. But if your house really is on fire, it is likely the only thing that works.
>SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time.
This for me doesn't seem logical. It could be that a long term imbalance makes you depressed, and reverting that imbalance takes time to affect the thought processes towards the positive. Only because the reaction is delayed, it doesn't mean it's not causal.
There's a lot of evidence around hippocampus size in depressed patients. They tend to be smaller than average. After 6 months to a year of treatment with antidepressants the hippocampus grows to a larger size.
It's speculated that hippocampus size might be one of the driving components of depression, but who knows. Mental illness is complex.
I have a completely unscientific, subjective theory that some significant portion of depression in the population as a whole is caused by the economic circumstances that some people live in.
Things like being trapped in a dead end job to keep healthcare benefits in the USA, living in a never ending treadmill of debt.
If being down about your job causes symptoms of depression that last more than 2 weeks, then it's the same thing. Psychiatrists diagnose based on symptoms. Worse, its usually what you say your symptoms are, with words and talking. They don't scan your brain. I've been seeing psychiatrists for almost 30 years. The good ones take plenty of interest in your situation, lifestyle, and other non-chemical non-medical factors. Psychiatrists don't distinguish between so-called 'situational' and 'clinical' depressions. Laypeople do that. If you get diagnosed by a clinician, that is the part that makes it clinical - it isn't a different kind of condition.
That is an incredibly dismissive and reductive argument to make. "Feeling sad about your job" isn't limited to burnt out software engineers with a safety net. It can also apply to, for example, someone stuck in a shitty, low paying job with few, if any, prospects for better employment. The lack of a path to a decent future can, in itself, be incredibly demoralizing, even if your present circumstances might be decent. After all, what's the point in continuing if I can see that it's all downhill from here?
That isn't major depressive disorder either. Even if those people think their life sucks, they're capable of, say, getting out of bed every day and don't regularly attempt suicide.
Russian serfs might've revolted when they got the chance, but they were more or less psychologically normal until then. Their society adapts to not kill them all. (Or they all become alcoholics or something.)
But when, for the vast majority of history, the population faced a much poorer, more monotonous, and less free existence than what the modern worker faces then you jolly well can.
> the population faced a much poorer, more monotonous, and less free existence
That's an over simplification.
People could still have more free time than we do now[1], while their life could be more monotonous on some aspect, I believe an average office worker life today can be even more monotonous than what a serf life could be. You also have to consider labor alienation, which is a something that didn't exist so much before industrialization.
Most importantly, life commonly revolved around tight communities, while today most people live in individualist societies.
Individualism certainly has a larger impact on happiness than most modern convenience has.
If there are people today who want to put their money where their mouth is and give up the conveniences of modernity to go back to communal subsistence farming under serf-like conditions (and there are places in the world that still live like that), more power to them. I haven't seen any takers.
I don't understand this need to make everything white or black, unless we want to pretend we live in a word as simple as a kids' novel. You can't just throw away milleniums of history and people because in the past 60 years we have become too lazy and addicted to modern convenience.
No, preindustrial ages weren't the hell they're made to be nor a golden age by any means. The same can be said of today. Stop playing defensive and think openly instead, there's lot we can improve by learning from the past.
It isn’t someone’s personal/unique suffering that I am invalidating. They are saying that we are having uniquely depressing times _in general_ which if you take a brief look at history is laughably invalid.
Yeah they are probably into some extremely toxic, unnatural things that cause them to secretly hate themselves. I wonder how much shady sexual shenanigans happens in the households of the top 1%? Plenty of drugs, gossip, gluttony, lust, etc.
Happiness comes from the overcoming of not unknowable obstacles toward a known goal. It's the journey, not the destination. And the trick is to set another goal once you attained the one you're on.
>Happiness comes from the overcoming of not unknowable obstacles toward a known goal. It's the journey, not the destination. And the trick is to set another goal once you attained the one you're on.
I find this kind of bizarre because you can look around and see how it's obviously not true. Dogs are happy as clams to just socialize with their owners / other dogs and just live. People hustling to always get to the next goal don't seem particularly happier than people who don't have a goal and just have a healthy social life.
A. People aren't dogs. We are of a much higher level intelligence and self awareness. That's why psychological studies of rats, or even apes, as human analogs is ludicrous.
B. The happiest people on the planet are extremely ethical, have a good moral compass and have a will to help others. They have goals and attain them. And they especially don't blame their environment for their shortcomings. They find ways to adjust their environment to themselves and not the other way around.
Someone who is content with a simple life is still following that maxim. Their goal is to live each day in relative comfort according to their own standards.
We have it way better than almost any period in history and are profoundly unhappy.
Also, we always like to think we will be happy “once I have…X” and then we get X and say well actually what I need is Y.
Most unhappiness is driven by vanity and desire (a bargain you make with yourself where you chose to be unhappy until you get something) to be better than our peers.
Until you can be content with nothing you wont be content even with everything.
If people can be happy in concentration camps we can be happy in dead end office jobs. They cant stop us from being happy.
How are we measuring "better"? If suicide rates have risen significantly, then perhaps there are ways in which our modern paradise is worse than the past.
This is an article about clinical depression, not 'unhappiness'. While distress can result in clinical depression, they aren't at all the same thing. One gets better if the stressor is removed, the other does not.
IOW: Are you ready for me to diagnose your totally normal reaction to our shitty society as mental illness so I can get you addicted to mind altering drugs for the rest of your life? https://imgur.com/Jb1mJyx
Or as the Unabomber said, "Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness. Science fiction? It is already happening to some extent in our own society. Instead of removing the conditions that make people depressed modern society gives them antidepressant drugs. In effect antidepressants are a means of modifying an individual's internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable."
I think you're right. The problem is, this is the only life most of us have lived, and so we cannot imagine it otherwise, like a fish who cannot conceive of a world above water, or even that water is the medium surrounding it. If our entire society is causing this, then what can we do? Wage slavery, oligarchy, attention theft by tech companies, disintegration of community from various causes. Life for so many people is crawling through glass Monday through Friday, then getting shitfaced on the weekend. Is that happiness? How do we escape?
It's a strange mode of persuasion, making arguments about how we should frame psychological dysfunction that quote a man who pooped into a hole in the corner of a shack while in hiding after trying to down a passenger jet.
You wish to vilify him. That's fine. It's extremely uncomfortable to find that this mathematician was right about something. I respect your feelings. But that doesn't alter the substance of his social critiques.
Sure it does. It's strange to argue that it wouldn't. Kaczynski is a madman, and perhaps the only person in the history of the United States whose quality of life was drastically improved by incarceration in a Supermax prison.
It's very funny to describe SSRIs or SNRIs essentially as "happy pills". They are very unpleasant drugs to take, especially in the first month or so when starting to use them, and no one would be using them if they didn't feel there is a serious problem in their lives.
Not to mention, depression takes several forms, and not all of them are related to unhappiness. A common form is related to anxiety, with people experiencing a constant feeling that something awful is about to happen, sometimes getting terrible panic attacks. Given that many of these people live in objectively and subjectively extremely safe environments, much safer than at any other time in history, it's very hard to take seriously any environmental theory of this kind.
Edit: corrected one bad auto-correct typo ("problem", not "purulente") .
I know for sure that I have much more anxiety when I'm in an unsafe environment than a safe one, regardless of how free I am in each. Lack of freedom does lots of bad things to your mind, but anxiety isn't one of them.
>no one would be using them if they didn't feel there is a serious purulente in their lives.
You are playing into the argument, people often don't have a choice to avoid a depression inducing environment, they only have the choice of using drugs or not.
This site has an unbelievable amount of armchair-science that gets rattled off. You are right, because depression and anxiety are primarily biological phenomena.
For example, in the talk, he points out one of the most telltale signs of depression is waking up early, which is completely backwards from the common perception that depression is someone staying in bed all day.
This reminds me a lot of Mark Fisher and Capitalist Realism. Obviously if the article is true then who is to say about low serotonin levels, but in any case "It goes without saying that all mental illnesses are neurologically instantiated, but this is nothing about their causation if it is true, for instance, the depression is constituted by low serotonin levels, was still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; ... This pathologization these problems - treating them as if they were caused only by chemical imbalances in the individuals neurology and/or by their family background - any question of social systemic causation is ruled out."
In essence a liberal worldview is not equipped to deal with mental illness.
Now look at what it gets spent on. Specifically, take a closer look at housing, healthcare and higher education. All three of those have risen far, far faster than inflation for many years.
whats really interesting is, while some things like electronics and automobiles etc have been getting cheaper, intangibles like healthcare and education have been increasing in cost... whats the cause?
Obviously, I don't know the full story, but one thing the three things I named have in common is relatively inelastic demand. In the case of education and healthcare, I suspect Baumol's cost disease is also a factor.
Cars and other manufactured goods tend to get cheaper over time because they can take advantage of economies of scale, as well as global supply chains and free trade. We're seeing that very concretely right now as the global chip shortage has put pressure on the used car market.
Education, housing, and healthcare are largely unaffected by free trade, and Baumol's cost disease is literally a statement about how certain industries cannot take advantage of economies of scale.
Come to think of it, let's also toss childcare in the bucket of "things that have gotten more expensive faster than inflation over time" since, among households with children, we have a predominance of households where all parents who are present work. Again, we have inelastic demand and Baumol's cost disease rearing their ugly heads, so maybe there's something to this theory.
TV and automobile manufacturing are a lot more productive than they were 50 years ago. A teacher can still only teach one classroom at a time.
Therefore, service industries like healthcare, education, and even construction get less and less efficient relative to manufacturing and production industries, which enjoy massive increase in efficiency year after year. This is partly why an 80 inch 4K TV is eventually going to cost $500 and a 4 year college education is going to cost $500,000.
if i understand it correctly, its supposed that overall wage increases mean other industries have to compete to get/keep workers but they dont have effeciency increases like manufacturing so prices continue to rise
it makes logical sense, but i wonder if it really is wage competition causing this when wages have been mostly stagnant for the past 50 years?
This inflation adjustment business needs adjusting I think if you think the average worker today has more buying power than they did in decades when they were actually buying homes.
You don't even have to be broke to be trapped in the stranglehold of modern society and feel like shit about it. Just because you are paid well doesn't mean the work you are doing is remotely engaging or interesting or doesn't want to make you hate yourself. Being rich doesn't insulate you from toxic coworkers, in fact probably the higher you end up marching up the economic ladder the more of these narcissistic and toxic personalities you are liable to run into.
At the end of the day we are probably happiest when we are foraging for berries or mushrooms. This whole abstract 'society' crap we put upon ourselves leads to a lot of self directed scorn, embarassment, disrespect, and no doubt depression. How many billions of calories have been burned to fuel thoughts of worry about an outfit choice around the world? How many grey hairs have sprung up as a result of fretting about appearance? The stress society tries to shovel on you is such a waste of energy and does nothing to help you.
> How many billions of calories have been burned to fuel thoughts of worry about an outfit choice around the world?...The stress society tries to shovel on you is such a waste of energy and does nothing to help you.
Sadly, not enough to offset our sedentary lifestyle and diets. I can't be too concerned about the energy expenditure involved in worrying about meaningless things. For now anyway, we've got energy to spare. The toll of all that stress on our bodies is much worse than the calories we lose. Still, I'd rather be worried about the trivial things that we occupy ourselves with than the life or death worries humans regularly faced when we were berry foragers. Going from worrying over "Will we eat today?" to "Which of several restaurants should we go to for lunch?" is a blessing.
Actually there is something worse than a deadend job. Having a job you are financially dependent on but where you aren't assigned any work so you must constantly come up with ways to look busy and productive.
I'm overall pretty happy and have a pretty great job, life, and family. I'm still often hit with waves of despair when I realize housing prices are insane, retirement feels like a joke, and the biggest issues the world is facing seem to be ignored.
It's pretty depressing if you dwell on it for any period of time.
Came here to say this. Although few people are aware of it, it is said behind closed doors that for some people, it is a cure for depression, although it’s very controversial to make that claim in public, and obviously, it needs to be used carefully and with great respect.
My psychologist tells me that in his profession there is a significant gulf emerging between the ones who feel the prescribing is justified, and the ones (like him) with significant concerns:
1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it.
2. the drugs were tested inadequately across race, age, weight, sex.
3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal
4. almost all successful uses of the drugs are accompanied by CBT and like processes.
> 1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it.
"Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist might be overestimating their own knowledge of a different field (psychiatrist formally study these systems and medications, psychologists do not) and underestimating the amount of research being performed in this field.
Regardless, these drugs don't really work as "boosters" like commonly thought. It's better to think of them as modulators. In fact, in conditions like anxiety SSRIs are well-known to actually reduce serotonin transmission in certain areas of the brain. The research has diverged quite a bit from the simple marketing-material models that a lot of people have about these drugs.
The purpose of the drugs is to induce changes that result in positive downstream effects. It's not actually a contradiction that enhancing and inhibiting certain receptors could result in similar downstream effects. For example, a number of receptors in your brain will downregulate in response to both agonists and antagonists, even though they have opposite direct effects. Your psychologist's understanding of this topic is deeply flawed.
> 2. the drugs were tested inadequately across race, age, weight, sex.
SSRIs have been in widespread use since the 80s and tricyclics since the 50s. At this point, the idea that we haven't tested enough or that we haven't collected enough data is just a strawman argument proposed by people with impossibly high standards. I suspect no amount of testing would actually satisfy someone proposing this argument for drugs that have been studied for this long.
> 3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal
It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard. Benzodiazepines should absolutely be prescribed for brief periods and this is reflected in their status as controlled substances and all of the prescribing literature. There are some doctors who ignore this advice and overprescribe, of course, but they are going counter to standard practice.
On the other hand, medications like SSRIs can actually take weeks or months to reach full effect and many patients unnecessarily relapse by quitting them early.
I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.
> 4. almost all successful uses of the drugs are accompanied by CBT and like processes
The most successful uses of SSRIs are accompanied by therapy. However, we have plenty of studies where SSRIs are prescribed without any accompanying therapy and a positive result is still seen. If you're suggesting that the therapy is actually doing 100% of the work, that's easily disproven by the studies that test all combination (placebo, therapy alone, SSRI alone, therapy + SSRI).
I'd recommend getting your psychiatry advice from actual psychiatrists. The number of misunderstandings and mistruths in what you've relayed here is quite high.
