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Calling for a new approach to depression

170 points by MrBuddyCasino 9y ago

Y_Y 9y ago
Is everything you think you know about headlines wrong? Is depression caused primarily by clickbait?
foobarbecue 9y ago
tl;dr: Depression is just sadness resulting from modern society being kinda lame. (The article argues this point cogently, and I agree with it.)
Kluny 9y ago
Suggest alternate title: Many people are depressed because they lack control over their work.
- kiliantics 9y ago
  Yes the most important part in this article to me was how a group was able to alleviate the stress of their working lives by forming a co-operative together with no hierarchical power relationships, thus controlling their own workplace.
com2kid 9y ago
This explanation does not work for all types of depression. There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed. We need to be more careful in our language, the word depression has become overused, much like the drugs used to treat it.
- wu-ikkyu 9y ago
  >There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed. If someone truly feels and believes they have a "wonderful" life, it would seem they are not suffering from crippling depression. Though what I think you're trying to say is there are people who are depressed even though they seem to have all of their basic human needs being met.
  - xiphias 9y ago
    For most of us depression is something that just comes from different expectations from our life from what we have. For a long time I thought that this is depression until.I got to know a real person who has everything he wants to.have (he's very moderate person with moderate needs, a family supporting him), but he can't control his illness. When he gets depressed, he's not even mentally capable of doing very simple tasks.
  - whichdan 9y ago
    It's entirely possible for someone to suffer from depression despite knowing that they have a good life.
    - TheSpiceIsLife 9y ago
      The questions, then, are: Why? How can this be the case? What are we not taking in to consideration in order to properly treat, or at least understand the condition(s)? Maybe having all those things actually isn't what leads people to feel grateful for being alive.
    - juicyfroot 9y ago
      What's a good life? A lot of people would say that making 75k and healthy is a "good life". Yet we know that most of us are in dead end jobs and in a constant rat race. A lot of people,including researchers, have such low standards and they look at other people with those standards and think "but they have a good life!"
    - nixpulvis 9y ago
      Sure they have a good life when they try to enumerate the qualities of a good life, what they forget is that some "needs" may be unknown to them, though if they listen the needs aren't usually very quite.
      - com2kid 9y ago
        Or they have bi-polar disorder and are on a downswing. That alone will do it. Some forms of depression are medical, people need to be aware of this. Thinking that everyone can be cured by running off and finding one's true self is incredibly dangerous. For some people, that is the solution, but for others, running away from their support network is the exact wrong thing to do. All that said, soul crushing jobs are soul crushing. The modern world's insistence that we all have true purpose in life has not helped things any. A lot of people used to just be happy getting married, having kids, and seeing their kids do well. Now, we all want some sort of higher purpose (I'm guilty of this as well), which makes obtaining happiness really hard. For the longest time, success was "at least a few of your kids survived". Since then, standards have been raised to a point that only a fraction of the population can meet the current bar.
- nixpulvis 9y ago
  Seems to me this person has a secret issue you're not aware of then...
  - ravenstine 9y ago
    That's why I have doubts as to how often depression is actually caused by a medical condition. Judging by myself, I suspect that a lot of people, including people who are seemingly happy and successful, have hidden disappointments that even a psychologist can't pry out of them.
  - mabbo 9y ago
    You're missing the point, I think. What they are saying is that some depression is just purely a disease and not caused by events in life, or not caused by any psychological problem. If you disagree, that's fine, but it sounds to me like you're simply dismissing that idea. Consider it like this: most qualities in humans fall into some sort of normal distribution. Some 1% of the population are the 1% with the least natural serotonin production. Genetics play a large role in that. Could that cause of depression not exist?
    - nixpulvis 9y ago
      I don't think I'm missing the point. And I'm not saying people aren't effected by chemical levels and biological systems I don't fully understand... what I am saying is, anyone who tells you they have a wonderful life and then tells you they are depressed is leaving out something important. Now for the critique, the OP didn't really make it clear who's idea of a wonderful life it is. I also use the word secrect as a way to throw some shade, because the word secret implies the owners knowledge of the secret, which is not alway the case here, I should have just said "... has a secret."
      - newfoundglory 9y ago
        What you're saying is nonsense, and I know that for certain because I have been the person who had a wonderful life and was depressed, and I wasn't keeping anything from myself.
- mabbo 9y ago
  That's how I've often described it before. Feeling like shit when your life is terrible is normal. Feeling like shit when your life is awesome is not. The problem is that the pill often works regardless of why you feel like shit.
  - wu-ikkyu 9y ago
    >Feeling like shit when your life is terrible is normal. Feeling like shit when your life is awesome is not. Could it possibly be that our idea of an "awesome life" is mistaken?
    - nixpulvis 9y ago
      BOOM, exactly.
  - EdwardDiego 9y ago
    I was very depressed because life was shit, and the symptoms were preventing me from fixing the issues causing it. So I take antidepressants not to fix the issues, but to alleviate the symptoms so that I am able to take on the actual problems.
  - kps 9y ago
    > The problem is that the pill often works regardless of why you feel like shit. Why is that a problem, if you're not a Luddite or Puritan?
foobarbecue 9y ago
Why did my comment get flagged? I assume this was a mistake, so reposting: tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame. (The article argues this point cogently, and I agree with it.) [I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]
- deleted 9y ago
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- EGreg 9y ago
  I found, over the years of being on HN, that there's a sort of forceful response that always comes to these types of comments about depression, along with downvoting. The responses say basically, "Don't talk about what you don't know. Many people have real, chemical depression, and your comment that it's a product of life circumstances is not helpful". I was always a but puzzled about the regularity with which that above formula appeared on HN. Sure, many entrepreneurs and especially developers lead lonely, stressful lives. I am a developer and entrepreneur myself! But I also felt there is a sort of "groupthink" or "bullying" element to this, because there was hardly much substantive discussion about facts or statistics or science, in effect it was shaming the commenter into shutting up. This bothers me. I like to see real fact based discussion when there is disagreement. Not just downvoting and vague assertions. In this case I am sure you were downvoted by that exact same sentiment. Even if you had summarized the article, the content of the summary was enough to trigger the downvote.
  - foobarbecue 9y ago
    Oddly, it was upvoted twice /and/ flagged. I guess anyone with enough reputation can bury things just by hitting a "flag" button.
    - greenyoda 9y ago
      It could have been flagged multiple times (flags are additive). Even articles that have hundreds of upvotes can be killed by flagging if enough people flag them.
juicyfroot 9y ago
