4 ms·

Yes, we've made some great leaps and they shouldn't be discounted, but neural-science is still in its infancy. We still don't know the exact mechanism of action

Yes, we've made some great leaps and they shouldn't be discounted, but neural-science is still in its infancy. We still don't know the exact mechanism of action of many commonly prescribed psychoactive medications. We know they work because, unlike in the past, we conduct rigorous studies, but we can only theorise as to why the work and why they don't have the same effect in all patients. This has real implications for how medicine is practiced, which will undoubtedly make our methods look quite primitive to future generations. For instance, physiatrists are still forced into a 'trial and error' approach when finding the correct antidepressant and dosage for each patient.

pas 6y ago
I think we know their mechanism of action, but the grim reality is that they don't work that well at low doses, plus there are a lot of side effects even at low doses. (Because their mechanism is so general. Inhibit this, promote that. But those are all over our body. Plus eventually there are tolerance issues - so doctors switch from time to time. But then they have to fiddle with the dose.)
- tsimionescu 6y ago
  You would be quite wrong. We do know some bits about the effects of serotonin in the body, though I would be amazed if we really understood the whole story. But more than that, we have no idea what depression actually is, and that goes for any other psychiatric disease unrelated to direct brain damage. It would probably be more correct to call these syndromes rather than diseases, as we do not know the mechanisms causing the disease enough to even be sure if 'depression' is a meaningful diagnosis (in the sense that coughing is not a diagnosis). We also don't have proper neurological studies of emotional illnesses - there are basically no comparative neurological studies of people diagnosed with depression versus people showing similar symptoms who are expected to quickly recover (for example, people grieving for a lost one). We don't know whether the brain chemistry changes we see in depression are the cause of the disease, or just the way 'sadness'/'lack of motivation' looks like neuro-chemically.
  - pas 6y ago
    I think we're in agreement, but perhaps I wasn't precise enough in my phrasing. I mean we know what they do chemically, but as you said we have no idea what serotonin does. (Which is not true, but it's so complicated that what we know just makes us exhausted thinking about how truly complicated it is.) > We don't know whether the brain chemistry changes we see in depression are the cause of the disease, or just the way 'sadness'/'lack of motivation' looks like neuro-chemically. Indeed. Though it's always both. And probably asking whether we could, let's say take a pill every day as prevention seems unfathomable, because so far - again, just as you said - we don't really know what is depression. It's basically too much of feeling down. Feeling down when you shouldn't really be feeling that down, at least somehow "compared" to other people. So it's hard to know when prevention should start and when it's just normal case of the mondays. However, just as with the nurture-nature conundrum it seems natural to treat it as one thing very tightly coupled with the other. Which makes it likely that any kind of treatment and understanding has to always handle both in a lockstep. (Even if there are a lot of subgroups, some are more susceptible on the chemistry side, some more on the cognitive side, some are simply resilient enough to deal with it with some light touch counseling, some got a very bad ticket in life and need a whole support network to keep the darkness at bay, etc.)
ainiriand 6y ago
What still amazes me is the placebo effect. That is just pure mind-blowing-ness. - https://en.wikipedia.org/wiki/Placebo#Mechanisms https://en.wikipedia.org/wiki/Placebo#Mechanisms
- LocalH 6y ago
  I feel the placebo effect characterizes the true power of the mind, of which we’ve only scratched the surface. I think the newfound interest in researching psychedelics also shows some real promise in understanding consciousness.

pas 6y ago

I think we know their mechanism of action, but the grim reality is that they don't work that well at low doses, plus there are a lot of side effects even at low doses. (Because their mechanism is so general. Inhibit this, promote that. But those are all over our body. Plus eventually there are tolerance issues - so doctors switch from time to time. But then they have to fiddle with the dose.)

tsimionescu 6y ago
You would be quite wrong. We do know some bits about the effects of serotonin in the body, though I would be amazed if we really understood the whole story. But more than that, we have no idea what depression actually is, and that goes for any other psychiatric disease unrelated to direct brain damage. It would probably be more correct to call these syndromes rather than diseases, as we do not know the mechanisms causing the disease enough to even be sure if 'depression' is a meaningful diagnosis (in the sense that coughing is not a diagnosis). We also don't have proper neurological studies of emotional illnesses - there are basically no comparative neurological studies of people diagnosed with depression versus people showing similar symptoms who are expected to quickly recover (for example, people grieving for a lost one). We don't know whether the brain chemistry changes we see in depression are the cause of the disease, or just the way 'sadness'/'lack of motivation' looks like neuro-chemically.
- pas 6y ago
  I think we're in agreement, but perhaps I wasn't precise enough in my phrasing. I mean we know what they do chemically, but as you said we have no idea what serotonin does. (Which is not true, but it's so complicated that what we know just makes us exhausted thinking about how truly complicated it is.) > We don't know whether the brain chemistry changes we see in depression are the cause of the disease, or just the way 'sadness'/'lack of motivation' looks like neuro-chemically. Indeed. Though it's always both. And probably asking whether we could, let's say take a pill every day as prevention seems unfathomable, because so far - again, just as you said - we don't really know what is depression. It's basically too much of feeling down. Feeling down when you shouldn't really be feeling that down, at least somehow "compared" to other people. So it's hard to know when prevention should start and when it's just normal case of the mondays. However, just as with the nurture-nature conundrum it seems natural to treat it as one thing very tightly coupled with the other. Which makes it likely that any kind of treatment and understanding has to always handle both in a lockstep. (Even if there are a lot of subgroups, some are more susceptible on the chemistry side, some more on the cognitive side, some are simply resilient enough to deal with it with some light touch counseling, some got a very bad ticket in life and need a whole support network to keep the darkness at bay, etc.)

ainiriand 6y ago

What still amazes me is the placebo effect. That is just pure mind-blowing-ness. - https://en.wikipedia.org/wiki/Placebo#Mechanisms https://en.wikipedia.org/wiki/Placebo#Mechanisms

LocalH 6y ago
I feel the placebo effect characterizes the true power of the mind, of which we’ve only scratched the surface. I think the newfound interest in researching psychedelics also shows some real promise in understanding consciousness.