4 ms·

So I agree that there's been a move away from "low seretonin == depression" and the model that depression is due to low seretonin (if it was even in favour), is

So I agree that there's been a move away from "low seretonin == depression" and the model that depression is due to low seretonin (if it was even in favour), is giving way to "it's much more complex. We don't understand too well". [1] And, there is an argument that is made that such drugs aren't effective anyway (or no more than placebo). However, I think that's an over simplification [2]. And I don't necessarily accept the contention that SSRIs / SNRIs and others just treat symptoms. This goes back to what I was saying earlier, that what works for person X may not work for person Y, not because the treatment isn't effective by itself, but because the etiologies may be different. All the way from a single SNP (single nucleotide polymorphism)) introducing a subtle amino acid substitution in a receptor on the cell surface to the cause being due to a vitamin deficiency (B-complex, for instance, or vit D, as another comment mentioned, or low Mg levels!) to psychological trauma. There are so many reasons that can lead to depression & anxiety. It's like fever. Some fevers can be treated with Tylenol. Others will need quinine, and Tylenol in such a case would be ineffective. What it also means is that we need to find better therapeutic targets in addition to seretonin / dopamine receptors, etc., and maybe move to a combinatorial drug approach once the targets are identified & validated. (like is used in oncology). So please do not dismiss drugs. Or therapy. Or CBT. Or lifestyle changes (diet, exercise). Environmental changes (job, social circle). It could be any of these that can help someone deal with, navigate through and resolve depression. And it can be frustrating to try and narrow down among these. But that's the nature of the beast :/. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ [2] http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

AnIdiotOnTheNet 9y ago
I'm a largely ignorant nobody with no medical degree, but from my perspective this doesn't look like treatment, it looks more like sacrificing chickens and trying to re-balance the humors, claiming victory when the condition clears up and thats why what works for person X may not work for person Y. If the model was any good, then the relationship between treatment and result would be much more consistent, you'd be able to say why what worked for X won't work for Y. It's possible I'm just bitter from my experience with doctors over the years.
- moh_maya 9y ago
  I understand where you are coming from, and you are absolutely right in pointing out that our understanding of the disorder is woefully inadequate. And therefore, the ways in which how we can treat / address it effectively, reliably, are limited. So you are absolutely correct that it can be, and often is, a crapshoot in terms of figuring out what treatment / approach would work for a person. It is frustrating. And I speak from experience too! It is hard to keep telling yourself, the next one will work, in the middle of depression when making the effort just to stick to the current plan seems like an thankless pointless task. Almost seems sisyphean. But., what we know today about the disorder is tons more than what we knew 10 years back. And treatment approaches are improving. Don't give up is the only useful thing I can say, having walked some of the same paths as you have.

AnIdiotOnTheNet 9y ago

I'm a largely ignorant nobody with no medical degree, but from my perspective this doesn't look like treatment, it looks more like sacrificing chickens and trying to re-balance the humors, claiming victory when the condition clears up and thats why what works for person X may not work for person Y. If the model was any good, then the relationship between treatment and result would be much more consistent, you'd be able to say why what worked for X won't work for Y. It's possible I'm just bitter from my experience with doctors over the years.

moh_maya 9y ago
I understand where you are coming from, and you are absolutely right in pointing out that our understanding of the disorder is woefully inadequate. And therefore, the ways in which how we can treat / address it effectively, reliably, are limited. So you are absolutely correct that it can be, and often is, a crapshoot in terms of figuring out what treatment / approach would work for a person. It is frustrating. And I speak from experience too! It is hard to keep telling yourself, the next one will work, in the middle of depression when making the effort just to stick to the current plan seems like an thankless pointless task. Almost seems sisyphean. But., what we know today about the disorder is tons more than what we knew 10 years back. And treatment approaches are improving. Don't give up is the only useful thing I can say, having walked some of the same paths as you have.