Quote from article: "Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”" This. I have been saying this on HN and other forums for years. Each time I get downvoted for how dare I suggest that it is other things in a person's life and that clinical "depression" is unscientific. Most people would rather play victim i think
wu-ikkyu 9y ago
It still seems many people believe there is strong scientific evidence to the "chemical imbalance" theory as an independent cause of depression, which is a myth. It is a paradoxical issue though, because chemicals can indeed play a crucial role to overcoming depression.
- nixpulvis 9y ago
  What even is a chemical anyway... honestly people throw this word around in these kinds of contexts with all kinds of meanings.
  - wu-ikkyu 9y ago
    Great question! Though it would seem we are delving into the realm of metaphysics, which is unfortunately taboo for modern psychiatry.
    - nixpulvis 9y ago
      I mean, are the electronic signals that constitute my nervous system a "chemical balance" (I could make that argument), well then SURE all depression is completely 100% chemical... But I digress.
- deleted 9y ago
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- empath75 9y ago
  ‘Chemical imbalance’ pure marketing from the drug companies. It’s sort of amazing how much money we’ve wasted trying to get people to quit heroin, meth and ecstasy on the one hand while selling them OxyContin Ritalin and Prozac on the other.
nixpulvis 9y ago
I've been depressed, and I'll tell you this straight up. If a doctor gave me a cow instead of the pills, I would have been way better off... ignoring all the actual problems the cow solved for the rice farmer in the article, just the honesty of the doctors recognizing the real issue in the right spirit would have made me laugh, and prolly "cure" me, at least for a little while.
- TheSpiceIsLife 9y ago
  Getting two (sibling, Border Collie x Foxhound) puppies, and taking a boatload of magnesium and Vitamin D, a fair bit of rock climbing, skiing, jogging, and weight training, seems to have alleviated me of all my anxiety and depression. I obtained a prescription for an SSRI from a doctor, sat in the car outside the pharmacy for an hour staring at the prescription, then drove home. No way, fuck that those drugs. I've already wasted the better part of 10 years of my life to meth-amphetamine. I'm gonna work this out without drugs.
  - rootw0rm 9y ago
    I can tell you from experience that you made the best decision of your life right there. I started down that road as an impressionable teenager, and it took me a decade to regain control over my life.
  - macawfish 9y ago
    YES to magnesium & vitamin D... they must be taken together and work wonders.
    - nasredin 9y ago
      I HATE people who put IANAL and other acronym disclaimers everywhere, but I just feel these type of posts can negatively influence people. I am glad magnesium and vitamin D worked for you, but some people may need prescription medications from a psychiatrist.
      - 9y ago
drumhead 9y ago
I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a rising journalistic star in the UK. He'd won awards was regularly on TV and radio, until it was discovered he had been plagiarising others for a lot of his articles. It was also found that he had been editing wikipedia articles to attack people who critisised him. An interestingly tragic character. https://en.wikipedia.org/wiki/Johann_Hari https://en.wikipedia.org/wiki/Johann_Hari
- wu-ikkyu 9y ago
  >I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. You might like to read up on the short history of modern psychiatry. You'll find a great deal of mistakes, pseudoscience, and human rights atrocities.
  - jdietrich 9y ago
    The same could be said of all of medicine, albeit over a longer timespan. Semmelweis was vilified for suggesting that doctors should wash their hands. Chemie Grünenthal covered up the devastating effects of thalidomide. American manufacturers spent much of the 1980s selling HIV-contaminated blood products to the rest of the world. Less than 20 years ago, rofecoxib (Vioxx) killed about 100,000 people. A lot of surgeries that are routinely performed today are completely unsupported by clinical evidence. It's largely a good thing that recent history looks hopelessly primitive and barbaric to us, because it means that we're making progress. Psychiatry still has a long way to come, but we need to be careful to not throw the baby out with the bathwater. Access to psychiatric care has a hugely positive impact on the overall disease burden; mediocre treatment is better than no treatment at all. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
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blhack 9y ago
There are two things that both get called "depression". Like so many other confusing things, this all is the result of fuzzy language. There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables. There is also depression: the neurochemcial/neurophysiological disorder that has depression (sadness) as one of its symptoms. It can be treated with various (miracle) drugs. -- People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates. Required viewing: a lecture on this topic by somebody who knows more about it that anybody else who is currently alive: https://youtu.be/NOAgplgTxfc https://youtu.be/NOAgplgTxfc
- deleted 9y ago
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- tcj_phx 9y ago
  > People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, The modern miracle drugs that effectively treat and cure debilitating depression are not SSRI's. Whatever benefits SSRIs have are probably a result of their influence on neurosteroids: >> Certain antidepressant drugs such as fluoxetine and fluvoxamine, which are generally thought to affect depression by acting as selective serotonin reuptake inhibitors (SSRIs), have also been found to normalize the levels of certain neurosteroids (which are frequently deficient in depressed patients) at doses that are inactive in affecting the reuptake of serotonin. This suggests that other actions involving neurosteroids may also be at play in the effectiveness of these drugs against depression [0] [0] https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepressant_action https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepre... Other miracle drugs are also helpful for addressing the cause. Big Pharma doesn't care about cause/effect, they just want patients on maintenance treatments. Depressed people usually have some sort of metabolic problem, caused by thyroid problems, inadequate diet, etc. Emotional stress is usually a major factor too. > belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates. Where do you belong? Are you a tireless advocate for the status quo?
justasitsounds 9y ago
There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that wears off over time - as your body adapts to the induced serotonin imbalance. The only answer from the medical profession? Increase the dose. I saw this with my own mother. She went from being a mildly depressed retired housewife to suicidal within the space of 12 months. She started on low-dose SSRIs which seemed to work for a while before she regressed. Each time she started to feel depressed again she would be prescribed with an increased dosage. This pattern repeated until she was taking the maximum 'allowed' dosage, by this point she was delusional, paranoid and suffered terrifying, persecution-style hallucinations - perhaps not surprising seeing how much her brain chemistry must have been out of whack. Sadly, I'm making these observations with hindsight, she took her own life in 2015. I wish I could share this article with my dad, if I knew it wouldn't break his heart. Both she and my father couldn't share with their children how gravely ill she was until it was too late. They both trusted their doctors implicitly. What they weren't prepared for was the fact that the theory that formed the basis of her treatment was, it seems, no more than guesswork supported only by publication bias, wishful thinking and greed. Ironically, one of my first web development jobs, way back in 2000, was at a 'medical communications company' where I created an intranet site for GSK (IIRC) for use by their salespeople to shore up the claims of the effectiveness of Seroxat/Paxil and counter negative studies. So, I guess that makes me complicit in all this too.
- dsego 9y ago
