I cannot overstate how much harm this myth caused me. I first got sent to a doctor for depression when I was 12. They asked nothing about my life or my home, just gave me a test with a checklist of symptoms and then told me I had this chemical imbalance. If they had asked anything about my home, they would have discovered that my father was abusive. Then they could have told me that my father's behaviour was abuse and my depression was a natural reaction to abuse. By ignoring my life, the doctors implicitly communicated to me that the way my father treated me was normal and to be expected, and in fact his behaviour was so obviously normal that experts don't even bother asking about it.
I spent the next 20 years taking drug after drug after drug trying to find one that really and truly worked, while I was in a string of abusive relationships. Every one of the frequent trips to the doctor further cemented the idea that my relationships were normal and had nothing to do with my depression, and that this was so obvious it wasn't even worth looking into.
I finally figured it out 5 years ago. I turned instead to a domestic abuse counsellor who trained me in how to identify the difference between abusive and healthy relationships. I applied those principles and was finally depression-free.
If I had never been told this myth, then I would have reflected on what in my life might be causing the way I feel and I would have "cured" it decades earlier. The myth actively stopped me from ever doing that.
So much of this, the chemical imbalance narrative has been incredibly harmful. SSRIs can be helpful for people but should never be given in a vacuum. People are usually are depressed because of something
> the chemical imbalance narrative has been incredibly harmful.
Yet beneficial for others. I know several people who only sought help, and came to terms with their depression, after understanding that it was not their home life, not their fault, and that it was, in their case, just a physiological imbalance (seemingly inherited for most), and where helped tremendously by ingesting chemicals.
I also have examples of people who were told that antidepressants should be avoided, and it's better to "just change" and "be happy", who are no longer with us. I think the most harm comes from oversimplifying complex topics that we barely understand, which appears to be what happened in your case, and what you appear to be approaching now.
You can't know that it was the chemicals that helped them.
There are studies suggesting SSRIs work better than placebo- but only slightly. Placebo works extremely well.
What I am saying is that if a doctor gives a depressed patient a sugar pill with no chemicals in it, there is a very high chance they will make a significant recovery and credit the pill. Almost as high as if they are given an actual drug.
Telling people to "just change" and "be happy" are not solutions. That's just ignoring the problem. Real help involves significant attention, resources and social support, which is expensive.
> There are studies suggesting SSRIs work better than placebo- but only slightly.
> but only slightly
I can't imagine telling someone, who's at the lowest part of their life, that they shouldn't take a medication because it will help "only slightly", especially if one is simplifying depression, and not considering context, which can result in different efficacy [1].
There are also studies that suggest that the most at risk, for certain types of depression, aren't appropriately represented in the studies [2].
> Real help involves significant attention, resources and social support, which is expensive.
I will stand by my perspective that simplifying depression is harmful, as you experienced. For some, chemicals are the best, even sometimes temporary, solution, especially when there are studies suggesting that genes play a role in some forms of depression [3], which social support probably doesn't influence.
I think it would be worth putting more value into the expert opinions, rather than simplifications/anecdotes/speculation.
Totally agree, for some people chemicals are life saving, for others they are actually life ending. I think we just need to do a deeper analysis of the individual and ongoing therapy. Challenge is the economics of that
Ask yourself deep down how often do you feel depressed? I bet 90% of people feel depressed sometimes. Feeling depressed sometimes is just the human condition.
I bet the discussion around depression would look a lot different if it weren't so profitable to make antidepressants.
> Feeling depressed sometimes is just the human condition.
Sure, but when we're talking about Depression it's about consistent behaviours and feelings over at least two weeks.
I mean, sure, I can deal with a day of suicidal-thoughts but having them over a month is not healthy and it certainly is not just "feeling depressed sometimes".
The antidepressants made me numb. I can agree with that. But that numbness was way more preferable than the mental anguish I had to go through.
Clinical depression has a defined definition and symptoms exhibited need to be present for 2+ weeks at a time.
As someone that has been medicated for depression in the past I can tell you that having suicidal thoughts for weeks on end is not normal. The thing that honesty saved me was therapy.
I say all this because I think you’re potentially doing a great harm in downplaying depression. If someone reading this does feel persistently bad for an extended amount of time seeking therapy is a good idea.
If you imagine clinical depression is some kind of "funk"... just keep it to yourself. People with clinical depression do not need your abuse added to their troubles.
That’s a good question. My guess is that research clustered people around that point.