I'm not a psychiatrist or psychologist. He is, and has professional standing. You're judging him, on my paraphrases of what is said to me. Perhaps what you really should be saying is "don't try to represent the views of professionals in a field you are not an expert in" which btw, I would take as good advice.
None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use.
> None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use.
Which field? You said he was a psychologist. Your post was about psychiatry and neuroscience topics.
I don't disagree that psychologists have a lot of opinions, but it's not really their domain. I think it's a mistake to think that a psychologist is better educated on psychiatry topics than actual psychiatrists or neuroscientists who actually study these things and understand the research.
I think the gap between GPs, Psychologists and Psychiatrists lies at the heart of this. GPs can (and do) prescribe psychoactive drugs. What they do subsequently is subject to the constraints of the health economics which apply: In the UK (I am told) the delay to be seen by anyone other than your GP can be measured in YEARS because of the backlog in patents presenting. Many of these patients are young people. The GP has the determinant of the path. They can recommend something like CBT and a clinical psychologist, or they can recommend drugs and a psychiatrist. They can do either, for what is the same presentation of problem.
They get seen by a GP, with limited time and tools. They are prescribed SSRIs, and booked in to see "some other health professional" and what emerges is a delay of some significant time, before they get that next stage of engagement.
I was also triaged by my GP, in Australia, and was put into the non-drug path, and I am content. If my health practitioner prefers not to use drugs, and that is a bias, so be it.
I can say that my mother in law was treated in other ways, became addicted to Xanax, and narrowly missed being placed in "deep sleep" therapy which wreaked havoc on many people, although it was "peak treatment" at the time. She was a deeply unhappy woman. I cannot say she would have been better off without drugs, but I do know the process of managing her drug regime was intense.
Deep sleep therapy lasted a long time. It was credible for decades. Psychiatry is as capable as any other science of being led a long way down paths it subsequently walks back on.
ECT, which is much more "confronting" in some ways, remains a useful tool. If you ask most people in the streets, They react with horror.
I place great hopes in ketamine, and in psylocybin. Again, both require a context of use, and are still experimental. What I like about both, is that they appear to being considered as rapid-intervention therapies, not as sustained, long lived treatments. I like that because of the short duration. I guess I don't like the SSRI story precisely because of the long duration, and the consequences on young kids, especially on things like sexual dysfunction. (I'm not a young kid and that isn't an immediate concern for me)
This is for the most part a thread about SSRIs. Xanax is a benzodiazapine. There are no controversies on this thread, or really any ordinary place, about the dangers of benzodiazapines; they're scary drugs.
To stick to SSRI's I know one person who reacted badly to a change of meds, predicated on her personal dislike of the effects of the prior, but finding the replacement had extremely strong negative effect. I think had she been absent any support, this could have ended tragically, the effect was so strong and so sudden.
This, coupled with the emerging reports of longterm sexual dysfunction in young women, I think represent pretty severe concerns. Obviously anecdata is not science, but this is what informs my own sense of place here. I am not anti drug in the wider sense. I think drugs of all kinds have been and are and will be beneficial. I am concerned with how SSRIs are being used in practice, with what longterm consequences, and short-term risks.
There's a strong vibe of "butt out, stick to your knowledge" in responses to my posting here. I will take that advice. I'm off-piste, this isn't my area of work.
Agree that the system is a bit fucked, in pretty much every country (as far as I can tell).
Unless you are involuntarily committed, you won't be put on the drug path if you don't want to. Psychiatric medications like SSRIs are generally awful. What I mean when I say "awful" is that the experience of taking them is awful. You may end up with symptoms that are under control, but you may still experience symptoms, or the symptoms can sometimes get worse, and the side effects are often just kind of shitty to deal with. These are generally not habit-forming drugs. These are nasty pills that you'll look at in the morning and dread taking.
Non-compliance rates are already high, when you have patients who want to take the medication. There is no way you're going to prescribe antidepressants to somebody who says they don't want to take them. It's just a waste of time.
Xanax is different. It's a benzodiazepine. The entire category of benzodiazepines is known to have a high rate of misuse, and Xanax in particular has a high rate of misuse. It's prescribed because it's an extremely effective and fast-acting. Very different from SSRIs.
I would add the caveat that low doses of SSRI do seem to be quite effective for issues like compulsiveness and anxiety without much in the way of negative side-effects.
I'm not sure what the scientific support for this is, but at least anecdotally I know 5+ people who take an low-dose SSRIs and claim it works.
> It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard.
> I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.
Yeah, as someone who has been close to people who need antipsychotics, I sometimes feel the anti-antidepressant crowd extrapolates to all psychiatric drugs and this is very scary. Especially since people with conditions like schizophrenia or bipolar frequently think they don't need medication.
I think it's different for a lot of people. But one common thing is to get grandiose and think that all problems are with other people. Why would such a person need meds? Clearly there is something wrong with the person who might suggest that.
Then potentially add paranoia on top of that...
Edit: and as the sibling comment said, people can feel pretty shitty on them. I know I've heard and been sympathetic to that for many years, so don't want to sound insensitive by only focusing on anosognosia.
I think you might want to do some research as to why schizophrenics might end up non-compliant. Antipsychotics are serious drugs that, historically, have had severe side effects. Additionally, they’re rarely a complete solution (people can still have delusions and hallucinations while taking medication). Additionally, like other psychiatric medication, not all antipsychotics will work for people, sometimes they’ll stop working, etc.
Antipsychotics are nasty medications. Here are the list of problems I’ve had:
- Sedation (too tired to function)
- Emotional numbness if I need to increase the dose to stop an episode.
- Headache
- Loss of balance.
- Impaired fine motor control.
- My arms and legs don’t move properly. I’ll command my arm to move, and it only moves
halfway. I used to fall a lot before I learned to be very careful walking.
- Inability to orgasm.
These get pretty bad in the first four hours after taking them. During the day, if I get dehydrated or have low blood sugar, I can easily get incapacitated and be unable to drive.
And no, my dosage isn’t too high. This is the lowest effective dose I can be on. The alternative is lithium, which can be worse.
There are many, many, many pharmacy drugs that can stop suicidal thoughts fast and don't have the track record of the "modern antidepressants". Long, long, long track records. Small dose lithium and lamotrigine come to mind right away. But how they work--nope, not clear. Okay, we'll agree it's not serotonin, how does that help us? Would it help if American doctors could prescribe 3 weeks for a spa holiday like European doctors? Maybe, for low-level depression, but not for suicidal thoughts, that just won't cut it. There is bipolar I and bipolar II and so big differences. Schizophrenia, big difference. But again, knowing that it isn't serotonin, that's nice, now what?
It's interesting that anyone other than the R&D arm of the pharma industry even cares how it works.
From the medical side what's important is what risk/benefit which is independent.
Antidepressant as a term is really only for convenience which the medications themselves being quite broad in action.
Antipsychotics too are having a bit of a revolution, the first generation seemed to all be about D2 blockade, the second generation acting on 5HT-2a much more than D2. Finally, pimavaserin acting only on seratonin (5HT-2a) and not on dopamine at all [0] now there's SEP-363856 [1] which has action not at D2 or 5HT-2A but TAAR1 and 5HT-1A.
The point is that psychiatrists are not particularly married to any mode of action or mechanism. Only the results.
I had the same feedback talking to a few professionals. There is doubt about the exact effect of the prescription and the science behind it, and they regularly have patients that get no clear effect from commonly prescribed treatments.
But they also see other patients showing measurable improvement, and trying different prescriptions until finding one that seem to have an effect is a common practice.
All in all, this is very murky situation, but drug prescription can still be effective and might be the only option for some patient for who other approaches didn't work.
> they prescribe both boosters, and inhibitors, to treat the same symptoms
So here's the interesting thing - there's evidence that 5-HT2a receptors are way too dense in people with depression. Antagonists obviously have a blocking effect, but increasing serotonin at the synapse counterintuitively has a similar effect - your body responds to it by paradoxically downregulating 5-HT2a receptors. Two totally opposite approaches with a similar outcome.
I don't think the number of different anti-depressants make it inevitable that some work significantly better than others. You can get casts in many different colors.
I'm sure they do but I only have anecdotal evidence from people that tried a number before the "ahaaa" moment.
I don't take them (well, except for sleep with a low dosage of Trazadone (which I can't anymore because it gives me priapism) and mirtazapine(which made me sleepy even the next day)), but my experience is with stimulants for ADHD.
I've tried quite a few stimulants and while all worked for my ADHD (heck even pure nicotine works somewhat), some combinations were brilliant but illegal, and metylphenidate (Concerta) does an amazing job for my impulsivity and an ok-ish job for my focus.
Sure, I can't just snap my fingers, pop some low dosage meth (and I need to stress low dosage -- 15-20mg) or my favorite (3-1 isopropylphenidate + metylphenidate) and enter a flow state at will, but Concerta just changed my life for the better.
I'm sure that a lot(most) of people with depression just as with ADHD need more than just the medication.
If you're depressed because of your circumstances and have 0 power to change them, perhaps anti-depressants work less well, but I've read about numerous people who had a purely "chemical" depression -- there was nothing "bad" about their life and they changed nothing and after anti-depressants they were just not depressed anymore.
There are probably a million different causes for depression and im convinced for all but the most extreme cases that usage of anti depressants is a mistake.
I think viewing depression as a disease instead of a symptom is a mistake. So many people eat food completely devoid of nutrition, stay indoors all day, have erratic sleep schedules, drink absurd amounts of alcohol and smoke weed all day. Why are we giving these people antidepressants when what they need is to go outside and walk and to take a multivitamin?
Completely agree with you, although I think that "going outside and taking a multivitamin" is an inadequate substitute for "live inside a prosperous, functional human-shaped society".
It's not society. It actually starts with the individual. In order to have nay kind of decent society, each individual needs to recognize that they are responsible for themselves and their own society. Going outside, exercising and consuming nourishing foods are the literal starting place. Then seek to find things you like doing and become competent in them. Find a good wife or husband. Don't cheat on them. Don't take alcohol to excess, etc. etc.
The point is, you cant start from the outside and work your way down the the individual. It starts with the person.
While this is true in terms of finding a solution to depression, I do think that the societal norms of our society are extremely conducive to these sort of depressive behaviors. E.g. many societies are setup to make these kinds of behaviors (self isolation, dopamine seeking hedonic treadmill type behavior, etc) very difficult to engage in without being chastised
I see your point, and my argument supports it. Who creates "societal norms" other than the individuals that make up society? It starts with individual action to reverse the dwindling spiral.
I completely disagree with that. If you are a westerner with a 50th percentile mind and follow every rule set up for you, you end up on a console for 8-10 hours per day, struggling with bills and health insurance and watching the land and culture around you be slowly eroded into a formless mass of concrete and advertisements.
"Depression" is a natural response to living an alienating modern lifestyle. The people who can appropriately "deal" with it (like myself) all have something extra going for then, like deep family structures or unusual minds.
One of the most interesting things I heard recently that really hit me like a bolt of lightning…
Depression is a disease of despair, and all these treatments are really just treating the symptoms.
In other words, people experience despair because of some underlying situation - examples: death of child, lonely, broken home. “Normal” things, and we try to treat it with pharmaceuticals. It would be like treating depression with cocaine or marijuana (they actually did and still do this btw) - might make you feel good temporarily; but it’ll never stop the despair.
The question is really how to address the despair. People often visit a therapist; I can see that helping some. But to many, they can’t seem to find the cause.
It reminds me of the post the other day about how people live over 100 [1]. It’s all about community:
> Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy.
> Loved ones first. Successful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love. (They’ll be more likely to care for aging parents when the time comes.)
> Right tribe. The world’s longest lived people chose—or were born into—social circles that supported healthy behaviors, Okinawans created moais—groups of 5 friends that committed to each other for life. Research from the Framingham Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.
Yes some people have real hormone or other biological issues. But 99% of people likely need to address the root cause. I’d put money depression is on the rise as our communities are collapsing due to the industrial / technological nature of our world.
Sure, but it would be more constructive to explain why it's wrong. GP's comment has some interesting ideas and it would be better to directly refute them than just claiming they're "factually wrong".
> The question is really how to address the despair.
It's known that people have genetic predispositions to depression. People experience depression due to many causes. Not all causes are known and we don't have very good understanding of the mechanisms, but it's just not damn likely that we can treat this as a purely psychological / environmental issue.
No doubt, but this article is about how the SSRIs don’t seem to be effective.
To be clear a disorder (ie depression disorder) can be caused by a variety of factors, including (but not limited to): genetics, environment, trauma, illness, etc.
Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important.
Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect.
Which imo is why this is often not discussed. The vast majority of the research money is poured into drug research or clinical research around therapies. Often this overlooks other avenues — one which I mentioned.
> No doubt, but this article is about how the SSRIs don’t seem to be effective.
Where does the article say that?
> Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important.
It's not for lack of trying.
> Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect.
That explanation doesn't have any legs.
By this theory, dentists have no incentives for prophylaxis, but in practice, that's a large part of what dentists do and it's very effective. By this theory, the medical industry wouldn't choose to eradicate any infections diseases, since it can make money from treatment. It turns out we can and do eradicate infectious diseases, but it is difficult, expensive, and time-consuming. We've only successfully eradicated two infectious diseases and only one of those affects humans in the first place.
If you look at other infectious diseases, there are tons of diseases which can be outright cured and tons which can't. This isn't for lack of trying, it's just that these diseases are different. You can kill bacteria with antibiotics, but if you get HIV, the best we can do is antiretroviral therapy.
Treatment of symptoms with pharmaceuticals is often a rational, good decision. There are simply too many diseases for which we don't have any known cure. Depression is one of them. The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three. So we have stuff like SSRIs, which are known to work for some people.
> The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three.
I don’t think we disagree in almost any of this.
I’m simply pointing out depression may be caused by environmental factors, one which can be treated. It could be why they found “nothing convincing” in the study.
I have yet to meet a depressed person or almost any person who couldn’t use more community. I suspect most peoples depression is a rational / emotional response to lack of basic needs of some kind. Whether that’s community, sleep, job, food, etc
That’s not to say all people have environmental factors or that drugs can’t help people cope. I’m merely sharing what struck me and for some reason hadn’t clicked with me prior, even seeing people get out of depression.
The people I know who overcame depression all did the following: worked out, improved sleep patterns, joined some activities. One could argue correlation (ie as depression reduced, they became more active). But it didn’t seem that way looking in. Anyway, just an observation and contemplation really.