  Almost all antidepressants list the increase of suicide risk as a side effect, which is frightening. Zoloft for example [1]: > An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. [1]https://www.drugs.com/sfx/zoloft-side-effects.html https://www.drugs.com/sfx/zoloft-side-effects.html On a personal note, I am very sorry for your loss.
seibelj 9y ago
Years of strict exercise, diet, meditation, breathing techniques, various forms of therapy, and numerous self-help books did not cure my anxiety and depression. 2 weeks after starting a low-dose (10mg / day) of Lexapro made me feel better than I had in 10 years. Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is solved to this day with Lexapro. I consider it a drug that saved my life.
- cpncrunch 9y ago
  >My life was ostensibly fine But you said in a previous comment "I was working 35 hours a week at a startup and studying two difficult subjects at my university (computer science and Latin) while maintaining an active social life. I kept pushing myself harder and harder, and essentially collapsed". I think most people would burn out with that amount of stress.
  - seibelj 9y ago
    I was paraphrasing a period of my life. I didn't go on Lexapro for 2 years following that. Before Lexapro I was doing all of the non-medical stuff I mentioned. No need to tell me that what I experienced is false - it's my own life, afterall.
    - cpncrunch 9y ago
      I wasn't telling you anything you experienced was false. I was simply pointing out that the stressful period you mentioned would definitely be a factor causing depression. Even if you are doing exactly what you want to do with your life and you're happy with it, excessive stress will still cause depression. I've edited my original comment slightly.
- dsego 9y ago
  Glad it works for you. I took a small does for one week. First two days was great, everything had an aura about it. Also, I felt very warm all the time. After 3-4 days I lost erections and then just threw them into the trash bin. Didn't want to risk it. I have a family member who needs viagra because antidepressants messed up his nerves. Psyhcs will tell you it's temporary, well, not always, but they won't admit it.
thaw9876 9y ago
> We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most... This (emphasized) is what I think is causing my increasing anxiety and depression. I look around at people, talking loudly, showing off, taking selfies, buying expensive crap they don't need from expensive shops, etc. I try to puzzle out why they're so happy, they all seem so superficial, and I can't understand why they don't feel miserable about the people less fortunate than them who live right next door, the people serving them, who are all struggling to just get by and by all measures increasingly failing. I really want to live in a more equal society that takes care of all citizens.
- flowless 9y ago
  Same here. One of the most disturbing scenes I'm witnessing like every night is couple of homeless people sleeping in front of the church while each morning there are these noble ignorants walking around them who even call them selves Christians.. Anxiety is just another term for caring too much in some cases (This was mentioned here on HN last time I was reading similar discussion).
  - nasredin 9y ago
    Disagree. I think you are descibing empathy and selfishness, not anxiety. Anxiety and empathy are probably somehow connected, but they are different things.
ianamartin 9y ago
The part about funding studies and throwing away the ones that don't say what they want about a drug is worse than described because a lot of the funding goes to graduate programs where the students have no choice but to find results favorable to the drug. I have an ex-girlfriend that went into the PhD program for Neuroscience at a reputable university. Her entire degree and living stipend was paid for by a pharmaceutical company. The company "suggested" that her PhD research revolve around a drug that lowered aggressive tendencies. The sloppiness of the study appalled me. I couldn't say that much because she and I were dating at the time, but it was absurd. There was no funding for getting a reasonable sample of people. So they went to a halfway house and brought in 30 males and 30 females. All criminals, all on probation or parole, all with serious histories of substance abuse, and most of the women were pregnant. Almost all of the males dropped out for one reason or another. Many of the women did as well. I believe the final tally was 3 males and 13 women. All of whom tested positive for some assortment of drugs. The sample size is obviously problematic here. What was possibly even worse was when I would go to the lab and watch this person sift through ECGs. The test itself that defined aggressiveness was totally ill-defined, and the neural response to the test was basically, "Well, let's just take a look at it. Okay, this one looks aggressive. That one doesn't." It was a total shitshow. The end result? A published paper in a prestigious journal about how this drug reduces aggressiveness, a PhD, and FDA approval for the drug. I hate to identify with conspiracy theorists, and all that. But I literally watched this process happen with a person I was dating for almost all of it. When it comes to drugs, you really have to do your own research. Your doctor isn't going to do it for you. That's the double burn of healthcare in the U.S. Even when you have it, you can't really trust it. You have to pay for it, you have to know what's wrong with you, and you have to know what you need. And if it isn't a drug, then fuck off. You have to pay for it anyway. People say, "Fuck you, that's one story that probably went badly. Science is self-sufficient and self-correcting. The plural of anecdote is not data." Fair enough on all points. But there is a systematic and broken way of doing science in the medical industry. And doctors are not scientists and don't really get trained to know the difference between good and bad science.
- newfoundglory 9y ago
  I don't know if you're aware of this, but drugs don't get FDA approval based on any single study, let alone the one you described.
deleted 9y ago
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marian_ge 9y ago
Dismissing the scientific trials as flawed by cherry picking and then choosing an anecdotal cow to make a point seems ironic to me. The only thing I can get from this is that we may not have the whole picture regarding depression and focusing only on medication is the wrong thing. But as far as I know from people battling with this is that even in my country the doctors strongly recommend lifestyle changes and hours of therapy with a psychologist for long term success
- SubiculumCode 9y ago
  Thanks for writing this. Saved me some time, and you did it better.
- Sean1708 9y ago
  Yeah the author said something along the lines of > beyond only the packs of pills we have been offered as often the sole item on the menu for the depressed and anxious several times in that article, and it just doesn't ring true for me. Maybe the author is specifically talking about American psychiatry or maybe the people I know were just lucky, but all the people I know that have been to their GP about depression or anxiety (granted not a huge sample size) were offered CBT first and foremost and only one of them was prescribed medication at all in the end.
pmoriarty 9y ago
"And that’s when, after two more years studying civil servants, he discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed." I wonder how this research squares up with the so-called Executive Monkey experiment, which found that it was actually the monkey with more control that had more stress.[1] [1] - https://en.wikipedia.org/wiki/Ulcers_in_Executive_Monkeys https://en.wikipedia.org/wiki/Ulcers_in_Executive_Monkeys
- nasredin 9y ago
  I love reading about experiments performed in the 50s and 60s before all those pesky Ethical Review Boards(?) >In an early version of the study, Brady placed monkeys in 'restraining chairs' and conditioned them to press a lever.[2] They were given electric shocks every 20 seconds unless they pressed the lever during the same time period. This study came to an abrupt halt when many of the monkeys died from perforated ulcers.
dboreham 9y ago