> Who decides that's the cutoff?
Depends on how depression is defined. The DSM definition used in the US is published by the American Psychiatric Association which is written by clinicians, scientific researchers, etc…
> I think two weeks is a pretty minor "funk"
If you’ve literally had thoughts of suicide for two weeks please seek help. Honestly that’s not normal.
Anecdotal evidence like this isn't helpful, and creates stigma for those who really suffer from clinical depression from seeking treatment. The treatment doesn't always have to be medication and I believe that therapy is much more beneficial, especially in the long term.
Please don't equate clinical depression with normal feelings of sadness.
On the other hand, it's pretty clear that chronic depression (and other psychiatric illnesses) are partially heritable. So, maybe not an "imbalance" but chemicals are involved somewhere.
So, it is back to square one. Why do depression meds work? Hypothesis A failed, move on to B.
But any discussion of depression that fails to deal with it as at least a half-dozen independent illnesses, each with its own biochemical basis, is intrinsically garbage, and any conclusions bankrupt.
This is why we keep seeing spurious reports that "antidepressants don't work". In every case, they take "depression" as a biochemically meaningful diagnosis of one illness, and run a RCT of medication X on a sample with illnesses A, B, C, D, E, and F. If X helps F but makes E worse, and has no effect on A-D, what will the "result" of the trial be? Garbage. "Gold-standard" garbage, if you like. GIGO.
People promoting garbage results should be ashamed. Fired, too. Incompetents in medical research make things worse for us all.
When first prescribed depression meds, I once how the doctor came to the chemical imbalance diagnosis, could we measure these chemicals for a better diagnosis?
He told me it was guess work, we don’t know why the meds work, but often they do.
I understand that some people have somehow gotten stuck in a bad situation and can't see any way out of it. Expert help might be available for that.
But then there are aspects of life that we can change. Including how we think of ourselves For that, there's wisdom out there to help. Here's one kind. [https://wisdomquotes.com/zen-quotes/]
My gut says some of my crippling depression is down to multiple rounds of antibiotics throughout my life.
If fecal transplants, or some cheaper-to-prescribe version were made available, feels like that would go a long way to helping a certain portion of people who are depressed, anxious, and have weight or immune disorders etc.
I was never depressed and never really suicidal but I had suicidal thoughts and a lot of frustration.
When my social status rose they went away.
As a software developer I had a very low social status compared to say a lawyer.
I am now a CTO and have a high social status.
But I think software developer is generally a profession that comes with relatively low status for the education level, as compared to say doctor or lawyer.
I think it's also this relatively low status that got me frustrated, finishing my Uni best in class and then being at the mercy of pretty dumb project managers.
This is why I find it important to give my developers a high social status, expensive office, expensive clothes, an assistant, etc.
Though society these days tries to teach you status is not important, I believe you cannot escape the nature of the beast.
33 comments
[ 3.7 ms ] story [ 78.9 ms ] threadI spent the next 20 years taking drug after drug after drug trying to find one that really and truly worked, while I was in a string of abusive relationships. Every one of the frequent trips to the doctor further cemented the idea that my relationships were normal and had nothing to do with my depression, and that this was so obvious it wasn't even worth looking into.
I finally figured it out 5 years ago. I turned instead to a domestic abuse counsellor who trained me in how to identify the difference between abusive and healthy relationships. I applied those principles and was finally depression-free.
If I had never been told this myth, then I would have reflected on what in my life might be causing the way I feel and I would have "cured" it decades earlier. The myth actively stopped me from ever doing that.
I’d say selling mass produced drugs on a subscription basis is a lot easier money than to talk through one patients’ problems, one at a time.
(It’s also the fault of us consumers. We do often prefer the magic pill over doing the work. This is one more story that perhaps will make us wiser.)
Yet beneficial for others. I know several people who only sought help, and came to terms with their depression, after understanding that it was not their home life, not their fault, and that it was, in their case, just a physiological imbalance (seemingly inherited for most), and where helped tremendously by ingesting chemicals.
I also have examples of people who were told that antidepressants should be avoided, and it's better to "just change" and "be happy", who are no longer with us. I think the most harm comes from oversimplifying complex topics that we barely understand, which appears to be what happened in your case, and what you appear to be approaching now.
As someone else posted, some expert opinions that are worth reading: https://www.sciencemediacentre.org/expert-reaction-to-a-revi...