> I have yet to meet a depressed person or almost any person who couldn’t use more community.
Depression is known to cause this. Yes, it’s not that simple. But this reasoning is extremely dubious.
> The people I know who overcame depression all did the following: worked out, improved sleep patterns, joined some activities.
All the people I know who graduated high school got married and had children. Maybe we should encourage people to get married and have children to increase the graduation rate!
Sarcasm aside, this reasoning is just beyond dubious. Do you know what the symptoms of depression are? Are you familiar with the very basics of what depression is? All of the things that you described that people overcame are actual symptoms of depression.
Or maybe to abuse another analogy—everyone I know who got over chicken pox stopped getting those pustules. That doesn’t make “stop getting pustules” actionable advice!
There's one cause that is really hard to detect (unless you're informed about it) and that I suspect is behind a lot of people with depression. In fact it took me decades, and only by chance did I realise what it was:
Emotional abuse / neglect, especially the one that occurs in childhood.
* You feel something in life is lacking but dont know what, or blame yourself for it, or look for it in in thrill seeking activities, or through buying stuff to fulffill this emptiness, or you escape from this ever present painful feeling with addiction (hint of what that thing is: being really loved, not romantically loved, but actual unconditional love, the one that only healthy parents can give and which you feel in some way when you have a community behind you. Partial love given by a lot of people ends up almost feeling like parental unconditional love.)
* Can't seem to make friends, or make friends but don't seem to connect at a deep level and end up feeling lonely anyway.
* Also the cause of social anxiety.
* Burnouts due to lack of boundaries (which also come from abuse). Feeling like you put others first all the time, and end up feeling somewhat fake.
* (...)
All of these can lead to depression. And they all have the same root-cause. And barely anybody talks about this (unless you go really looking for these communities, but unfortunately they're not really mainstream).
There are many people who are anti-psychiatry who would probably still benefit immensely from treatment. My worry is that such people will look at this and say: "see look, the psychiatrists got it wrong. I was right to question treatment all along; Anti-depressants don't work." But the message here isn't that SSRIs don't work for depression. It's that depression is a complex illness and can't be reduced to a single chemical deficiency.
Anti-depressants mechanism of action is more complex than 'corrects a chemical deficiency.' I hope such people considering treatment know that while theories may change as we learn more: medications still have to be evaluated against real-world results. So the effectiveness of a drug remains the same.
It's less a specific study and more that almost none of their research is reproducible and there have been a number of serious breaches of trust, like Prozac being widely prescribed to kids and turning out to be horrifically bad for them.
Your comment is the most sensible I hav seen so far. I have seen lives utterly decimated by SSRIS. Suicides and murders caused by its side effects. Violent and suicidal tendencies are on the warning labels on many of these drugs.
Same here. I've seen multiple people after getting along fine for years get prescribed these meds, and within two years end up completely unable to function, hold a job, maintain composure during a conversation (breaking down in tears or becoming violently angry), cook their own food, etc. and need to talk to a therapist multiple times a week.
I'm sure "they're doing it wrong", but these were fully licensed doctors, prescribing drugs in an approved manner.
While I only had positive experiences with SSRI so far, I can definitely say that substances can cause suicidal thoughts. When I took xanax, I had a lot of suicidal thoughts and really had to fight to not kill myself. It’s just like being on autopilot and having to fight against autopilot who wants to crash your car into a wall.
I could imagine that SSRI can activate this autopilot for some people and worsens their negative thoughts.
There's some very scary anecdotes out there. I saw one on an obscure subreddit for people suffering from negative antidepressant drug symptoms where a person said they went to the hospital immediately after taking an SSRI due to an adverse reaction and they have had trouble concentrating on things since.
If the person is correct and not dusional they had a statistically unlikely reaction to the drug- presumably too rare to show up in the drug approval process- and it ruined their life.
They have been saving mine. My anxiety has been improving tremendous amounts since starting both an SSRI and therapy a few months ago. Therapy came a couple months after starting an SSRI, but I was already feeling a tangible improvement before even starting that.
This is a dangerous thing to spread, in my opinion. I have struggled with depression and anxiety for years, but during COVID it hit me like nothing I have ever experienced before. I would have probably died during COVID without finding a doctor to prescribe me medicine. And I don't think it would have been suicide. I would have probably become dehydrated and/or starved or become mal-nutritioned because it was a literal war to eat. I was having to wash down food with water after chewing it enough to swallow. (Note that I never had COVID, which would have been impossible having barely left my house during the first 9 months of 2020.) I couldn't sleep and would wake up wide awake and stressed at 4-5am. I couldn't relax. Was having panic attacks. It was pure and quite literal torture. My body and mind was literally on fire with stress activity. I honestly probably should have been hospitalized long before I finally got help.
While not fun working through the gamut of medicines, some of them finally pulled me through it all. It took almost a year to fully recover with dedication to the medicine and modifications of it and therapy.
If I didn't have a good family and primary care doctor, I guarantee I would have died in some manner unless hospitalized.
People need to realize there is danger to their words. Psychiatry is nowhere near perfect, but people are trying. It is an incredibly difficult thing to understand. But I feel people who speak against medicine have never truly experienced deep depression or anxiety. A panic attack can hit you sitting on the couch, and then by literally doing nothing, your heart rate can reach 200bpm and massive amounts of hormones making your chest and skin feel like it's burning, and next thing you're calling an ambulance because you think you aren't breathing.
Anecdata, but I was often depressed for most of my adjust life. Around 5-6 years ago (age 33 at the time), I started taking 20mg Citalopram. I have experienced almost no depression since I started taking this medication, I'm far more focused and productive than I have ever been. It could be a factor of age and getting married as well, and just settling into my life. But my depression felt like something out of my control.
Same here, but with Fluoxetine (Prozac).
However, I don’t think exactly that fluoxetine made me less depressed. It only made me more „aggressive“ and more risk taking, and the antidepressing effect came from the positive results of taking such risks. I just „don’t care“ about failures as much as I used to.
E.g. I finally started talking to girls, because I wouldn’t care about rejection that much. => Got into my first relationship and was happy.
Also, I started working on my passion project full time and I recently registered a company for it. Two years ago I would have not thought about doing this, as working for an employer is way „safer“.
I have ADHD, frequently exhibited risky behaviour, ADHD medication (MPH) reduced this effect for me, I'm more conscious and think things through before they happen.
Sertraline has almost entirely fixed my panic disorder.
It had no obvious cause and months of therapy had no impact. Within a few days of taking sertraline, it was essentially cured. I still get anxious from time to time but I'm able to live a completely normal life again. I had a few side effects (GI especially) for a few weeks but now the only side effect I have is I yawn a lot more, which is pretty tame.
I'm a big believer in the gut-brain connection and wonder if maybe it was something to do with the drug's GI effects that helped, but ultimately I have no idea and it doesn't really matter.
It's not just anecdotal evidence, the whole anti-antidepressant hype seems to re-emerge every few years, like a plague.
After trying a few different anti-depressant the vast majority of people do improve.
And the people bashing antidepressants fail to come up with any proven alternatives.
Is there a conspiracy shutting down depression curing alternatives all around the world?
We know how and why SSRIs work in regards to serotonin. We don’t understand why some people produce little or absorb serotonin too quickly requiring SSRIs drugs to manage it.
We know that a group of people who suffer from depression have lower serotonin levels when compared to someone who is considered... not depressed. And we know that SSRI's prohibit or prevent the bodies ability absorb serotonin allowing it to accumulate and be more effective and pull it in line with someone who is not depressed, resulting in the depressed person becoming less or not depressed.
So. I'm unsure how my statement is untrue in response to the parent statement stating we have no idea how they work.
The article seems to say that lower levels of serotonin is not the /cause/ of the depression. But it doesn't change the fact that most studies seem to conclude that one of the things we can determine in people who suffer from depression is that they have lower levels of serotonin, and in some of those cases SSRIs help.
Not all forms of depression are caused by serotonin, and anti-depressants may not always be the solution.
Again, my point is we know how SSRIs work and what they do. What we do not know is why some people have lower levels of serotonin or why they absorb it too quickly compared to... non depressed people.
The issue with depression is that its a huge complicated thing that we know a lot about, but at the same time, we also know very little.
I would agree that we over perscribe medication for depression as we do for MANY different things. In Asia, antibiotics is handed out like candy when people are sick. You have the common cold, boom you get antibiotics, despite the fact that colds are caused by virus, and antibiotics only helps with bacterial infections not viral invections.
The US has a major problem with big phama where people can be perscribed medicine for many things, and then have side-affects resulting in more things being perscribed. Painkills for injury > painkillers causing depression > Prozac, Prozac causes insomnia > sleeping pills, sleeping pills causes you to lose sexual drive > viagra, viagra causes you to gain weight > apatite suppresents. It goes on and on.
I wonder if a big part of the problem is that depression and other mental illnesses are slightly unusual in that they are categorised based on symptoms rather than underlying biology, which are poorly understood. As a diagnosis it’s about as useful as ‘chest pains’
Maybe (I am not a clinical psychiatrist) there are 1, 10, or 100 very different underlying causes which would indicate different treatment if only they were better understood. But nonetheless the existing classification / ontology is established and will be hard to displace.
The crisis in mental health is that suicide levels have been rising since 2000. This is good evidence that the new drugs are worse than the old drugs. If you look at consumers rating of drugs they're on, mao inhibitor anti-depressants like nardil have very high ratings, especially compared to SSRIs. Unfortunately, the drug companies don't like competing with generics, so it goes that the newest drug is considered the best drug.
> The crisis in mental health is that suicide levels have been rising since 2000. This is good evidence that the new drugs are worse than the old drugs.
Or this is good evidence that cellphone usage is causing suicide (~1/3 of people in US had cellphones in 2000, ~100% do now).
> This is good evidence that the new drugs are worse than the old drugs.
That's incorrect. There's good evidence that economics, in combination with lack of funding for suicide prevention programs is driving the increase in suicide rates. See https://www.bbc.com/news/world-us-canada-44416727
As a member of the anti-psychiatry side after seeing primary care doctors wreck my mother... I think we will see a sea change in how we approach this with things like psychedelics.
I recently got treated with six weeks of Ketamine, and it works. If you ever thought about rebooting your brain, then I recommend it. However, you really have to surrender yourself to the experience; it is a very intentional act.
Ketamine treatment is interesting, but it's not really a replacement for SSRIs. The anti-depressant effects of Ketamine are unfortunately relatively short-lived. Tolerance also seems to develop to the effects over time. There are some adventurous providers experimenting with frequent ketamine dosing over long periods of time, but the results haven't really been great from what I've seen.
Also, a psychedelic experience is definitely not necessary for ketamine's antidepressant effects. In fact, the more responsible providers and studies are careful to keep peak plasma levels low enough to avoid this, and it works just fine. A lot of unscrupulous providers are using excessively high doses to induce psychedelic experiences, but this isn't actually supported by the evidence.
SSRIs and other traditional antidepressants will continue to be mainstays of long-term depression treatment if for no reason other than their sustainability and long-term efficacy is so much better than ketamine.
I support psychadelic legalization but at the same time I wonder how much of the antidepressive effect of psychadelics is just from giving space for thought in your day to day life. For exmaple, the modern human wakes up, starts scrolling instagram, goes to work, goes home, continues scrolling instagram, then sleeps. There is no period of reflection or introspective thought, since every mundane activity where you could be reflecting internally, e.g. washing the dishes or walking to the train, is consumed by a podcast you have playing from your airpods. For some people, taking a psychadelic drug is the only time they give themselves to do nothing but think internally for a few hours. I wonder if they would get the same benefit just setting aside regular designated meditation time where their thoughts aren't being interloped by all these forces in modern society that vie for our attention.
For my first infusion, I didn't wear an eye-mask and I was kind of incapacitated as I watched people come and check on my vitals. I felt this deep sense of caring that we are all in this world together and love is the most important thing.
It's not just time to reflect, but also a new perspective which is hard to allow to enter the mind due to all the anxieties of the world.
I agree with your general point, but psilocybin does a heck of a lot more than give you space to think. It temporarily (or, as studies suggest, perhaps more long-term) also changes quite a bit about how you think.
I'm finding the biggest impact from the psychedelic experience as a spiritual awakening, and the biggest thing I feel is that I'm no longer in the nihilism trap.
Can you articulate how your brain allowed you to escape from that trap? Did K affect you on some low-level inarticulable level? Sincerely curious. Nihilism is a struggle for me!
So, what I can surmise is that I felt a deep connection to the universe. You _feel_ the ramifications of not only being a part of the universe, but also the part of the universe trying to understand it.
I'd say I was an atheist before, but now I feel there is something and that something is curious. It's like consciousness is independent of the universe, and didn't create the universe. Instead, it's trying to figure out the puzzle. So, this tiny spark of faith cures nihilism because I'm part of the consciousness, and as long I as wake up and solve by piece of the puzzle, there is meaning in that.
100% same feelings. But really it was never as much like this with K as it was much moreso with the shrooms.
I can totally see why K is an immediate relief for people who are immensely depressed. Within 1 hour it basically rips you away from your sense of self, that you were so unnecessarily attached to and that had all the depressive emotions with it.
Shrooms seem like they produce a guttal connective feeling to your surroundings and the natural world around you. Longer lasting imo.
Please don't break the site guidelines like this, regardless of how wrong someone else is or you feel they are. It makes the thread significantly worse.
Also, posting this way discredits your position, which in the case that you happen to be right, is quite a bad thing.
There's a significant population of science denying cranks and so those who want to raise legit concerns about the quality and alas, often motivation of medical studies are easily grouped with those. But:
1. There's no such thing as good / bad cholesterol. This is complete baloney and Pfizer lost a staggering amount of money when a drug raising good cholesterol got as far as human trials -- and failed them. There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. There's growing amount evidence though that cholesterol is a symptom and not a cause.
2. The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Last year there was a study pretty much confirming it is overdiagnosed in children. But even worse, whether ADHD is even a thing or multiple conditions wrongly bundled under a single name is basically an open question. We basically put labels on children with "problematic behaviors" like "autistic spectrum disorder" and "ADHD" and then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things?
3. I would bet dollars to doughnuts in a few decades we will look at all current nutrition advice to something akin of medieval quackery. How is this not self evident: genes obviously affect how foodstuff interact with our bodies thus any sweeping generalization is inherently suspect or most likely complete baloney. Like, how can anyone seriously think only lactose intolerance is an inherited genetic trait.