I'm surprised to see this as "new" because there has been work published since the late 60's [1] and widely known since the early 90's [2] showing that depression is often no more and no less than "having depressing thoughts". That is, if you can persuade the person to believe that they don't have a good reason to be depressed, they stop showing signs of depression. [1] https://en.wikipedia.org/wiki/Martin_Seligman https://en.wikipedia.org/wiki/Martin_Seligman [2] https://books.google.com/books?id=qreACUdDAc0C https://books.google.com/books?id=qreACUdDAc0C
- taneq 9y ago
  I thought that, if you're actually depressed, it kind of implies you don't have "good reason" to be? I mean, if you're feeling terrible because bad things are happening to you, you're not depressed, you're just legitimately miserable.
  - newfoundglory 9y ago
    I believe it’s called endogenous v exogenous depression. Someone who is considering suicide because they failed an exam is not very well described as “just miserable", even though there's an exterior trigger for their feelings.
aaavl2821 9y ago
One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another important problem with mental healthcare in the US: shortage of mental health providers Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $y for a 90, etc. Reimbursement for "medication management", i.e. prescribing drugs, is not based on time, but generally is a fixed amount. So the more prescriptions you write, the more money you make. Psychiatrists therefore focus on meds rather than therapy, as the reimbursement rates for therapy can't support a practice. Many psychiatrists don't take insurance at all bc they don't want to be "medication mills", so they charge $200-600+ per hour for therapy and only rich clients can pay. Psychologists and other licensed therapists can't prescribe meds, so they do therapy, but often make less than $60-70k a year. People don't want to go into psychology / psychiatry because of the stress of dealing with suffering people without having the tools to help them, and then getting paid relatively little (compared to other health care professionals) This results in much of depression and other mental health being treated in primary care. PCPs aren't trained that well in treating mental health beyond what pharma sales reps tell them, so they wrote an rx and call it a day. 70% of patients don't respond to the first trial of antidepressants, but PCPs don't really know how to handle this
- gcb0 9y ago
  thank you for finally making clear the evil incentives behind US psychiatrist being less than drug peddlers. always wondered how the drug industry managed to coerce a whole professional group into being so malignous to society.
- refurb 9y ago
  Doctors don't make any money from writing a script (beyond the payment for the consultation). In fact, the would make more money if they used counseling rather an a drug.
  - nasredin 9y ago
    IIRC there is an issue here. Former doctors who now work for pharma companies and take their peers to dinners and push the new (patented) drugs. Doctors then prescribe these new drugs perhaps needlessly (Vioxx?) or over generic ones. Also in my experience counseling is only affordable to the wealthy or people in the criminal justice system (where it is already too late IMHO).
milankragujevic 9y ago
I am disenhearted by the apparent pseudo-scientific thinking in the comments on this article, and how it'll "be better if you just go workout and eat better", which might work for some people, but not for everyone. If there was a scientific study about changing life habits to stop depression, I'd bet that it would have the same amount of effectiveness or even less than SSRIs. I myself have been "miraculously" cured from depression by the most ridiculed profession in modern medicine, psychiatry, and with "poison" that was supposed to ruin my life and make me kill myself. Basically, aripiprazole and fluoxetine helped me, and help me live life, work and be happy. There was nothing wrong with my life until one day I tried to kill myself, and I was very resistant to treatment because of years of people's anecdotes how psychiatrists were crazy, were "out to get them" and "chemically lobotomize" them. This is bullshit, and we all know it, during my stay in a hospital I have seen many cases of teenagers who were "beyond repair" get "fixed" with medications, and would you look at that, 3-4 years on, they haven't regressed (I kept in contact). Neither have I. It's dangerous to spread conspiracy theories to impressionable and vulnerable minds, and you should think twice before dismissing the whole modern science of psychiatry, just because you fell that hippie life and smoking pot is the way to fix anyone's life. I don't care about the downvotes, but had to get this off my chest.
- stephengillie 9y ago
  Being rich won't solve all of your problems. But wealth/funding does solve some problems, and reduces most of the rest by orders of magnitude. In the same way, being in good physical shape, eating healthful foods, sleeping well every night, and not being stressed won't solve every medical problem. But a dependable and healthy body does solve some problems directly, and reduces most of the rest by orders of magnitude.
  - nasredin 9y ago
    I would say wealth not only reduces but eliminates a lot of the problems for an average person. Every week there's a study that being poor causes a lot of damage to your body (on the DNA level IIRC).
- zbobet2012 9y ago
JDiculous 9y ago
> 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it. In my opinion this should be a national emergency on par with something like the opioid crisis (a symptom of this). We're a nation of depressed, drugged up zombies sleepwalking to our unfulfilling office jobs everyday to pay off our student loan / mortgage debt (yes I know not everyone is in that situation, but even if only 10% are that's 30 million people).
solarkraft 9y ago
Thanks for changing the senseless title in the submission.
ascorbic 9y ago
Quite apart from the generally pseudo-scientific content, there is a big part of missing context in this: the author's background. Johann Hari was first found to have plagiarised large amounts of his published work over many years, and then to have used sockpuppet accounts to make negative (and libellous) edits to the Wikipedia pages of his critics. This is his first major publication since his disgrace. Is it really that surprising that somebody whose career was left in ruins is likely to identify hating ones job as a cause of depression?
zaptheimpaler 9y ago
I totally agree with this, and I will repeat a somewhat controversial view I hold: Governments & business owners directly gain power & influence in the world via their citizens/workers productivity. The western attitude to "mental illness" is shaped VERY strongly by this - when you get "depressed" working an overly stressful job with no hope of anything better, it is better to convince the poor sap that its a problem with THEM rather than a problem with the world. Then give you some pills to make it better. This dysfunctional culture will swallow up all your time, force you to work on things you fundamentally don't believe in, leave you isolated from people and then tell you its your fault for being depressed. We need to make the world stop dehumanizing us. Monkeys in cages get depressed. When 5% of people are depressed, maybe its fair to say they should seek treatment on their own. When 30%, 40%, 50% of people are depressed.... its time to adapt the world to fit peoples well-being instead of the other way around..
qwerty456127 9y ago
Nevertheless, all the major emotions/moods one can feel: sadness, joy, laziness, vigour, fear, enthusiasm, anger, limerence etc are almost nothing but chemical conditions. If you feel panic or are angry at somebody - that doesn't necessarily mean you are in danger or that somebody is an asshole - that means you have elevated level of norepinephrine and/or low serotonin and/or something like that. Feeling lazy doesn't mean you have fallen to the sin of sloth but that you have low levels of thyroxine and/or dopamine and/or norepinephrine and/or serotonin and/or something else. That's a huge problem the majority of people don't understand this, just keeping this in mind makes the life a lot easier for you, your family and everybody around. Also it usually is enough to take something as natural, cheap and harmless as L-tryptophan (an essential amino-acid, the precursor to 5-HTP and serotonin, easily available as an over-the-counter supplement and found in many foods naturally) to fix the problem, SSRIs and benzodiazepines are not necessary in every case.