There are studies suggesting SSRIs work better than placebo- but only slightly. Placebo works extremely well.
What I am saying is that if a doctor gives a depressed patient a sugar pill with no chemicals in it, there is a very high chance they will make a significant recovery and credit the pill. Almost as high as if they are given an actual drug.
Telling people to "just change" and "be happy" are not solutions. That's just ignoring the problem. Real help involves significant attention, resources and social support, which is expensive.
> but only slightly
I can't imagine telling someone, who's at the lowest part of their life, that they shouldn't take a medication because it will help "only slightly", especially if one is simplifying depression, and not considering context, which can result in different efficacy [1].
There are also studies that suggest that the most at risk, for certain types of depression, aren't appropriately represented in the studies [2].
> Real help involves significant attention, resources and social support, which is expensive.
I will stand by my perspective that simplifying depression is harmful, as you experienced. For some, chemicals are the best, even sometimes temporary, solution, especially when there are studies suggesting that genes play a role in some forms of depression [3], which social support probably doesn't influence.
I think it would be worth putting more value into the expert opinions, rather than simplifications/anecdotes/speculation.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073803/
2. https://jamanetwork.com/journals/jama/article-abstract/22932...
3. https://www.nature.com/articles/s41398-021-01270-5
I bet the discussion around depression would look a lot different if it weren't so profitable to make antidepressants.
Sure, but when we're talking about Depression it's about consistent behaviours and feelings over at least two weeks. I mean, sure, I can deal with a day of suicidal-thoughts but having them over a month is not healthy and it certainly is not just "feeling depressed sometimes". The antidepressants made me numb. I can agree with that. But that numbness was way more preferable than the mental anguish I had to go through.
As someone that has been medicated for depression in the past I can tell you that having suicidal thoughts for weeks on end is not normal. The thing that honesty saved me was therapy.
I say all this because I think you’re potentially doing a great harm in downplaying depression. If someone reading this does feel persistently bad for an extended amount of time seeking therapy is a good idea.
I think two weeks is a pretty minor "funk"
That’s a good question. My guess is that research clustered people around that point.
> Who decides that's the cutoff?
Depends on how depression is defined. The DSM definition used in the US is published by the American Psychiatric Association which is written by clinicians, scientific researchers, etc…
> I think two weeks is a pretty minor "funk"
If you’ve literally had thoughts of suicide for two weeks please seek help. Honestly that’s not normal.
I think 90% is pretty funk, don't you think?
Anecdotal evidence like this isn't helpful, and creates stigma for those who really suffer from clinical depression from seeking treatment. The treatment doesn't always have to be medication and I believe that therapy is much more beneficial, especially in the long term.
Please don't equate clinical depression with normal feelings of sadness.
But any discussion of depression that fails to deal with it as at least a half-dozen independent illnesses, each with its own biochemical basis, is intrinsically garbage, and any conclusions bankrupt.
This is why we keep seeing spurious reports that "antidepressants don't work". In every case, they take "depression" as a biochemically meaningful diagnosis of one illness, and run a RCT of medication X on a sample with illnesses A, B, C, D, E, and F. If X helps F but makes E worse, and has no effect on A-D, what will the "result" of the trial be? Garbage. "Gold-standard" garbage, if you like. GIGO.
People promoting garbage results should be ashamed. Fired, too. Incompetents in medical research make things worse for us all.
He told me it was guess work, we don’t know why the meds work, but often they do.
I was surprised.
Worth researching if one is in a similar situation.
But then there are aspects of life that we can change. Including how we think of ourselves For that, there's wisdom out there to help. Here's one kind. [https://wisdomquotes.com/zen-quotes/]
If fecal transplants, or some cheaper-to-prescribe version were made available, feels like that would go a long way to helping a certain portion of people who are depressed, anxious, and have weight or immune disorders etc.
I was never depressed and never really suicidal but I had suicidal thoughts and a lot of frustration.
When my social status rose they went away.
As a software developer I had a very low social status compared to say a lawyer.
I am now a CTO and have a high social status.
But I think software developer is generally a profession that comes with relatively low status for the education level, as compared to say doctor or lawyer.
I think it's also this relatively low status that got me frustrated, finishing my Uni best in class and then being at the mercy of pretty dumb project managers.
This is why I find it important to give my developers a high social status, expensive office, expensive clothes, an assistant, etc.
Though society these days tries to teach you status is not important, I believe you cannot escape the nature of the beast.
We need social status to be happy.