I would need to dig into my notes if someone needs them but a group of statisticians at a university started to look into medical studies and then FOIA the raw data and found like 80% of them cherry picking the data.
The incentives are not exactly at the right place.
> The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect.
Go on…
(I’m adult diagnosed, for disclosure, but please do go on and tell me how suspect my diagnosis was, how I shouldn’t have been diagnosed as a child, how my medication is harmful. Go on and tell me about my life which you know better than I do.)
Just because you might have gotten a diagnosis that helped you doesn’t mean everyone has.
I for one am actually interested if he can back up that claim. So when you as them to “Go on…”, please leave it at that. There’s no reason to be snarky.
> Findings In this systematic scoping review of 334 published studies in children and adolescents, convincing evidence was found that ADHD is overdiagnosed in children and adolescents. For individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits.
You have the benefit of being casually disconnected from the topic and presenting yourself as intellectually curious. I have the experience of being alive because I was diagnosed and treated. Your curiosity about whether I get to live or die is up to you, but my place to speak to that isn’t up to you until I’m dead.
Don't take it personal. Both things can be true, you can have adhd and adhd can be overdiagnosed, doesn't mean that none of those diagnostics are valid.
I'm sure you must be tired of people telling you about how overdiagnosed adhd is, I'm sorry about that, but don't take it personal, it's just a person on the internet.
GP also claimed the treatment is extremely suspect yet provided nothing to back up the claim. Does GP think the treatment does not work? AFAIK it is among the most treatable psychiatric illnesses.
> In this systematic scoping review of 334 published studies in children and adolescents, convincing evidence was found that ADHD is overdiagnosed in children and adolescents. For individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits.
What I mean is that we feed children Ritalin without a second thought. It's absolute nuts. There are many many ways to work with ADHD which doesn't require giving a children meds. We should be way more cautious about doing that.
This study comes nowhere close to supporting the claim you made upthread, that "The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect". The claims it makes are much narrower than your claim (in particular, it focuses on mild ADHD cases, and the "harms" it discusses from medication are subjective, like the diagnosis providing "an excuse for problems".
Oh I take it personally. I’m alive today because I sought diagnosis and treatment. I very nearly wasn’t alive from the consequences of being undiagnosed and untreated. I very probably would be dead today if I had taken this “just person on the internet” more seriously than I already had. I’m more than tired of people offering their ignorant opinions about stuff they don’t understand.
On the other hand, the state threw a ADD diagnosis on me because I was bored in school, pumped me full of a methamphetamine analog and put me into classes with profoundly disabled people ruining my social life from a early age. I'd stare at the wall in my bedroom for hours due to the drugs, eventually my parents stopped giving them to me when I was at home, but that lead my dad to try them, and eventually get addicted to meth proper himself.
I dropped out at 15 and taught myself computer science, so it was all provably horseshit but it sure made my life harder as a child.
In all seriousness, I’m sorry you went through this. I also grew up with a parent and family with addiction. I’m in no place to assess anything about your life, but what you describe is consistent with the diagnosis. And unfortunately your dad taking your meds and becoming an addict is consistent too.
ADHD is frequently hereditary, and substance abuse and addiction are common for people with undiagnosed ADHD.
Your own story of dropping out and teaching yourself isn’t just familiar to me, it’s similar to both my brothers’ stories as well.
I’m sorry you experienced this the way you did. I wish you had better medical care, and better parental guidance. I hope the life that you’ve made for yourself is joyful and prosperous, and I hope if it’s ever not you’ll find your way to that however it makes sense.
As somebody who was diagnosed with ADHD in my youth and who has tried various medications, I've reached the point of suspecting that the disease model is just a poor fit here.
Does my brain work differently than other people? Yes. Would this have been a problem for me in any pre-industrial society? (Which, to be clear, is most of human history?) I don't think so. Is it a problem for me when I have a fair bit of control over the work I do? Not really! I only experience it as a problem when I am expected to function in contexts with industrial-age labor models, where there's a hierarchy that expects me to labor like a robot in line with how my betters have decided how the work should be done.
So I can entirely believe that authority figures over-use ADHD as a diagnosis so that their lives are easy. Reading through the DSM, it seems to me there are quite a number of diagnoses that could be used as Authority Inconvenience Syndrome. And I don't think I've ever seen one where people might need treatment for being too obedient.
I find the idea that we are born defective to be inherently suspect.
It is quite illogical but very popular because well adapted people can just talk about superior genes and how everyone else has inferior genes and they can never change anything about that except with extensive medical treatment.
For sure. I've read some really interesting stuff under the "medicalization of deviance" label. A classic example being how homosexuality was treated as a psychological illness because the dominant group saw it as a societal offense.
I see people downvoting this and I think that's a mistake. There's a fair bit of stigma for all sorts of mental health treatment, and I think that's a reasonable thing to be angry about. It's possible that some people are over-treated and also that some people are under-treated. People who have suffered from either end of that are allowed to be angry about their suffering.
I want to support you, also toward HN, that I do take it personally and am pretty exhausted by people all the way back to both of my parents denying I have a condition.
People of the internet: there are better things you can be doing than playing armchair psychiatrist, especially by invoking notions that can ultimately be harmful to a class of people who have forever been told they just need to put in more effort. You don't know what it's like to live with this so please stop with the conjectures. Thank you.
We're glad you're alive. Please don't take HN threads into flamewar.
People have different experiences/backgrounds. It's both inevitable and natural that there are different points of view on this or any other complex topic.
I hear you. The ignorance around ADHD is appalling. My medication (Elvanse) works wonders - being able to focus like normal people has entirely changed my life.
I remember the first time I took one of those pills, I was astounded my how clear my mind became. It was like the noise switched off, and I could just get on with what I needed to.
Like you, I was diagnosed as an adult. I have considerable regret for all those years prior wasted without diagnosis and medication. I'm trying to undo all the maladaptive behaviours I've developed likely because of this, and shed myself of the many, many guilts I feel. But it's a long hard slog.
I wish my parents were still alive so I could talk to them about it all, and show them the person I've become since.
When I see confident expressions of ignorance about ADHD, or even worse, scammers and liars trying to take advantage of people with ADHD, it also makes me see red. You're not alone in this. I think you were right to speak out here, whatever anyone else says.
I think OP is just saying that 'ADHD' is not that valid of a diagnosis, in terms of any kind of underlying 'pathology'. The fact that many people appear to benefit from the use of 'medication' (i.e. amphetamines and derivatives, from Adderall to Desoxyn(methamphetamine) to Ritalin), is mostly unrelated to any 'diagnosis'.
Personally I think all drugs should be legal and people should be able to take whatever they think helps them, although I always recommend the 'less is more' mentality and would urge people not to develop dependencies.
Ignoring the fact that basically all drug development outside of the computational stuff is large amounts of trial and error, there is ample evidence that ADHD results from dysfunction of specific neural pathways, and stimulant medication benefits ADHD individuals (more than just "speed helps everyone focus").
> This literature is increasingly contributing to the notion that the pathophysiology of ADHD reflects abnormal interplay among large-scale brain circuits. Moreover, recent studies have begun to illuminate the mechanisms of action of pharmacological treatments.
> I think OP is just saying that 'ADHD' is not that valid of a diagnosis
I understand this in the comment’s expression too, and it’s emphatically wrong.
> benefit from the use of 'medication' (i.e. amphetamines and derivatives, from Adderall to Desoxyn(methamphetamine) to Ritalin), is mostly unrelated to any 'diagnosis'.
You’re incorrect.
> Personally I think all drugs should be legal and people should be able to take whatever they think helps them
I agree, but this has nothing to do with the validity of actual diagnoses of actually treatable conditions.
I think the point is that actual diagonoses are often wrong and potentially harmful, which I agree with. I share a bit of your story, getting diagonised with ADHD benefited me greatly and led me down a path that likely saved my life. At the same time, while many people are helped by the medical system many others aren't and psych drugs are an area where there is a lot of finger waving in how drugs are perscribed.
I would be curious to see discrepancies in ADHD diagnosis between countries. You hear about it all the time in the U.S. but rarely in many other places, including Europe.
Genetic errors which cause high LDL levels result in significant cardiovascular disease. It's a very strong cause and effect.
I won't argue that inflammation doesn't play some role (it seems to play a role in many diseases), but I wouldn't dismiss current medical opinion on LDL.
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL cholesterol), in the blood and early cardiovascular disease.
Why aren't you adjusting for LDL subfractions? Seriously, yes having too much LDL can be a sign of having harmful subfractions but that doesn't mean high LDL actually is harmful or low LDL is healthy.
> There is lots of data to suggest elevated LDL is a risk of cardiovascular disease and that high HDL lower risk.
There is zero data to suggest that once you adjust for oxidized/damaged LDL.
Smokers don't have elevated LDL but they still suffer the effects of inflammation/oxidization that ultimately lead to cardiovascular disease. If you want to guarantee cardiovascular disease just eat straight up oxidized cholesterol in the form of trans fats.
> then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things?
80% of ASD kids meeting criteria for ADHD doesn't mean that 80% of ADHD kids meet the criteria for ASD. ADHD seems a lot more common.
> Last year there was a study pretty much confirming [ADHD] is overdiagnosed in children.
That paper is very clear that they did not study misdiagnosis. They are a bit jargony with the use of "overdiagnosed."
"Overdiagnosed" does not mean incorrectly diagnosed, it means that there are subgroups who get a net harm from being treated.
A more understandable term for what they measure is "overtreated." The solution is likely better protocols for mild cases, not to state that ADHD is not a thing.
> 2. The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Last year there was a study pretty much confirming it is overdiagnosed in children. But even worse, whether ADHD is even a thing or multiple conditions wrongly bundled under a single name is basically an open question. We basically put labels on children with "problematic behaviors" like "autistic spectrum disorder" and "ADHD" and then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things?
You know, just the other day I read about some brain scan study which suggested high-functioning autism looked, in brain scans, more like ADHD than like profound autism. But I think to some extent this sort of problem is inevitable if you're trying to dream up a taxonomy for conditions entirely from how they present themselves with a limited understanding of their biological basis.
> I would bet dollars to doughnuts in a few decades we will look at all current nutrition advice to something akin of medieval quackery.
All current nutrition advice? Does this equally include the nutrition advice that your cousin gives on Facebook, as well as the advice given by doctors of nutritional science?
I get where this skepticism comes from. Nutrition is complicated, and there's a lot of bad advice shared by random people you meet. There's also the diet supplement aisle at your local grocery store, which is full of poorly-regulated products with dubious claims. (At least, in the US, we have these. They are not regulated as drugs.)
At the same time, nutrition-based interventions are some of the most effective public health policies we've ever implemented. In the US, we have programs like WIC. We have iodized salt. We cure blindness in children. We cure scurvy. These are all amazing things--things which we kind of take for granted, because we're not ever exposed to scurvy, childhood blindness, etc.
This is not the first time I've heard such extreme skepticism of nutritional science and it just boggles the mind because if you talk to someone who works in the field, they have amazing success stories to talk about.
Anecdote but I always noticed change in sleep patterns after starting antidepressants. Actually, terminal insomnia (you wake up and then are unable to fall asleep) are characteristic of chronic depression. Add to this that SSRI causes increase in sleep hours (maybe even quality?) and then you have a theory about how it might just have been due to lack of sleep after all?
Given the placebo effect is 75% of the effect of antidepressants, and placebos have a large effect on sleep, I would say that the placebo effect is the first thing that should be considered.
I'm going to go out on a limb and guess the prominence of depression is largely caused by a broken interface with the world at large. The traps created by modern society wherein you struggle for other people's benefit are better designed than ever before. What our social machine procedurally treats as progress is advances in subjugation. Depression may often be an artifact of "efficiency" with respect to extracting value from the population at large. We might need to dial back the exploitation of the currently-exploitable class to have a sustainable society, assuming pills don't work. In different terms, maybe we have too many rich people (exploiters) in a situation where it's clearly very foolish to keep growing in number (and productivity) to support them. Maybe we just need to rebalance our economy to make it work better for those currently exploited and endemically depressed people.
I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.
How would you "medically disprove" the notion that some people are unhappy because the circumstances of their lives are bad rather than biological defects?
OK. And the notion that psychiatry has been used to simply stamp anyone agitating for political change as insane is also attested (see https://en.wikipedia.org/wiki/The_Protest_Psychosis for instance). So what's your objection to this line of inquiry?
I don't know what you're trying to argue here, but it doesn't seem to have anything to do with the claim at the root of the thread, and I apologize but I'm not interested in the tangent.
I wonder how a week of low dose amphetamine usage, like adderall, might help disrupt no-motivation mood loops. A friend of mine (cycling through many antidepressants) seems like he would respond well to this. As in, he would feel better and be able to “shift gears.” Not to get more work done, but say, enjoy going to an art museum. And feel what it is like to be enthusiastic again.
If it helps, unhappiness/despair seem like different degrees of the same feeling. Depression is a different feeling.
The closest analogy I can think of is that "amused" and "satisfied" are both positive feelings, but they are different and you can't treat the cause the same even if some of the symptoms are similar.
“Exogenous depression” is supposed to be experienced by about a fifth of people at one point or another. What if many persistent cases of depression were actually exogenous? That might be more interesting than parsing the difference between despair, hopelessness, anhedonia, and depression.
The idea that a terrible life can cause depression is not the limb he's going out on. It's the idea that somehow depression is caused by being way more exploited than our ancestors in the 1700's who were working on someone else's farms and factories as children is the limb he's going out on.
OK, well, that's an easy rhetorical maneuver but one that can be met with equally facile ripostes, such as "how do you determine that people weren't just as if not more depressed in the 18th Century when the concept was less familiar?" or "perhaps having the gulf between themselves and the wealthy rubbed in their faces every day is what causes the distress, since there can be little sense of exploitation if one is surrounded only by those in similar straits."
Daily I very much doubt because it’s not like most people were commuting to work. Would you sometimes see them, sure, but people also had a belief system that would have done more to justify the social order, and it would probably be limited to provincial elites for most.
Weren't a lot of towns built basically surrounding a castle?
I guess people in towns would see wealthy people often, but people in remote farms and villages wouldn't.
I'm not sure exactly what wealth is being rubbed in my face today. News about rich people? I would assume there would also be news and gossip about rich people back then too.