170 points by MrBuddyCasino 9y ago

Y_Y 9y ago

Is everything you think you know about headlines wrong? Is depression caused primarily by clickbait?

tl;dr: Depression is just sadness resulting from modern society being kinda lame. (The article argues this point cogently, and I agree with it.)

Kluny 9y ago

Suggest alternate title: Many people are depressed because they lack control over their work.

kiliantics 9y ago
Yes the most important part in this article to me was how a group was able to alleviate the stress of their working lives by forming a co-operative together with no hierarchical power relationships, thus controlling their own workplace.

com2kid 9y ago

This explanation does not work for all types of depression. There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed. We need to be more careful in our language, the word depression has become overused, much like the drugs used to treat it.

wu-ikkyu 9y ago
>There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed. If someone truly feels and believes they have a "wonderful" life, it would seem they are not suffering from crippling depression. Though what I think you're trying to say is there are people who are depressed even though they seem to have all of their basic human needs being met.
- xiphias 9y ago
  For most of us depression is something that just comes from different expectations from our life from what we have. For a long time I thought that this is depression until.I got to know a real person who has everything he wants to.have (he's very moderate person with moderate needs, a family supporting him), but he can't control his illness. When he gets depressed, he's not even mentally capable of doing very simple tasks.
- whichdan 9y ago
  It's entirely possible for someone to suffer from depression despite knowing that they have a good life.
  - TheSpiceIsLife 9y ago
    The questions, then, are: Why? How can this be the case? What are we not taking in to consideration in order to properly treat, or at least understand the condition(s)? Maybe having all those things actually isn't what leads people to feel grateful for being alive.
  - juicyfroot 9y ago
    What's a good life? A lot of people would say that making 75k and healthy is a "good life". Yet we know that most of us are in dead end jobs and in a constant rat race. A lot of people,including researchers, have such low standards and they look at other people with those standards and think "but they have a good life!"
  - nixpulvis 9y ago
    Sure they have a good life when they try to enumerate the qualities of a good life, what they forget is that some "needs" may be unknown to them, though if they listen the needs aren't usually very quite.
    - com2kid 9y ago
      Or they have bi-polar disorder and are on a downswing. That alone will do it. Some forms of depression are medical, people need to be aware of this. Thinking that everyone can be cured by running off and finding one's true self is incredibly dangerous. For some people, that is the solution, but for others, running away from their support network is the exact wrong thing to do. All that said, soul crushing jobs are soul crushing. The modern world's insistence that we all have true purpose in life has not helped things any. A lot of people used to just be happy getting married, having kids, and seeing their kids do well. Now, we all want some sort of higher purpose (I'm guilty of this as well), which makes obtaining happiness really hard. For the longest time, success was "at least a few of your kids survived". Since then, standards have been raised to a point that only a fraction of the population can meet the current bar.
nixpulvis 9y ago
Seems to me this person has a secret issue you're not aware of then...
- ravenstine 9y ago
  That's why I have doubts as to how often depression is actually caused by a medical condition. Judging by myself, I suspect that a lot of people, including people who are seemingly happy and successful, have hidden disappointments that even a psychologist can't pry out of them.
- mabbo 9y ago
  You're missing the point, I think. What they are saying is that some depression is just purely a disease and not caused by events in life, or not caused by any psychological problem. If you disagree, that's fine, but it sounds to me like you're simply dismissing that idea. Consider it like this: most qualities in humans fall into some sort of normal distribution. Some 1% of the population are the 1% with the least natural serotonin production. Genetics play a large role in that. Could that cause of depression not exist?
  - nixpulvis 9y ago
    I don't think I'm missing the point. And I'm not saying people aren't effected by chemical levels and biological systems I don't fully understand... what I am saying is, anyone who tells you they have a wonderful life and then tells you they are depressed is leaving out something important. Now for the critique, the OP didn't really make it clear who's idea of a wonderful life it is. I also use the word secrect as a way to throw some shade, because the word secret implies the owners knowledge of the secret, which is not alway the case here, I should have just said "... has a secret."
    - newfoundglory 9y ago
      What you're saying is nonsense, and I know that for certain because I have been the person who had a wonderful life and was depressed, and I wasn't keeping anything from myself.
mabbo 9y ago
That's how I've often described it before. Feeling like shit when your life is terrible is normal. Feeling like shit when your life is awesome is not. The problem is that the pill often works regardless of why you feel like shit.
- wu-ikkyu 9y ago
  >Feeling like shit when your life is terrible is normal. Feeling like shit when your life is awesome is not. Could it possibly be that our idea of an "awesome life" is mistaken?
  - nixpulvis 9y ago
    BOOM, exactly.
- EdwardDiego 9y ago
  I was very depressed because life was shit, and the symptoms were preventing me from fixing the issues causing it. So I take antidepressants not to fix the issues, but to alleviate the symptoms so that I am able to take on the actual problems.
- kps 9y ago
  > The problem is that the pill often works regardless of why you feel like shit. Why is that a problem, if you're not a Luddite or Puritan?

foobarbecue 9y ago

Why did my comment get flagged? I assume this was a mistake, so reposting: tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame. (The article argues this point cogently, and I agree with it.) [I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]

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EGreg 9y ago
I found, over the years of being on HN, that there's a sort of forceful response that always comes to these types of comments about depression, along with downvoting. The responses say basically, "Don't talk about what you don't know. Many people have real, chemical depression, and your comment that it's a product of life circumstances is not helpful". I was always a but puzzled about the regularity with which that above formula appeared on HN. Sure, many entrepreneurs and especially developers lead lonely, stressful lives. I am a developer and entrepreneur myself! But I also felt there is a sort of "groupthink" or "bullying" element to this, because there was hardly much substantive discussion about facts or statistics or science, in effect it was shaming the commenter into shutting up. This bothers me. I like to see real fact based discussion when there is disagreement. Not just downvoting and vague assertions. In this case I am sure you were downvoted by that exact same sentiment. Even if you had summarized the article, the content of the summary was enough to trigger the downvote.
- foobarbecue 9y ago
  Oddly, it was upvoted twice /and/ flagged. I guess anyone with enough reputation can bury things just by hitting a "flag" button.
  - greenyoda 9y ago
    It could have been flagged multiple times (flags are additive). Even articles that have hundreds of upvotes can be killed by flagging if enough people flag them.

juicyfroot 9y ago

Quote from article: "Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”" This. I have been saying this on HN and other forums for years. Each time I get downvoted for how dare I suggest that it is other things in a person's life and that clinical "depression" is unscientific. Most people would rather play victim i think

wu-ikkyu 9y ago

It still seems many people believe there is strong scientific evidence to the "chemical imbalance" theory as an independent cause of depression, which is a myth. It is a paradoxical issue though, because chemicals can indeed play a crucial role to overcoming depression.

nixpulvis 9y ago
What even is a chemical anyway... honestly people throw this word around in these kinds of contexts with all kinds of meanings.
- wu-ikkyu 9y ago
  Great question! Though it would seem we are delving into the realm of metaphysics, which is unfortunately taboo for modern psychiatry.
  - nixpulvis 9y ago
    I mean, are the electronic signals that constitute my nervous system a "chemical balance" (I could make that argument), well then SURE all depression is completely 100% chemical... But I digress.
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empath75 9y ago
‘Chemical imbalance’ pure marketing from the drug companies. It’s sort of amazing how much money we’ve wasted trying to get people to quit heroin, meth and ecstasy on the one hand while selling them OxyContin Ritalin and Prozac on the other.

nixpulvis 9y ago

I've been depressed, and I'll tell you this straight up. If a doctor gave me a cow instead of the pills, I would have been way better off... ignoring all the actual problems the cow solved for the rice farmer in the article, just the honesty of the doctors recognizing the real issue in the right spirit would have made me laugh, and prolly "cure" me, at least for a little while.

TheSpiceIsLife 9y ago
Getting two (sibling, Border Collie x Foxhound) puppies, and taking a boatload of magnesium and Vitamin D, a fair bit of rock climbing, skiing, jogging, and weight training, seems to have alleviated me of all my anxiety and depression. I obtained a prescription for an SSRI from a doctor, sat in the car outside the pharmacy for an hour staring at the prescription, then drove home. No way, fuck that those drugs. I've already wasted the better part of 10 years of my life to meth-amphetamine. I'm gonna work this out without drugs.
- rootw0rm 9y ago
  I can tell you from experience that you made the best decision of your life right there. I started down that road as an impressionable teenager, and it took me a decade to regain control over my life.
- macawfish 9y ago
  YES to magnesium & vitamin D... they must be taken together and work wonders.
  - nasredin 9y ago
    I HATE people who put IANAL and other acronym disclaimers everywhere, but I just feel these type of posts can negatively influence people. I am glad magnesium and vitamin D worked for you, but some people may need prescription medications from a psychiatrist.
    - 9y ago

drumhead 9y ago

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a rising journalistic star in the UK. He'd won awards was regularly on TV and radio, until it was discovered he had been plagiarising others for a lot of his articles. It was also found that he had been editing wikipedia articles to attack people who critisised him. An interestingly tragic character. https://en.wikipedia.org/wiki/Johann_Hari https://en.wikipedia.org/wiki/Johann_Hari

wu-ikkyu 9y ago
>I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. You might like to read up on the short history of modern psychiatry. You'll find a great deal of mistakes, pseudoscience, and human rights atrocities.
- jdietrich 9y ago
  The same could be said of all of medicine, albeit over a longer timespan. Semmelweis was vilified for suggesting that doctors should wash their hands. Chemie Grünenthal covered up the devastating effects of thalidomide. American manufacturers spent much of the 1980s selling HIV-contaminated blood products to the rest of the world. Less than 20 years ago, rofecoxib (Vioxx) killed about 100,000 people. A lot of surgeries that are routinely performed today are completely unsupported by clinical evidence. It's largely a good thing that recent history looks hopelessly primitive and barbaric to us, because it means that we're making progress. Psychiatry still has a long way to come, but we need to be careful to not throw the baby out with the bathwater. Access to psychiatric care has a hugely positive impact on the overall disease burden; mediocre treatment is better than no treatment at all. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/fulltext http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
- 9y ago

blhack 9y ago

There are two things that both get called "depression". Like so many other confusing things, this all is the result of fuzzy language. There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables. There is also depression: the neurochemcial/neurophysiological disorder that has depression (sadness) as one of its symptoms. It can be treated with various (miracle) drugs. -- People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates. Required viewing: a lecture on this topic by somebody who knows more about it that anybody else who is currently alive: https://youtu.be/NOAgplgTxfc https://youtu.be/NOAgplgTxfc

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tcj_phx 9y ago
> People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, The modern miracle drugs that effectively treat and cure debilitating depression are not SSRI's. Whatever benefits SSRIs have are probably a result of their influence on neurosteroids: >> Certain antidepressant drugs such as fluoxetine and fluvoxamine, which are generally thought to affect depression by acting as selective serotonin reuptake inhibitors (SSRIs), have also been found to normalize the levels of certain neurosteroids (which are frequently deficient in depressed patients) at doses that are inactive in affecting the reuptake of serotonin. This suggests that other actions involving neurosteroids may also be at play in the effectiveness of these drugs against depression [0] [0] https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepressant_action https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepre... Other miracle drugs are also helpful for addressing the cause. Big Pharma doesn't care about cause/effect, they just want patients on maintenance treatments. Depressed people usually have some sort of metabolic problem, caused by thyroid problems, inadequate diet, etc. Emotional stress is usually a major factor too. > belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates. Where do you belong? Are you a tireless advocate for the status quo?

justasitsounds 9y ago

There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that wears off over time - as your body adapts to the induced serotonin imbalance. The only answer from the medical profession? Increase the dose. I saw this with my own mother. She went from being a mildly depressed retired housewife to suicidal within the space of 12 months. She started on low-dose SSRIs which seemed to work for a while before she regressed. Each time she started to feel depressed again she would be prescribed with an increased dosage. This pattern repeated until she was taking the maximum 'allowed' dosage, by this point she was delusional, paranoid and suffered terrifying, persecution-style hallucinations - perhaps not surprising seeing how much her brain chemistry must have been out of whack. Sadly, I'm making these observations with hindsight, she took her own life in 2015. I wish I could share this article with my dad, if I knew it wouldn't break his heart. Both she and my father couldn't share with their children how gravely ill she was until it was too late. They both trusted their doctors implicitly. What they weren't prepared for was the fact that the theory that formed the basis of her treatment was, it seems, no more than guesswork supported only by publication bias, wishful thinking and greed. Ironically, one of my first web development jobs, way back in 2000, was at a 'medical communications company' where I created an intranet site for GSK (IIRC) for use by their salespeople to shore up the claims of the effectiveness of Seroxat/Paxil and counter negative studies. So, I guess that makes me complicit in all this too.

dsego 9y ago
Almost all antidepressants list the increase of suicide risk as a side effect, which is frightening. Zoloft for example [1]: > An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. [1]https://www.drugs.com/sfx/zoloft-side-effects.html https://www.drugs.com/sfx/zoloft-side-effects.html On a personal note, I am very sorry for your loss.