Fair criticism as usual and maybe I should have been more specific, but I didn't say anything about the 1700s or prior specifically. If we talk about trends in the lifespan of people alive today (which represents a huge number of people) the picture is much different.
What evidence do you have for this? Do you think chattel slaves of the USA weren't broken in mind - indoctrinated into Christianity, stripped of their original languages, culture and names? That was not some novel evil created by Southerners - it's the tried-and-true method for enslaving populations throughout history.
But I'm sure the existence of TikTok is an existential threat.
It depends on the timespan and comparative frame you are thinking about. If we limit ourselves to post-WW2 MAD world, there are much different overall trends in quality of life than starting in the middle ages or from colonial times, where many people did not enjoy the rights or luxuries modern people would, not in small part because they couldn't, technologically speaking. It's easy to compare modern poverty to peasantry and say we have it good now, but it doesn't address modern problems in a meaningful way.
> It depends on the timespan and comparative frame you are thinking about
There are few dimensions where pre-industrial life is better before than after. The quality of life for the average human is many standard deviations above what it was just a few centuries prior. It wasn't that long ago cholera was a death sentence.
> In different terms, maybe we have too many rich people (exploiters) in a situation where it's clearly very foolish to keep growing in number (and productivity) to support them. Maybe we just need to rebalance our economy to make it work better for those currently exploited and endemically depressed people.
Don't all those rich people also get depression? I think that rules out a marxist reading here.
If you're going to go this general direction, i'd say a better way would be, we now live in a system where work is never done, stress is pretty constant, and labour is less physical but more mental in the modern world. Perhaps our mind is just not made for continous mental labour. Being a farmer in pre modern times sucked, but at least you could turn your brain off more often.
Marx clearly stated that alienation was a phenomenon that affected all classes. Marxism explains alienation just intervenes in a different manner.
Depression then also happens among rich people. But the source, and expression of it might differ. An anecdotal saying explains that wealth is often a barrier to create true friendships because it insulates you from society and creates antisocial thought processes: the "thinking people just want to be your friend because you're rich" rhetoric.
Rich people aren't automatically immune to exploitation. It's more a finely tuned web of pressures than a strict hierarchy. I'm also aware of differences in genetics and diet and other behavior that predispose people to depression.
I'm not rooting for Marxism exactly. I think it is an extreme overcorrection, but that some correction has been and is still warranted at times, given regulatory capture and other abuses that come from concentration of power. Anti-trust action and semi-effective democracy/representation are needed.
I think we are in a society with solutions to almost every problem except for those that require cooperation on the scale we exist at, which is unprecedented.
I sympathise with the idea of mindless hard labor being more fulfilling. Working food service in the backroom as a teenager worked my body but left me less stressed mentally than anything I've done post-graduation.
People lament their functional redundancy in society. Markus Persson Notch got depression after he became a billionaire. The workers lament their redundancy because they can be replaced and abandoned all the time.
People want to be needed, instead we have become isolated individuals that need no one in particular.
Gonna attempt to short circuit the "you think WE have it bad? Whatabout 1700s?" argument by adding that the "broken interface" theory may be much more about the patient's perception and confidence of the trap we're in than the actual truth of relative conditions. There also might now be a greater philosophical understanding of the global picture than the average person back in the day. Back then we didn't have an internet to give us rigorous detail on both the widespread extent the human race is trapped in a broken system and the futility of the common man's attempts to change it. Even if this wasn't true (I'm hard pressed to find a more optimistic take, though I'm always searching and fighting for it - technology is the best hope imo), it is an easy perception to fall into, especially for anyone already a few steps into depression. It's a reasonable bet that even if people in the past were just as likely to get beaten down and depressed about their own lives, they still might have been able to look at the world around them and the future of humanity and see optimism and hope that the next day might be better/luckier. The world was also much more malleable at the local level - both politically and individually (i.e. go outside and chop a tree down) and less of a complex leviathan of laws and exploitations which immediately instills a feeling of being trapped in the jaws of something that you can't even explain or understand.
Alternatively - or just, adjacently - with the internet (and big business, and widespread university education) we are culture-shocking vastly more people into a medium that can barely be understood from a detached intellectual and philosophical perspective, and is almost impossible to fathom from historical, traditional, ancestral or biological ways of understanding (the way humans operated for vast majority of our existence). We have little history to compare this new way of life to, and it's unsurprising if it's doomed to breed mental disease by its very nature. We have awakened far more people to an absurd reality, and "what is meaning?" is no longer just a question for a tiny group of overintellectual philosophers. Some of those philosophers say that one must walk through the valley of the shadow of death before we can find that answer for ourselves - but even they're gonna admit that a whole lot of people are gonna get stuck in that valley for a while if you just throw the masses in like we have. Hopefully that's just a temporary growing pain of our society as we gather our strength and do better but - time will tell!
(P.S. rich people are just as trapped in this malaise of meaninglessness. They have more agency, sure, but they're also still part of the systemic trap and unlikely to have much better answer on how to change anything than the common man. Only so long even a rich person can hide in hedonism before the depression catches up - or they just embrace the cold reality and adopt the "I got mine" attitude which said system is naturally inclined to. Depression may very well be due to our moralistic social being nature chafing with a cruel capitalist system which has won by almost every measure possible)
Don't feel too bad about it, you hit the nail on the head.
It might be helpful though to define the term "rich".
A rich person usually isn't your manager, or their boss, or even the owner of the business, because the people supervising you may have never had a raise in life either, and the owner might be in debt.
A rich person is someone who dismisses their dependence on others. They will act impeccably in all situations and often appear to have an untarnished reputation. A rich person will deny help to someone in need, and then justify their lack of empathy with something along the lines of tough love. A rich person will demand that others work and portray an image that they themselves work, while secretly delegating all work to others. A rich person will wear a suit, a lapel pin, all manner of regalia, to preserve their image at all cost. A rich person has an untethered ego that will go to any length to maintain control. A rich person will decide for others. A rich person will never question their own beliefs. A rich person achieves affluence by denying it to others.
Unfortunately the rich are in charge of all facets of our lives in the US and pretty much everywhere else. Their undying devotion to wealth inequality and the status quo is specifically the primary cause of suffering for the rest of us.
Thanks! Yeah you shouldn't feel bad - rich people are a good example, and I would expect them to have a lot more resources to escape depression in general
I tend to think that our disconnection from the nature causes depression to humans. We have come so far from our natural living conditions that we fall ill to depression and other diseases. Another aspect is the lack of physical work that is very unnatural for us. We sit in cubicles (or at home office nowadays), use our brains and fingers to do work and at best hit the gym few times a week. After which we eat our stomach full and entertain us with things that were invented during last generation. Life certainly is safer and better for us, but it's making us unhappy. We live like medieval royals and like them we suffer mental illnesses (https://en.wikipedia.org/wiki/List_of_mentally_ill_monarchs).
Imagine a kid growing up in the US today, they are functionally under house arrest as neighborhoods are built for cars and not people. Everyone is isolated to their family unit almost entirely and all activity gated on parents time and willigness (or control).
Equal and opposite reaction. Right now may literally be the best time to be alive in the world history for those who have direction, purpose, inner strength. Endless possibilities and safety nets.
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Not all patients with depression find relief from SSRIs, or medications in general, but some certainly do.
Double blind trials are hard, double blind comparative trials are more or less impossible.
[1]: https://www.science.org/content/blog-post/how-antidepressant...
This makes intuitive sense to people when discussing other topics. For example, when someone is in pain they don't need to have an "endogenous opioid deficiency" for opioid painkillers to alleviate their pain. They're just in pain, and modulating the opioid system with drugs is one way we can reduce that pain. Or COX-2 inhibitors. Or a number of other substances.
Likewise, modulating the serotonin system with SSRIs is one way we can modulate depression symptoms. People don't need to have a "serotonin deficiency" to see benefits from modulating their serotonin system.
Maybe it’s a bit cute, but with this understanding, I think the headline is not shocking. We will never find the one cause of depression because there isn’t one.
In my opinion, our best bet is more personalized medicine: helping people identify which rivers are filling up their lake of depression. For most people it will be a weighted combination of many things, but I think there will usually be some principal components.
> ...A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness.
> These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/
https://www.science.org/content/article/nimh-wont-follow-psy...
It reminds me of Pfizer's work on gabapentin. A professor from Northwestern was working on GABA antagonists (by modifying GABA itself) and eventually came up with the drug. It was hailed as a great example of "structure-based drug design".
The drug was approved by the FDA and efficacious for a number of issues like neuropathic pain. The submission documents from Pfizer had all this data on the binding efficiency of the drug to GABA receptors.
Except it didn't work through the GABA receptor at all.
After approval, more research was done and they said it worked through glutamate channels. Then more work was done and it seems most of its effect is through calcium channels.
(Probably making anyone who actually knows what they're talking about cringe. Take it easy, lol)
You can just google older papers on gabapentin. Just like most drugs it impacts a number of different receptors in the body. We still don't fully understand them all.
Edit: Tipper Gore; I did not remember her name (I’m not from the US).
I read she was a big fan of the serotonin theory in a book (whose title I don’t remember at the moment).
In chapter 2: The year after I swallowed my first antidepressant, Tipper Gore -- the wife of Vice President Al Gore -- explained to the newspaper USA Today why she had recently become depressed.
Just so that it's clear: I have nothing against Al Gore -- except that he lost the election.
The key thing to understand is that serotonin levels don't have to be low for SSRIs to induce positive changes. SSRIs don't just "raise serotonin levels" as many have come to believe, but rather change the dynamics of serotonin in the brain. This produces downstream changes that, over time, can contribute to lessening depressive symptoms in some patients.
This makes more sense if you think about other conditions like chronic pain. Someone suffering from chronic pain doesn't have an "endogenous opioid deficiency". They're just in pain. Opioids are one medication we can use to modulate their pain.
Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field.
The first "S" is for selective, meaning they have minimal affinities beyond the serotonin transporter.
However, increased serotonin receptor agonism also increases downstream dopamine and norepinephrine release.
Let’s be clear though, I had an actual licensed psychiatrist say this to me last week. It’s not like people are getting this “pop-culture” information via blog articles…
Anyone who spent even in a couple hours reading about depression (one of the most common ailments) in the last decade knows that low serotonin is not the cause of depression.
You mean the TV commercials that played about 6 times per hour in the 00s explaining that depression is caused by a chemical imbalance ?
Also, kind of happy to be off it right now honestly, heat is something that doesn’t go along well at all with SSRIs.
However I was in a quite sorry state before... I was having several panic attacks a week. My therapy alone was also not working well, I was doing twice a week. After starting it, everything started falling into place. I never had a panic attack again.
I never had any downside whatsoever from taking them (didn't know they don't go well with summer!), including the regular complaints, it wasn't really a burden on me other than having to buy them monthly and take them every day.
Did wonders for my anxiety too.
Pointing to alterations isn’t really helpful without context. An anti-depressant should induce long-term helpful alterations in order to alleviate symptoms.
The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that his training explicitly made this claim, that his textbooks make this claim, and that he himself was later passing it down to other students.
Other sources quoted by the news article are similar to your own claims. Overall, it sounds like there are camps in psychiatry that have indeed long abandoned this theory, but others who still hold onto it.
Furthermore, the meta analysis being talked about in the article does make the additional claim that SSRIs are perhaps not necessary for the treatment of depression. I don't believe they are right, but it's also misleading to suggest that theur research is entirely in line with psychiatric orthodoxy.
However, like I said in my post above, we’ve know for decades that it’s not the explanation because SSRIs boost extrasynaptic serotonin levels within hours but their therapeutic efficacy is famously delayed by weeks.
I suppose it’s possible that the author had some weird textbook that misrepresented the state of research, or that he misunderstood the relative confidence and significant of each theory presented. However, the state of research didn’t even believe that the serotonin hypothesis of depression was the full, accurate explanation when SSRIs were introduced for the reasons I stated above and more.
** warning ** If you are on any prescription anti-depressants, don't stop taking them or modify your routine without talking to your doctor first.
5-HTP: nasty side effects from unwanted metabolism in the gut and excess serotonin levels in the brain that border on serotonin syndrome sometimes. After the initial 8 hours or so of bad side effects the anti-depressant effects last for about two days followed by a very hard crash on day 3. During the 2 "good" days the quality of the effect is a bit "off" and gives me an unusually "comfortable feeling" that is while much better than depression is not the most productive or normal feeling (see melatonin below for contrast). Be extremely careful with 5-HTP, serious serotonin syndrome can easily develop, especially if you are on other anti-depressants and can be fatal. I don't take 5-HTP anymore because of these side effects and better options (below).
THC: Very effective during use (edibles = 4-6 hours), but tolerance levels build requiring higher doses. mild anti-depressant effects trail off gradually after day or two and quality is generally good. Of course cannabis has some side effects: short term memory impairment, general slight cognitive reduction but I have found these side effects can be virtually eliminated with L-Dopa (see below)
L-Dopa: Taken with vitamin B-6, this is one of the few things I have found that enhances the cannabis experience rather than taking away from it. This increases dopamine levels in the brain which enhances the high and for me also seems to miraculously eliminate the side effects of cannabis (maybe this is due to offsetting dopamine depletion by THC?). I have also found that L-Dopa even seems to increase general cognitive functioning beyond undoing the effects of THC (maybe reversing age related degredation? It makes my brain feel like it did when I was 18). L-Dopa does have serious side effects however: It dramatically and seriously increases anxiety/paranoia for several hours so I only take it with cannabis edibles and even then not every time, no more than once per week. It's very important to know how to manage paranoia since THC also frequently triggers paranoia and the L-Dopa seems to amplify that. My method is to consciously and affirmatively "acknowledge and disregard" any paranoid or anxiety related thoughts. I have found that once I consciously identify and acknowledge certain thoughts are caused by the drugs/supplements and are not real (or as important as they seem), they disappear and everything is ok.
Melatonin: This is by far the best anti-depressant I have ever used. Essentially no side effects other than putting you to sleep 30 mins after use, which when taken before bed is a huge plus (I have had difficulty falling asleep my entire life). Anti-depressant effects last for a few days, gradually trailing off without the hard crash of 5-HTP. The quality of the effect is also excellent (much better than 5-HTP). The best way I can describe it is "feeling healthy, energetic yet relaxed, and normal" most of the time. It's like a miracle drug, at least for me. I take 5mg every 3-4 days as needed.