seibelj 9y ago

Years of strict exercise, diet, meditation, breathing techniques, various forms of therapy, and numerous self-help books did not cure my anxiety and depression. 2 weeks after starting a low-dose (10mg / day) of Lexapro made me feel better than I had in 10 years. Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is solved to this day with Lexapro. I consider it a drug that saved my life.

cpncrunch 9y ago
>My life was ostensibly fine But you said in a previous comment "I was working 35 hours a week at a startup and studying two difficult subjects at my university (computer science and Latin) while maintaining an active social life. I kept pushing myself harder and harder, and essentially collapsed". I think most people would burn out with that amount of stress.
- seibelj 9y ago
  I was paraphrasing a period of my life. I didn't go on Lexapro for 2 years following that. Before Lexapro I was doing all of the non-medical stuff I mentioned. No need to tell me that what I experienced is false - it's my own life, afterall.
  - cpncrunch 9y ago
    I wasn't telling you anything you experienced was false. I was simply pointing out that the stressful period you mentioned would definitely be a factor causing depression. Even if you are doing exactly what you want to do with your life and you're happy with it, excessive stress will still cause depression. I've edited my original comment slightly.
dsego 9y ago
Glad it works for you. I took a small does for one week. First two days was great, everything had an aura about it. Also, I felt very warm all the time. After 3-4 days I lost erections and then just threw them into the trash bin. Didn't want to risk it. I have a family member who needs viagra because antidepressants messed up his nerves. Psyhcs will tell you it's temporary, well, not always, but they won't admit it.

thaw9876 9y ago

> We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most... This (emphasized) is what I think is causing my increasing anxiety and depression. I look around at people, talking loudly, showing off, taking selfies, buying expensive crap they don't need from expensive shops, etc. I try to puzzle out why they're so happy, they all seem so superficial, and I can't understand why they don't feel miserable about the people less fortunate than them who live right next door, the people serving them, who are all struggling to just get by and by all measures increasingly failing. I really want to live in a more equal society that takes care of all citizens.

flowless 9y ago
Same here. One of the most disturbing scenes I'm witnessing like every night is couple of homeless people sleeping in front of the church while each morning there are these noble ignorants walking around them who even call them selves Christians.. Anxiety is just another term for caring too much in some cases (This was mentioned here on HN last time I was reading similar discussion).
- nasredin 9y ago
  Disagree. I think you are descibing empathy and selfishness, not anxiety. Anxiety and empathy are probably somehow connected, but they are different things.

ianamartin 9y ago

The part about funding studies and throwing away the ones that don't say what they want about a drug is worse than described because a lot of the funding goes to graduate programs where the students have no choice but to find results favorable to the drug. I have an ex-girlfriend that went into the PhD program for Neuroscience at a reputable university. Her entire degree and living stipend was paid for by a pharmaceutical company. The company "suggested" that her PhD research revolve around a drug that lowered aggressive tendencies. The sloppiness of the study appalled me. I couldn't say that much because she and I were dating at the time, but it was absurd. There was no funding for getting a reasonable sample of people. So they went to a halfway house and brought in 30 males and 30 females. All criminals, all on probation or parole, all with serious histories of substance abuse, and most of the women were pregnant. Almost all of the males dropped out for one reason or another. Many of the women did as well. I believe the final tally was 3 males and 13 women. All of whom tested positive for some assortment of drugs. The sample size is obviously problematic here. What was possibly even worse was when I would go to the lab and watch this person sift through ECGs. The test itself that defined aggressiveness was totally ill-defined, and the neural response to the test was basically, "Well, let's just take a look at it. Okay, this one looks aggressive. That one doesn't." It was a total shitshow. The end result? A published paper in a prestigious journal about how this drug reduces aggressiveness, a PhD, and FDA approval for the drug. I hate to identify with conspiracy theorists, and all that. But I literally watched this process happen with a person I was dating for almost all of it. When it comes to drugs, you really have to do your own research. Your doctor isn't going to do it for you. That's the double burn of healthcare in the U.S. Even when you have it, you can't really trust it. You have to pay for it, you have to know what's wrong with you, and you have to know what you need. And if it isn't a drug, then fuck off. You have to pay for it anyway. People say, "Fuck you, that's one story that probably went badly. Science is self-sufficient and self-correcting. The plural of anecdote is not data." Fair enough on all points. But there is a systematic and broken way of doing science in the medical industry. And doctors are not scientists and don't really get trained to know the difference between good and bad science.

newfoundglory 9y ago
I don't know if you're aware of this, but drugs don't get FDA approval based on any single study, let alone the one you described.

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marian_ge 9y ago

Dismissing the scientific trials as flawed by cherry picking and then choosing an anecdotal cow to make a point seems ironic to me. The only thing I can get from this is that we may not have the whole picture regarding depression and focusing only on medication is the wrong thing. But as far as I know from people battling with this is that even in my country the doctors strongly recommend lifestyle changes and hours of therapy with a psychologist for long term success

SubiculumCode 9y ago
Thanks for writing this. Saved me some time, and you did it better.
Sean1708 9y ago
Yeah the author said something along the lines of > beyond only the packs of pills we have been offered as often the sole item on the menu for the depressed and anxious several times in that article, and it just doesn't ring true for me. Maybe the author is specifically talking about American psychiatry or maybe the people I know were just lucky, but all the people I know that have been to their GP about depression or anxiety (granted not a huge sample size) were offered CBT first and foremost and only one of them was prescribed medication at all in the end.

pmoriarty 9y ago

"And that’s when, after two more years studying civil servants, he discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed." I wonder how this research squares up with the so-called Executive Monkey experiment, which found that it was actually the monkey with more control that had more stress.[1] [1] - https://en.wikipedia.org/wiki/Ulcers_in_Executive_Monkeys https://en.wikipedia.org/wiki/Ulcers_in_Executive_Monkeys

nasredin 9y ago
I love reading about experiments performed in the 50s and 60s before all those pesky Ethical Review Boards(?) >In an early version of the study, Brady placed monkeys in 'restraining chairs' and conditioned them to press a lever.[2] They were given electric shocks every 20 seconds unless they pressed the lever during the same time period. This study came to an abrupt halt when many of the monkeys died from perforated ulcers.