5-HTP - There seems to be wide variation in the formulations available from manufacturers. Some have given me no issues at all, another brand, of the same strength, consistently leads to intense nausea and vomiting, followed by a significantly altered mental state. Almost tripping, and yes, I'm familiar with that.
THC - agree with your comments, but by far the biggest advantage for me is that it enabled me to completely quit drinking. Alcohol is terrible in that it will temporarily shut those intrusive thoughts off, but then they seem supercharged them when they inevitably return after a few hours. Drinking definitely exacerbates my actual depression even if it masks some symptoms.
I do use melatonin occasionally/as required but not super often. It's very effective as a sleep aid, but I have not noticed any antidepressive effects in myself. Valerian is also an extremely effective sleep aid for me. Will have to research L-Dopa.
Consider trying Sceletium Tortuosum extract (Kanna). It has been commercialized as "Zembrin" and is available in OTC supplements. There are peer-reviewed studies indicating that it is safe and effective, and personally, I've found it to noticeably effective against anxiety, less so for depression. As supplements go, it's inexpensive.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124331/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828542/
Finally, psilocybin has been revolutionary for managing my mental health, and specifically depression. I found microdosing to be ineffective. A full trip sets me right for several weeks, to the point where it is startling when the intrusive thoughts start up again.
Regarding L-Dopa, from what I'm aware of, L-Dopa gets metabolized before it makes it to the brain, so much of the L-Dopa gets metabolized into dopamine and norepinephrine outside of the brain and then those neurotransmitters activate the parasympathetic nervous system, resulting in increased anxiety, paranoia and physical discomfort. That parasympathetic activation can increase feelings of alertness and wakefulness without ever having L-Dopa enter the brain. Another interesting thing to see is how L-Dopa would fare when taking it with an inhibitor that would allow it to successfully enter the brain a la Carbidopa for Parkinson's patients.
Obviously don't do this, I'm just thinking out loud and fucking around with your body like this can have serious consequences if you aren't doing so under the supervision of your own doctor.
Finally, regarding THC, if anxiety and paranoia are problems for you, like you allude to when talking about L-Dopa, try delta-8-THC. I find it to be much more therapeutic than delta-9-THC. I get no anxiety or paranoia from delta-8-THC, but I do get the full therapeutic effect I got from normal THC when it comes to antiemesis, mood, pain, etc. It also has less of an intoxicating effect, and doesn't mess with my memory of motivation as bad as delta-9-THC does. I haven't used normal THC in years despite it being legal and readily available.
Drowning or having your leg cut off leads to a chemical imbalance, but chemistry isn't always the most productive lens to analyze the problem
Thats the basically the point I am taking issue with. Myopic focus on chemistry can be terribly misleading. There will always be a chemical component because we are beings made up of chemical components.
a chemical imbalance is by definition always going to be part of the problem. That does not mean it is always the best point of intervention, and certainly not the exclusive focus when trying to understand the problem.
If your only tool is a hammer then every problem looks like a nail.
The brain is a lot more than chemistry, and that's not even looking at the human being and their interactions with the environment.
there are patterns encoded in the structure and biology of the brain. There are psychological feedback loops and complicated interactions between a human and their environment.
Saying it must be a chemical imbalance is akin to debugging a malfunctioning computer and saying it must be a signal error from a loose wire. It ignores programming sending signals on those wires and it ignores the input to the machine from the environment
I'm often worried about neurochemical solutions if some part of your brain is still associating events/memories/ideas with pain.
Culture shock, being alone in a new country, seasonal affective disorder (I come from a warm tropical country), being in a long distance relationship - they all likely contributed.
I also made some pretty bad career moves immediately afterwards, which likely didn’t help.
Read anything by Irving Kirsch.
He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All.
He found they basically don't work better than Placebo.
Personally, I think the "Happy" drugs have been the biggest con job the American suffering have ever endured. At least we know opioids work--for awhile. Antidepesssnts just make Dr. Wealthy more wealthy.
My hope is most of these wonder drugs are sued into history, along with those mandatory doctor office visits.
Ask yourself this--why do Psychiatrists have the highest rate of suicide if these drugs work?
I'm glad we have residents whom picked an easy speciality upon graduation, but these drugs have such low efficy rates they should be illegal, or over the counter, with the exception of a few. Trazadone can be nasty. A bad reaction is cured by a needle to the middle part of the brain.
Most are easy on the body, but don't do anything besides make an Artist (Medicine is an art, and Psychiatrists are the milking to the bone.) wealthy.
God help our suffering Americans.
This for me doesn't seem logical. It could be that a long term imbalance makes you depressed, and reverting that imbalance takes time to affect the thought processes towards the positive. Only because the reaction is delayed, it doesn't mean it's not causal.
It's speculated that hippocampus size might be one of the driving components of depression, but who knows. Mental illness is complex.
Things like being trapped in a dead end job to keep healthcare benefits in the USA, living in a never ending treadmill of debt.
Russian serfs might've revolted when they got the chance, but they were more or less psychologically normal until then. Their society adapts to not kill them all. (Or they all become alcoholics or something.)
That's an over simplification.
People could still have more free time than we do now[1], while their life could be more monotonous on some aspect, I believe an average office worker life today can be even more monotonous than what a serf life could be. You also have to consider labor alienation, which is a something that didn't exist so much before industrialization.
Most importantly, life commonly revolved around tight communities, while today most people live in individualist societies.
Individualism certainly has a larger impact on happiness than most modern convenience has.
- [1]: https://groups.csail.mit.edu/mac/users/rauch/worktime/hours_...
No, preindustrial ages weren't the hell they're made to be nor a golden age by any means. The same can be said of today. Stop playing defensive and think openly instead, there's lot we can improve by learning from the past.
Happiness comes from the overcoming of not unknowable obstacles toward a known goal. It's the journey, not the destination. And the trick is to set another goal once you attained the one you're on.
Fidelio
I find this kind of bizarre because you can look around and see how it's obviously not true. Dogs are happy as clams to just socialize with their owners / other dogs and just live. People hustling to always get to the next goal don't seem particularly happier than people who don't have a goal and just have a healthy social life.
B. The happiest people on the planet are extremely ethical, have a good moral compass and have a will to help others. They have goals and attain them. And they especially don't blame their environment for their shortcomings. They find ways to adjust their environment to themselves and not the other way around.
Someone who is content with a simple life is still following that maxim. Their goal is to live each day in relative comfort according to their own standards.
Also, we always like to think we will be happy “once I have…X” and then we get X and say well actually what I need is Y.
Most unhappiness is driven by vanity and desire (a bargain you make with yourself where you chose to be unhappy until you get something) to be better than our peers.
Until you can be content with nothing you wont be content even with everything.
If people can be happy in concentration camps we can be happy in dead end office jobs. They cant stop us from being happy.
I don't think people in concentration camps are happy.
Or as the Unabomber said, "Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness. Science fiction? It is already happening to some extent in our own society. Instead of removing the conditions that make people depressed modern society gives them antidepressant drugs. In effect antidepressants are a means of modifying an individual's internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable."
I think you're right. The problem is, this is the only life most of us have lived, and so we cannot imagine it otherwise, like a fish who cannot conceive of a world above water, or even that water is the medium surrounding it. If our entire society is causing this, then what can we do? Wage slavery, oligarchy, attention theft by tech companies, disintegration of community from various causes. Life for so many people is crawling through glass Monday through Friday, then getting shitfaced on the weekend. Is that happiness? How do we escape?
Ooof
"Instead of removing the conditions that make people depressed modern society gives them antidepressant drugs."
Examining the social factors that contribute to pathology isn't controversial nor does it downplay the role of drugs in reducing harm.
Not to mention, depression takes several forms, and not all of them are related to unhappiness. A common form is related to anxiety, with people experiencing a constant feeling that something awful is about to happen, sometimes getting terrible panic attacks. Given that many of these people live in objectively and subjectively extremely safe environments, much safer than at any other time in history, it's very hard to take seriously any environmental theory of this kind.
Edit: corrected one bad auto-correct typo ("problem", not "purulente") .
You are playing into the argument, people often don't have a choice to avoid a depression inducing environment, they only have the choice of using drugs or not.
People looking for an actual expert discuss these things should watch Robert Sapolsky's talk: https://www.youtube.com/watch?v=NOAgplgTxfc
For example, in the talk, he points out one of the most telltale signs of depression is waking up early, which is completely backwards from the common perception that depression is someone staying in bed all day.
Yet there are more depressives around than ever.
Cars and other manufactured goods tend to get cheaper over time because they can take advantage of economies of scale, as well as global supply chains and free trade. We're seeing that very concretely right now as the global chip shortage has put pressure on the used car market.
Education, housing, and healthcare are largely unaffected by free trade, and Baumol's cost disease is literally a statement about how certain industries cannot take advantage of economies of scale.
Come to think of it, let's also toss childcare in the bucket of "things that have gotten more expensive faster than inflation over time" since, among households with children, we have a predominance of households where all parents who are present work. Again, we have inelastic demand and Baumol's cost disease rearing their ugly heads, so maybe there's something to this theory.
https://en.wikipedia.org/wiki/Baumol%27s_cost_disease
TV and automobile manufacturing are a lot more productive than they were 50 years ago. A teacher can still only teach one classroom at a time.
Therefore, service industries like healthcare, education, and even construction get less and less efficient relative to manufacturing and production industries, which enjoy massive increase in efficiency year after year. This is partly why an 80 inch 4K TV is eventually going to cost $500 and a 4 year college education is going to cost $500,000.
it makes logical sense, but i wonder if it really is wage competition causing this when wages have been mostly stagnant for the past 50 years?
https://www.thebalancecareers.com/industries-with-the-most-w...
At the end of the day we are probably happiest when we are foraging for berries or mushrooms. This whole abstract 'society' crap we put upon ourselves leads to a lot of self directed scorn, embarassment, disrespect, and no doubt depression. How many billions of calories have been burned to fuel thoughts of worry about an outfit choice around the world? How many grey hairs have sprung up as a result of fretting about appearance? The stress society tries to shovel on you is such a waste of energy and does nothing to help you.
Sadly, not enough to offset our sedentary lifestyle and diets. I can't be too concerned about the energy expenditure involved in worrying about meaningless things. For now anyway, we've got energy to spare. The toll of all that stress on our bodies is much worse than the calories we lose. Still, I'd rather be worried about the trivial things that we occupy ourselves with than the life or death worries humans regularly faced when we were berry foragers. Going from worrying over "Will we eat today?" to "Which of several restaurants should we go to for lunch?" is a blessing.
It's pretty depressing if you dwell on it for any period of time.
1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it.
2. the drugs were tested inadequately across race, age, weight, sex.
3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal
4. almost all successful uses of the drugs are accompanied by CBT and like processes.
"Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist might be overestimating their own knowledge of a different field (psychiatrist formally study these systems and medications, psychologists do not) and underestimating the amount of research being performed in this field.
Regardless, these drugs don't really work as "boosters" like commonly thought. It's better to think of them as modulators. In fact, in conditions like anxiety SSRIs are well-known to actually reduce serotonin transmission in certain areas of the brain. The research has diverged quite a bit from the simple marketing-material models that a lot of people have about these drugs.
The purpose of the drugs is to induce changes that result in positive downstream effects. It's not actually a contradiction that enhancing and inhibiting certain receptors could result in similar downstream effects. For example, a number of receptors in your brain will downregulate in response to both agonists and antagonists, even though they have opposite direct effects. Your psychologist's understanding of this topic is deeply flawed.
> 2. the drugs were tested inadequately across race, age, weight, sex.
SSRIs have been in widespread use since the 80s and tricyclics since the 50s. At this point, the idea that we haven't tested enough or that we haven't collected enough data is just a strawman argument proposed by people with impossibly high standards. I suspect no amount of testing would actually satisfy someone proposing this argument for drugs that have been studied for this long.
> 3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal
It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard. Benzodiazepines should absolutely be prescribed for brief periods and this is reflected in their status as controlled substances and all of the prescribing literature. There are some doctors who ignore this advice and overprescribe, of course, but they are going counter to standard practice.
On the other hand, medications like SSRIs can actually take weeks or months to reach full effect and many patients unnecessarily relapse by quitting them early.
I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.
> 4. almost all successful uses of the drugs are accompanied by CBT and like processes
The most successful uses of SSRIs are accompanied by therapy. However, we have plenty of studies where SSRIs are prescribed without any accompanying therapy and a positive result is still seen. If you're suggesting that the therapy is actually doing 100% of the work, that's easily disproven by the studies that test all combination (placebo, therapy alone, SSRI alone, therapy + SSRI).
I'd recommend getting your psychiatry advice from actual psychiatrists. The number of misunderstandings and mistruths in what you've relayed here is quite high.
None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use.
Do you disagree?
Which field? You said he was a psychologist. Your post was about psychiatry and neuroscience topics.
I don't disagree that psychologists have a lot of opinions, but it's not really their domain. I think it's a mistake to think that a psychologist is better educated on psychiatry topics than actual psychiatrists or neuroscientists who actually study these things and understand the research.
They get seen by a GP, with limited time and tools. They are prescribed SSRIs, and booked in to see "some other health professional" and what emerges is a delay of some significant time, before they get that next stage of engagement.
I was also triaged by my GP, in Australia, and was put into the non-drug path, and I am content. If my health practitioner prefers not to use drugs, and that is a bias, so be it.
I can say that my mother in law was treated in other ways, became addicted to Xanax, and narrowly missed being placed in "deep sleep" therapy which wreaked havoc on many people, although it was "peak treatment" at the time. She was a deeply unhappy woman. I cannot say she would have been better off without drugs, but I do know the process of managing her drug regime was intense.
Deep sleep therapy lasted a long time. It was credible for decades. Psychiatry is as capable as any other science of being led a long way down paths it subsequently walks back on.
ECT, which is much more "confronting" in some ways, remains a useful tool. If you ask most people in the streets, They react with horror.
I place great hopes in ketamine, and in psylocybin. Again, both require a context of use, and are still experimental. What I like about both, is that they appear to being considered as rapid-intervention therapies, not as sustained, long lived treatments. I like that because of the short duration. I guess I don't like the SSRI story precisely because of the long duration, and the consequences on young kids, especially on things like sexual dysfunction. (I'm not a young kid and that isn't an immediate concern for me)
This, coupled with the emerging reports of longterm sexual dysfunction in young women, I think represent pretty severe concerns. Obviously anecdata is not science, but this is what informs my own sense of place here. I am not anti drug in the wider sense. I think drugs of all kinds have been and are and will be beneficial. I am concerned with how SSRIs are being used in practice, with what longterm consequences, and short-term risks.
There's a strong vibe of "butt out, stick to your knowledge" in responses to my posting here. I will take that advice. I'm off-piste, this isn't my area of work.
Unless you are involuntarily committed, you won't be put on the drug path if you don't want to. Psychiatric medications like SSRIs are generally awful. What I mean when I say "awful" is that the experience of taking them is awful. You may end up with symptoms that are under control, but you may still experience symptoms, or the symptoms can sometimes get worse, and the side effects are often just kind of shitty to deal with. These are generally not habit-forming drugs. These are nasty pills that you'll look at in the morning and dread taking.
Non-compliance rates are already high, when you have patients who want to take the medication. There is no way you're going to prescribe antidepressants to somebody who says they don't want to take them. It's just a waste of time.
Xanax is different. It's a benzodiazepine. The entire category of benzodiazepines is known to have a high rate of misuse, and Xanax in particular has a high rate of misuse. It's prescribed because it's an extremely effective and fast-acting. Very different from SSRIs.
I'm not sure what the scientific support for this is, but at least anecdotally I know 5+ people who take an low-dose SSRIs and claim it works.
> I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.
Yeah, as someone who has been close to people who need antipsychotics, I sometimes feel the anti-antidepressant crowd extrapolates to all psychiatric drugs and this is very scary. Especially since people with conditions like schizophrenia or bipolar frequently think they don't need medication.
The ones I know also say there are times they miss the emotional highs. It's probably why they (and schizophrenics) go non-compliant.
Then potentially add paranoia on top of that...
Edit: and as the sibling comment said, people can feel pretty shitty on them. I know I've heard and been sympathetic to that for many years, so don't want to sound insensitive by only focusing on anosognosia.
- Sedation (too tired to function)
- Emotional numbness if I need to increase the dose to stop an episode.
- Headache
- Loss of balance.
- Impaired fine motor control.
- My arms and legs don’t move properly. I’ll command my arm to move, and it only moves halfway. I used to fall a lot before I learned to be very careful walking.
- Inability to orgasm.
These get pretty bad in the first four hours after taking them. During the day, if I get dehydrated or have low blood sugar, I can easily get incapacitated and be unable to drive.
And no, my dosage isn’t too high. This is the lowest effective dose I can be on. The alternative is lithium, which can be worse.
From the medical side what's important is what risk/benefit which is independent.
Antidepressant as a term is really only for convenience which the medications themselves being quite broad in action.
Antipsychotics too are having a bit of a revolution, the first generation seemed to all be about D2 blockade, the second generation acting on 5HT-2a much more than D2. Finally, pimavaserin acting only on seratonin (5HT-2a) and not on dopamine at all [0] now there's SEP-363856 [1] which has action not at D2 or 5HT-2A but TAAR1 and 5HT-1A.
The point is that psychiatrists are not particularly married to any mode of action or mechanism. Only the results.
[0] https://nbn2r.com/search#drug/90
[1] https://en.wikipedia.org/wiki/Ulotaront
The article contradicts this.
But they also see other patients showing measurable improvement, and trying different prescriptions until finding one that seem to have an effect is a common practice.
All in all, this is very murky situation, but drug prescription can still be effective and might be the only option for some patient for who other approaches didn't work.
So here's the interesting thing - there's evidence that 5-HT2a receptors are way too dense in people with depression. Antagonists obviously have a blocking effect, but increasing serotonin at the synapse counterintuitively has a similar effect - your body responds to it by paradoxically downregulating 5-HT2a receptors. Two totally opposite approaches with a similar outcome.
I don't know why people take such reductionistic stances.
There are dozens of anti-depressants, I think most people get significant improvement after trying a few.
I don't take them (well, except for sleep with a low dosage of Trazadone (which I can't anymore because it gives me priapism) and mirtazapine(which made me sleepy even the next day)), but my experience is with stimulants for ADHD. I've tried quite a few stimulants and while all worked for my ADHD (heck even pure nicotine works somewhat), some combinations were brilliant but illegal, and metylphenidate (Concerta) does an amazing job for my impulsivity and an ok-ish job for my focus.
Sure, I can't just snap my fingers, pop some low dosage meth (and I need to stress low dosage -- 15-20mg) or my favorite (3-1 isopropylphenidate + metylphenidate) and enter a flow state at will, but Concerta just changed my life for the better.
I'm sure that a lot(most) of people with depression just as with ADHD need more than just the medication.
If you're depressed because of your circumstances and have 0 power to change them, perhaps anti-depressants work less well, but I've read about numerous people who had a purely "chemical" depression -- there was nothing "bad" about their life and they changed nothing and after anti-depressants they were just not depressed anymore.
I think viewing depression as a disease instead of a symptom is a mistake. So many people eat food completely devoid of nutrition, stay indoors all day, have erratic sleep schedules, drink absurd amounts of alcohol and smoke weed all day. Why are we giving these people antidepressants when what they need is to go outside and walk and to take a multivitamin?
The point is, you cant start from the outside and work your way down the the individual. It starts with the person.
"Depression" is a natural response to living an alienating modern lifestyle. The people who can appropriately "deal" with it (like myself) all have something extra going for then, like deep family structures or unusual minds.
Depression is a disease of despair, and all these treatments are really just treating the symptoms.
In other words, people experience despair because of some underlying situation - examples: death of child, lonely, broken home. “Normal” things, and we try to treat it with pharmaceuticals. It would be like treating depression with cocaine or marijuana (they actually did and still do this btw) - might make you feel good temporarily; but it’ll never stop the despair.
The question is really how to address the despair. People often visit a therapist; I can see that helping some. But to many, they can’t seem to find the cause.
It reminds me of the post the other day about how people live over 100 [1]. It’s all about community:
> Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy.
> Loved ones first. Successful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love. (They’ll be more likely to care for aging parents when the time comes.)
> Right tribe. The world’s longest lived people chose—or were born into—social circles that supported healthy behaviors, Okinawans created moais—groups of 5 friends that committed to each other for life. Research from the Framingham Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.
Yes some people have real hormone or other biological issues. But 99% of people likely need to address the root cause. I’d put money depression is on the rise as our communities are collapsing due to the industrial / technological nature of our world.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125071/
> Depression is a disease of despair,
> The question is really how to address the despair.
It's known that people have genetic predispositions to depression. People experience depression due to many causes. Not all causes are known and we don't have very good understanding of the mechanisms, but it's just not damn likely that we can treat this as a purely psychological / environmental issue.
To be clear a disorder (ie depression disorder) can be caused by a variety of factors, including (but not limited to): genetics, environment, trauma, illness, etc.
Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important.
Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect.
Which imo is why this is often not discussed. The vast majority of the research money is poured into drug research or clinical research around therapies. Often this overlooks other avenues — one which I mentioned.
I believe they can be effective in reducing depression, it just has nothing to do with serotonin.
Where does the article say that?
> Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important.
It's not for lack of trying.
> Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect.
That explanation doesn't have any legs.
By this theory, dentists have no incentives for prophylaxis, but in practice, that's a large part of what dentists do and it's very effective. By this theory, the medical industry wouldn't choose to eradicate any infections diseases, since it can make money from treatment. It turns out we can and do eradicate infectious diseases, but it is difficult, expensive, and time-consuming. We've only successfully eradicated two infectious diseases and only one of those affects humans in the first place.
If you look at other infectious diseases, there are tons of diseases which can be outright cured and tons which can't. This isn't for lack of trying, it's just that these diseases are different. You can kill bacteria with antibiotics, but if you get HIV, the best we can do is antiretroviral therapy.
Treatment of symptoms with pharmaceuticals is often a rational, good decision. There are simply too many diseases for which we don't have any known cure. Depression is one of them. The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three. So we have stuff like SSRIs, which are known to work for some people.
I don’t think we disagree in almost any of this.
I’m simply pointing out depression may be caused by environmental factors, one which can be treated. It could be why they found “nothing convincing” in the study.
I have yet to meet a depressed person or almost any person who couldn’t use more community. I suspect most peoples depression is a rational / emotional response to lack of basic needs of some kind. Whether that’s community, sleep, job, food, etc
That’s not to say all people have environmental factors or that drugs can’t help people cope. I’m merely sharing what struck me and for some reason hadn’t clicked with me prior, even seeing people get out of depression.
The people I know who overcame depression all did the following: worked out, improved sleep patterns, joined some activities. One could argue correlation (ie as depression reduced, they became more active). But it didn’t seem that way looking in. Anyway, just an observation and contemplation really.
Depression is known to cause this. Yes, it’s not that simple. But this reasoning is extremely dubious.
> The people I know who overcame depression all did the following: worked out, improved sleep patterns, joined some activities.
All the people I know who graduated high school got married and had children. Maybe we should encourage people to get married and have children to increase the graduation rate!
Sarcasm aside, this reasoning is just beyond dubious. Do you know what the symptoms of depression are? Are you familiar with the very basics of what depression is? All of the things that you described that people overcame are actual symptoms of depression.
Or maybe to abuse another analogy—everyone I know who got over chicken pox stopped getting those pustules. That doesn’t make “stop getting pustules” actionable advice!
Emotional abuse / neglect, especially the one that occurs in childhood.
* You feel something in life is lacking but dont know what, or blame yourself for it, or look for it in in thrill seeking activities, or through buying stuff to fulffill this emptiness, or you escape from this ever present painful feeling with addiction (hint of what that thing is: being really loved, not romantically loved, but actual unconditional love, the one that only healthy parents can give and which you feel in some way when you have a community behind you. Partial love given by a lot of people ends up almost feeling like parental unconditional love.)
* Can't seem to make friends, or make friends but don't seem to connect at a deep level and end up feeling lonely anyway.
* Also the cause of social anxiety.
* Burnouts due to lack of boundaries (which also come from abuse). Feeling like you put others first all the time, and end up feeling somewhat fake.
* (...)
All of these can lead to depression. And they all have the same root-cause. And barely anybody talks about this (unless you go really looking for these communities, but unfortunately they're not really mainstream).
Anti-depressants mechanism of action is more complex than 'corrects a chemical deficiency.' I hope such people considering treatment know that while theories may change as we learn more: medications still have to be evaluated against real-world results. So the effectiveness of a drug remains the same.
I'm sure "they're doing it wrong", but these were fully licensed doctors, prescribing drugs in an approved manner.
I'll give an example, I read once that about 60% of people with bipolar disorder are unemployed. It isn't the diagnosis that does that.
So I just read that comment as "they sought treatment and ever since they were a wreck". Seems like the causality could go the other way.
I could imagine that SSRI can activate this autopilot for some people and worsens their negative thoughts.
If the person is correct and not dusional they had a statistically unlikely reaction to the drug- presumably too rare to show up in the drug approval process- and it ruined their life.
While not fun working through the gamut of medicines, some of them finally pulled me through it all. It took almost a year to fully recover with dedication to the medicine and modifications of it and therapy.
If I didn't have a good family and primary care doctor, I guarantee I would have died in some manner unless hospitalized.
People need to realize there is danger to their words. Psychiatry is nowhere near perfect, but people are trying. It is an incredibly difficult thing to understand. But I feel people who speak against medicine have never truly experienced deep depression or anxiety. A panic attack can hit you sitting on the couch, and then by literally doing nothing, your heart rate can reach 200bpm and massive amounts of hormones making your chest and skin feel like it's burning, and next thing you're calling an ambulance because you think you aren't breathing.
E.g. I finally started talking to girls, because I wouldn’t care about rejection that much. => Got into my first relationship and was happy.
Also, I started working on my passion project full time and I recently registered a company for it. Two years ago I would have not thought about doing this, as working for an employer is way „safer“.
But I don’t care about failing anymore.
It had no obvious cause and months of therapy had no impact. Within a few days of taking sertraline, it was essentially cured. I still get anxious from time to time but I'm able to live a completely normal life again. I had a few side effects (GI especially) for a few weeks but now the only side effect I have is I yawn a lot more, which is pretty tame.
I'm a big believer in the gut-brain connection and wonder if maybe it was something to do with the drug's GI effects that helped, but ultimately I have no idea and it doesn't really matter.
Is there a conspiracy shutting down depression curing alternatives all around the world?
So. I'm unsure how my statement is untrue in response to the parent statement stating we have no idea how they work.
I thought the whole point of the article was that there is no solid evidence of a relationship between serotonin levels and depression?
Not all forms of depression are caused by serotonin, and anti-depressants may not always be the solution.
Again, my point is we know how SSRIs work and what they do. What we do not know is why some people have lower levels of serotonin or why they absorb it too quickly compared to... non depressed people.
The issue with depression is that its a huge complicated thing that we know a lot about, but at the same time, we also know very little.
I would agree that we over perscribe medication for depression as we do for MANY different things. In Asia, antibiotics is handed out like candy when people are sick. You have the common cold, boom you get antibiotics, despite the fact that colds are caused by virus, and antibiotics only helps with bacterial infections not viral invections.
The US has a major problem with big phama where people can be perscribed medicine for many things, and then have side-affects resulting in more things being perscribed. Painkills for injury > painkillers causing depression > Prozac, Prozac causes insomnia > sleeping pills, sleeping pills causes you to lose sexual drive > viagra, viagra causes you to gain weight > apatite suppresents. It goes on and on.
I wonder if a big part of the problem is that depression and other mental illnesses are slightly unusual in that they are categorised based on symptoms rather than underlying biology, which are poorly understood. As a diagnosis it’s about as useful as ‘chest pains’
Maybe (I am not a clinical psychiatrist) there are 1, 10, or 100 very different underlying causes which would indicate different treatment if only they were better understood. But nonetheless the existing classification / ontology is established and will be hard to displace.
Or this is good evidence that cellphone usage is causing suicide (~1/3 of people in US had cellphones in 2000, ~100% do now).
Your causality is poorly explained.
That's incorrect. There's good evidence that economics, in combination with lack of funding for suicide prevention programs is driving the increase in suicide rates. See https://www.bbc.com/news/world-us-canada-44416727
I recently got treated with six weeks of Ketamine, and it works. If you ever thought about rebooting your brain, then I recommend it. However, you really have to surrender yourself to the experience; it is a very intentional act.