dboreham 9y ago

I'm surprised to see this as "new" because there has been work published since the late 60's [1] and widely known since the early 90's [2] showing that depression is often no more and no less than "having depressing thoughts". That is, if you can persuade the person to believe that they don't have a good reason to be depressed, they stop showing signs of depression. [1] https://en.wikipedia.org/wiki/Martin_Seligman https://en.wikipedia.org/wiki/Martin_Seligman [2] https://books.google.com/books?id=qreACUdDAc0C https://books.google.com/books?id=qreACUdDAc0C

taneq 9y ago
I thought that, if you're actually depressed, it kind of implies you don't have "good reason" to be? I mean, if you're feeling terrible because bad things are happening to you, you're not depressed, you're just legitimately miserable.
- newfoundglory 9y ago
  I believe it’s called endogenous v exogenous depression. Someone who is considering suicide because they failed an exam is not very well described as “just miserable", even though there's an exterior trigger for their feelings.

aaavl2821 9y ago

One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another important problem with mental healthcare in the US: shortage of mental health providers Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $y for a 90, etc. Reimbursement for "medication management", i.e. prescribing drugs, is not based on time, but generally is a fixed amount. So the more prescriptions you write, the more money you make. Psychiatrists therefore focus on meds rather than therapy, as the reimbursement rates for therapy can't support a practice. Many psychiatrists don't take insurance at all bc they don't want to be "medication mills", so they charge $200-600+ per hour for therapy and only rich clients can pay. Psychologists and other licensed therapists can't prescribe meds, so they do therapy, but often make less than $60-70k a year. People don't want to go into psychology / psychiatry because of the stress of dealing with suffering people without having the tools to help them, and then getting paid relatively little (compared to other health care professionals) This results in much of depression and other mental health being treated in primary care. PCPs aren't trained that well in treating mental health beyond what pharma sales reps tell them, so they wrote an rx and call it a day. 70% of patients don't respond to the first trial of antidepressants, but PCPs don't really know how to handle this

gcb0 9y ago
thank you for finally making clear the evil incentives behind US psychiatrist being less than drug peddlers. always wondered how the drug industry managed to coerce a whole professional group into being so malignous to society.
refurb 9y ago
Doctors don't make any money from writing a script (beyond the payment for the consultation). In fact, the would make more money if they used counseling rather an a drug.
- nasredin 9y ago
  IIRC there is an issue here. Former doctors who now work for pharma companies and take their peers to dinners and push the new (patented) drugs. Doctors then prescribe these new drugs perhaps needlessly (Vioxx?) or over generic ones. Also in my experience counseling is only affordable to the wealthy or people in the criminal justice system (where it is already too late IMHO).

milankragujevic 9y ago

I am disenhearted by the apparent pseudo-scientific thinking in the comments on this article, and how it'll "be better if you just go workout and eat better", which might work for some people, but not for everyone. If there was a scientific study about changing life habits to stop depression, I'd bet that it would have the same amount of effectiveness or even less than SSRIs. I myself have been "miraculously" cured from depression by the most ridiculed profession in modern medicine, psychiatry, and with "poison" that was supposed to ruin my life and make me kill myself. Basically, aripiprazole and fluoxetine helped me, and help me live life, work and be happy. There was nothing wrong with my life until one day I tried to kill myself, and I was very resistant to treatment because of years of people's anecdotes how psychiatrists were crazy, were "out to get them" and "chemically lobotomize" them. This is bullshit, and we all know it, during my stay in a hospital I have seen many cases of teenagers who were "beyond repair" get "fixed" with medications, and would you look at that, 3-4 years on, they haven't regressed (I kept in contact). Neither have I. It's dangerous to spread conspiracy theories to impressionable and vulnerable minds, and you should think twice before dismissing the whole modern science of psychiatry, just because you fell that hippie life and smoking pot is the way to fix anyone's life. I don't care about the downvotes, but had to get this off my chest.

stephengillie 9y ago
Being rich won't solve all of your problems. But wealth/funding does solve some problems, and reduces most of the rest by orders of magnitude. In the same way, being in good physical shape, eating healthful foods, sleeping well every night, and not being stressed won't solve every medical problem. But a dependable and healthy body does solve some problems directly, and reduces most of the rest by orders of magnitude.
- nasredin 9y ago
  I would say wealth not only reduces but eliminates a lot of the problems for an average person. Every week there's a study that being poor causes a lot of damage to your body (on the DNA level IIRC).
zbobet2012 9y ago

JDiculous 9y ago

> 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it. In my opinion this should be a national emergency on par with something like the opioid crisis (a symptom of this). We're a nation of depressed, drugged up zombies sleepwalking to our unfulfilling office jobs everyday to pay off our student loan / mortgage debt (yes I know not everyone is in that situation, but even if only 10% are that's 30 million people).

solarkraft 9y ago

Thanks for changing the senseless title in the submission.

ascorbic 9y ago

Quite apart from the generally pseudo-scientific content, there is a big part of missing context in this: the author's background. Johann Hari was first found to have plagiarised large amounts of his published work over many years, and then to have used sockpuppet accounts to make negative (and libellous) edits to the Wikipedia pages of his critics. This is his first major publication since his disgrace. Is it really that surprising that somebody whose career was left in ruins is likely to identify hating ones job as a cause of depression?

zaptheimpaler 9y ago

I totally agree with this, and I will repeat a somewhat controversial view I hold: Governments & business owners directly gain power & influence in the world via their citizens/workers productivity. The western attitude to "mental illness" is shaped VERY strongly by this - when you get "depressed" working an overly stressful job with no hope of anything better, it is better to convince the poor sap that its a problem with THEM rather than a problem with the world. Then give you some pills to make it better. This dysfunctional culture will swallow up all your time, force you to work on things you fundamentally don't believe in, leave you isolated from people and then tell you its your fault for being depressed. We need to make the world stop dehumanizing us. Monkeys in cages get depressed. When 5% of people are depressed, maybe its fair to say they should seek treatment on their own. When 30%, 40%, 50% of people are depressed.... its time to adapt the world to fit peoples well-being instead of the other way around..

qwerty456127 9y ago

Nevertheless, all the major emotions/moods one can feel: sadness, joy, laziness, vigour, fear, enthusiasm, anger, limerence etc are almost nothing but chemical conditions. If you feel panic or are angry at somebody - that doesn't necessarily mean you are in danger or that somebody is an asshole - that means you have elevated level of norepinephrine and/or low serotonin and/or something like that. Feeling lazy doesn't mean you have fallen to the sin of sloth but that you have low levels of thyroxine and/or dopamine and/or norepinephrine and/or serotonin and/or something else. That's a huge problem the majority of people don't understand this, just keeping this in mind makes the life a lot easier for you, your family and everybody around. Also it usually is enough to take something as natural, cheap and harmless as L-tryptophan (an essential amino-acid, the precursor to 5-HTP and serotonin, easily available as an over-the-counter supplement and found in many foods naturally) to fix the problem, SSRIs and benzodiazepines are not necessary in every case.