Also, a psychedelic experience is definitely not necessary for ketamine's antidepressant effects. In fact, the more responsible providers and studies are careful to keep peak plasma levels low enough to avoid this, and it works just fine. A lot of unscrupulous providers are using excessively high doses to induce psychedelic experiences, but this isn't actually supported by the evidence.
SSRIs and other traditional antidepressants will continue to be mainstays of long-term depression treatment if for no reason other than their sustainability and long-term efficacy is so much better than ketamine.
It's not just time to reflect, but also a new perspective which is hard to allow to enter the mind due to all the anxieties of the world.
I'd say I was an atheist before, but now I feel there is something and that something is curious. It's like consciousness is independent of the universe, and didn't create the universe. Instead, it's trying to figure out the puzzle. So, this tiny spark of faith cures nihilism because I'm part of the consciousness, and as long I as wake up and solve by piece of the puzzle, there is meaning in that.
I can totally see why K is an immediate relief for people who are immensely depressed. Within 1 hour it basically rips you away from your sense of self, that you were so unnecessarily attached to and that had all the depressive emotions with it.
Shrooms seem like they produce a guttal connective feeling to your surroundings and the natural world around you. Longer lasting imo.
Ketamines anti-depressant effects are some of the longest lasting in pharmaceutical history.
Tolerance is carefully managed by your infusion provider to not build up.
The long term efficacy is insanely good - which is why we approved it in the first place.
The psychedelic experience is necessary to approach the more permanent end of the spectrum - this is by the "evidence" that you are not reading.
SSRIs continue to be a mainstay because they aren't $800 per session with insurance and have an extreme margin. They are far, far, far lower efficacy.
What are you doing my man? You just straight lied in almost every sentence.
Also, posting this way discredits your position, which in the case that you happen to be right, is quite a bad thing.
If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
1. There's no such thing as good / bad cholesterol. This is complete baloney and Pfizer lost a staggering amount of money when a drug raising good cholesterol got as far as human trials -- and failed them. There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. There's growing amount evidence though that cholesterol is a symptom and not a cause.
2. The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Last year there was a study pretty much confirming it is overdiagnosed in children. But even worse, whether ADHD is even a thing or multiple conditions wrongly bundled under a single name is basically an open question. We basically put labels on children with "problematic behaviors" like "autistic spectrum disorder" and "ADHD" and then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things?
3. I would bet dollars to doughnuts in a few decades we will look at all current nutrition advice to something akin of medieval quackery. How is this not self evident: genes obviously affect how foodstuff interact with our bodies thus any sweeping generalization is inherently suspect or most likely complete baloney. Like, how can anyone seriously think only lactose intolerance is an inherited genetic trait.
I would need to dig into my notes if someone needs them but a group of statisticians at a university started to look into medical studies and then FOIA the raw data and found like 80% of them cherry picking the data.
The incentives are not exactly at the right place.
Go on…
(I’m adult diagnosed, for disclosure, but please do go on and tell me how suspect my diagnosis was, how I shouldn’t have been diagnosed as a child, how my medication is harmful. Go on and tell me about my life which you know better than I do.)
I for one am actually interested if he can back up that claim. So when you as them to “Go on…”, please leave it at that. There’s no reason to be snarky.
> Findings In this systematic scoping review of 334 published studies in children and adolescents, convincing evidence was found that ADHD is overdiagnosed in children and adolescents. For individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits.
I'm sure you must be tired of people telling you about how overdiagnosed adhd is, I'm sorry about that, but don't take it personal, it's just a person on the internet.
> Findings
> In this systematic scoping review of 334 published studies in children and adolescents, convincing evidence was found that ADHD is overdiagnosed in children and adolescents. For individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits.
What I mean is that we feed children Ritalin without a second thought. It's absolute nuts. There are many many ways to work with ADHD which doesn't require giving a children meds. We should be way more cautious about doing that.
Oh I take it personally. I’m alive today because I sought diagnosis and treatment. I very nearly wasn’t alive from the consequences of being undiagnosed and untreated. I very probably would be dead today if I had taken this “just person on the internet” more seriously than I already had. I’m more than tired of people offering their ignorant opinions about stuff they don’t understand.
I dropped out at 15 and taught myself computer science, so it was all provably horseshit but it sure made my life harder as a child.
ADHD is frequently hereditary, and substance abuse and addiction are common for people with undiagnosed ADHD.
Your own story of dropping out and teaching yourself isn’t just familiar to me, it’s similar to both my brothers’ stories as well.
I’m sorry you experienced this the way you did. I wish you had better medical care, and better parental guidance. I hope the life that you’ve made for yourself is joyful and prosperous, and I hope if it’s ever not you’ll find your way to that however it makes sense.
Does my brain work differently than other people? Yes. Would this have been a problem for me in any pre-industrial society? (Which, to be clear, is most of human history?) I don't think so. Is it a problem for me when I have a fair bit of control over the work I do? Not really! I only experience it as a problem when I am expected to function in contexts with industrial-age labor models, where there's a hierarchy that expects me to labor like a robot in line with how my betters have decided how the work should be done.
So I can entirely believe that authority figures over-use ADHD as a diagnosis so that their lives are easy. Reading through the DSM, it seems to me there are quite a number of diagnoses that could be used as Authority Inconvenience Syndrome. And I don't think I've ever seen one where people might need treatment for being too obedient.
It is quite illogical but very popular because well adapted people can just talk about superior genes and how everyone else has inferior genes and they can never change anything about that except with extensive medical treatment.
People of the internet: there are better things you can be doing than playing armchair psychiatrist, especially by invoking notions that can ultimately be harmful to a class of people who have forever been told they just need to put in more effort. You don't know what it's like to live with this so please stop with the conjectures. Thank you.
People have different experiences/backgrounds. It's both inevitable and natural that there are different points of view on this or any other complex topic.
https://news.ycombinator.com/newsguidelines.html
I remember the first time I took one of those pills, I was astounded my how clear my mind became. It was like the noise switched off, and I could just get on with what I needed to.
Like you, I was diagnosed as an adult. I have considerable regret for all those years prior wasted without diagnosis and medication. I'm trying to undo all the maladaptive behaviours I've developed likely because of this, and shed myself of the many, many guilts I feel. But it's a long hard slog.
I wish my parents were still alive so I could talk to them about it all, and show them the person I've become since.
When I see confident expressions of ignorance about ADHD, or even worse, scammers and liars trying to take advantage of people with ADHD, it also makes me see red. You're not alone in this. I think you were right to speak out here, whatever anyone else says.
Personally I think all drugs should be legal and people should be able to take whatever they think helps them, although I always recommend the 'less is more' mentality and would urge people not to develop dependencies.
> This literature is increasingly contributing to the notion that the pathophysiology of ADHD reflects abnormal interplay among large-scale brain circuits. Moreover, recent studies have begun to illuminate the mechanisms of action of pharmacological treatments.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876939/
I understand this in the comment’s expression too, and it’s emphatically wrong.
> benefit from the use of 'medication' (i.e. amphetamines and derivatives, from Adderall to Desoxyn(methamphetamine) to Ritalin), is mostly unrelated to any 'diagnosis'.
You’re incorrect.
> Personally I think all drugs should be legal and people should be able to take whatever they think helps them
I agree, but this has nothing to do with the validity of actual diagnoses of actually treatable conditions.
If you really want to dive into the wealth of counter narrative research that's being conducted, here's a huge collection http://haidut.me
This is untrue. There is lots of data to suggest elevated LDL is a risk of cardiovascular disease and that high HDL lower risk.
Pfizer's drug failed because of safety issues, not because "There's no such thing as good / bad cholesterol".
Elevated LDL is a symptom of inflammation. It is not a cause and lowering it doesn't help. The research mixed up cause vs correlation.
Genetic errors which cause high LDL levels result in significant cardiovascular disease. It's a very strong cause and effect.
I won't argue that inflammation doesn't play some role (it seems to play a role in many diseases), but I wouldn't dismiss current medical opinion on LDL.
https://en.wikipedia.org/wiki/Familial_hypercholesterolemia
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL cholesterol), in the blood and early cardiovascular disease.
There is zero data to suggest that once you adjust for oxidized/damaged LDL.
Smokers don't have elevated LDL but they still suffer the effects of inflammation/oxidization that ultimately lead to cardiovascular disease. If you want to guarantee cardiovascular disease just eat straight up oxidized cholesterol in the form of trans fats.
Trans fats aren't oxidized.
Like I said, I love reading HN health comments.
80% of ASD kids meeting criteria for ADHD doesn't mean that 80% of ADHD kids meet the criteria for ASD. ADHD seems a lot more common.
That paper is very clear that they did not study misdiagnosis. They are a bit jargony with the use of "overdiagnosed."
"Overdiagnosed" does not mean incorrectly diagnosed, it means that there are subgroups who get a net harm from being treated.
A more understandable term for what they measure is "overtreated." The solution is likely better protocols for mild cases, not to state that ADHD is not a thing.
You know, just the other day I read about some brain scan study which suggested high-functioning autism looked, in brain scans, more like ADHD than like profound autism. But I think to some extent this sort of problem is inevitable if you're trying to dream up a taxonomy for conditions entirely from how they present themselves with a limited understanding of their biological basis.
All current nutrition advice? Does this equally include the nutrition advice that your cousin gives on Facebook, as well as the advice given by doctors of nutritional science?
I get where this skepticism comes from. Nutrition is complicated, and there's a lot of bad advice shared by random people you meet. There's also the diet supplement aisle at your local grocery store, which is full of poorly-regulated products with dubious claims. (At least, in the US, we have these. They are not regulated as drugs.)
At the same time, nutrition-based interventions are some of the most effective public health policies we've ever implemented. In the US, we have programs like WIC. We have iodized salt. We cure blindness in children. We cure scurvy. These are all amazing things--things which we kind of take for granted, because we're not ever exposed to scurvy, childhood blindness, etc.
This is not the first time I've heard such extreme skepticism of nutritional science and it just boggles the mind because if you talk to someone who works in the field, they have amazing success stories to talk about.
If it helps, unhappiness/despair seem like different degrees of the same feeling. Depression is a different feeling.
The closest analogy I can think of is that "amused" and "satisfied" are both positive feelings, but they are different and you can't treat the cause the same even if some of the symptoms are similar.
I guess people in towns would see wealthy people often, but people in remote farms and villages wouldn't.
I'm not sure exactly what wealth is being rubbed in my face today. News about rich people? I would assume there would also be news and gossip about rich people back then too.
> In 1940 nearly half of houses lacked hot piped water, a bathtub or shower, or a flush toilet. Over a third of houses didn't have a flush toilet.
https://www.aceee.org/files/proceedings/2004/data/papers/SS0...
Or social isolation? People are very isolated these days. People can have good jobs, have lots of shallow acquittances but no true friends.
The idea that we're somehow way more exploited than the people who came before us does not seem compatible with any history book I've ever read.
Now, the mind is in chains.
But I'm sure the existence of TikTok is an existential threat.
There are few dimensions where pre-industrial life is better before than after. The quality of life for the average human is many standard deviations above what it was just a few centuries prior. It wasn't that long ago cholera was a death sentence.
Don't all those rich people also get depression? I think that rules out a marxist reading here.
If you're going to go this general direction, i'd say a better way would be, we now live in a system where work is never done, stress is pretty constant, and labour is less physical but more mental in the modern world. Perhaps our mind is just not made for continous mental labour. Being a farmer in pre modern times sucked, but at least you could turn your brain off more often.
Depression then also happens among rich people. But the source, and expression of it might differ. An anecdotal saying explains that wealth is often a barrier to create true friendships because it insulates you from society and creates antisocial thought processes: the "thinking people just want to be your friend because you're rich" rhetoric.
I'm not rooting for Marxism exactly. I think it is an extreme overcorrection, but that some correction has been and is still warranted at times, given regulatory capture and other abuses that come from concentration of power. Anti-trust action and semi-effective democracy/representation are needed.
I think we are in a society with solutions to almost every problem except for those that require cooperation on the scale we exist at, which is unprecedented.
I sympathise with the idea of mindless hard labor being more fulfilling. Working food service in the backroom as a teenager worked my body but left me less stressed mentally than anything I've done post-graduation.
People want to be needed, instead we have become isolated individuals that need no one in particular.
Alternatively - or just, adjacently - with the internet (and big business, and widespread university education) we are culture-shocking vastly more people into a medium that can barely be understood from a detached intellectual and philosophical perspective, and is almost impossible to fathom from historical, traditional, ancestral or biological ways of understanding (the way humans operated for vast majority of our existence). We have little history to compare this new way of life to, and it's unsurprising if it's doomed to breed mental disease by its very nature. We have awakened far more people to an absurd reality, and "what is meaning?" is no longer just a question for a tiny group of overintellectual philosophers. Some of those philosophers say that one must walk through the valley of the shadow of death before we can find that answer for ourselves - but even they're gonna admit that a whole lot of people are gonna get stuck in that valley for a while if you just throw the masses in like we have. Hopefully that's just a temporary growing pain of our society as we gather our strength and do better but - time will tell!
(P.S. rich people are just as trapped in this malaise of meaninglessness. They have more agency, sure, but they're also still part of the systemic trap and unlikely to have much better answer on how to change anything than the common man. Only so long even a rich person can hide in hedonism before the depression catches up - or they just embrace the cold reality and adopt the "I got mine" attitude which said system is naturally inclined to. Depression may very well be due to our moralistic social being nature chafing with a cruel capitalist system which has won by almost every measure possible)
I appreciate your take on this.
It might be helpful though to define the term "rich".
A rich person usually isn't your manager, or their boss, or even the owner of the business, because the people supervising you may have never had a raise in life either, and the owner might be in debt.
A rich person is someone who dismisses their dependence on others. They will act impeccably in all situations and often appear to have an untarnished reputation. A rich person will deny help to someone in need, and then justify their lack of empathy with something along the lines of tough love. A rich person will demand that others work and portray an image that they themselves work, while secretly delegating all work to others. A rich person will wear a suit, a lapel pin, all manner of regalia, to preserve their image at all cost. A rich person has an untethered ego that will go to any length to maintain control. A rich person will decide for others. A rich person will never question their own beliefs. A rich person achieves affluence by denying it to others.
Unfortunately the rich are in charge of all facets of our lives in the US and pretty much everywhere else. Their undying devotion to wealth inequality and the status quo is specifically the primary cause of suffering for the rest of us.