4 ms·

Great Post thank you, I need to express my unending frustrating with the manner in which educators are bringing up the roles of neurotransmitters in psychiatry

Great Post thank you, I need to express my unending frustrating with the manner in which educators are bringing up the roles of neurotransmitters in psychiatry. Quoting neurochemical imbalances as originators, or targets to fix, is mostly false. That narrative is also harmful to people's self knowledge, and to progress in the field. Engineers: how would you feel if someone described a technical problem, a UX issue, a data handling nuance or a security flaw... all as 'down to electricity'. Whilst pedantically correct it serves little use and may harm us by arresting the first tendrils of thought that were reaching out, hoping to understand this mystery. The narrative that psychiatric illness relates to 'neurochemical imbalances' is largely a hangover from pharma marketing. Of course, neurochemicals are involved, and there will be patterns to be found. But let's collectively reject those oversimplifications that helped sell semi efficacious drugs for decades whilst doing little for societal progress in coping with psychiatric illness. These mental health problems are bio psycho social. And the bio component is enormously more complex than "low mood, low serotonin". Its okay to just say, "It's bio psycho social, and it's complicated".

xibalba 5y ago
> oversimplifications that helped sell semi efficacious drugs YES. Anyone who has rotated through the kaleidoscope of antidepressants seeking help knows this in their bones. Current pharma options barely work and come with many unpleasant side effects.
- pas 5y ago
  At the same time many people got their life back thanks to those lame drugs. It's not a panacea.
  - RobertRoberts 5y ago
    To be fair, you have to consider a placebo effect for those same people.
  - fighterpilot 5y ago
    The evidence that this isn't just placebo is pretty weak. At least 4/5ths of the effect is placebo. The evidence is especially weak for people with only moderate depression, where there's literally no difference with placebo. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
    - bserge 5y ago
      There is so much more to it than serotonin. Sadly, few doctors care enough.
    - pas 5y ago
      Kirsch’s study lumps all antidepressants together. Eg Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. (After substracting the placebo effect's size of 1.2) Suppose that antidepressants were a growth hormone pill taken by short people. An effect size of 0.3 (standard deviation) is equivalent to a body height pill making you grow 0.8 in (2 cm), with placebo that's 2.6 in (6.6 cm). https://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y... https://slatestarcodex.com/2018/11/07/ssris-an-update/ https://slatestarcodex.com/2018/11/07/ssris-an-update/
getpost 5y ago
"Chemical imbalance" is not only a marketing phrase. Lots of people are willing to receive treatment for a "chemical imbalance," but aren't willing to engage in therapy, or admit they're depressed. This was very common in the last couple decades prior to the turn of the century, when mental illness was much more stigmatized than it is now.
- ericsoderstrom 5y ago
  Isn't that marketing?
bserge 5y ago
Well, that sure works the other way, too: stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well. To make it worse, doctors just get on the SSRI bandwagon and consider it a cure-all with zero consideration for anything else, making a sizeable minority of people suffer even more and longer. Yeah, biopsychosocial. Good luck finding a doctor who will actually help you find the root cause when you're on standard insurance and can't afford the best private ones (or worse, it's actually illegal to bypass the system).
- alecst 5y ago
  > stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well. He didn't say that though. In fact OP would agree with you that calling it a matter of willpower is an oversimplification. That was the whole point of his biopsychosocial thing. Anyway the drugs sometimes work and sometimes don't. Hitting a CRT TV sometimes makes the picture come back. That doesn't mean a TV has a hitting deficiency. It's not clear why it works. SSRIs sometimes work and sometimes don't. But depressives don't have a serotonin deficiency. It's not clear why they work.

xibalba 5y ago

> oversimplifications that helped sell semi efficacious drugs YES. Anyone who has rotated through the kaleidoscope of antidepressants seeking help knows this in their bones. Current pharma options barely work and come with many unpleasant side effects.

pas 5y ago
At the same time many people got their life back thanks to those lame drugs. It's not a panacea.
- RobertRoberts 5y ago
  To be fair, you have to consider a placebo effect for those same people.
- fighterpilot 5y ago
  The evidence that this isn't just placebo is pretty weak. At least 4/5ths of the effect is placebo. The evidence is especially weak for people with only moderate depression, where there's literally no difference with placebo. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
  - bserge 5y ago
    There is so much more to it than serotonin. Sadly, few doctors care enough.
  - pas 5y ago
    Kirsch’s study lumps all antidepressants together. Eg Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. (After substracting the placebo effect's size of 1.2) Suppose that antidepressants were a growth hormone pill taken by short people. An effect size of 0.3 (standard deviation) is equivalent to a body height pill making you grow 0.8 in (2 cm), with placebo that's 2.6 in (6.6 cm). https://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y... https://slatestarcodex.com/2018/11/07/ssris-an-update/ https://slatestarcodex.com/2018/11/07/ssris-an-update/

getpost 5y ago

"Chemical imbalance" is not only a marketing phrase. Lots of people are willing to receive treatment for a "chemical imbalance," but aren't willing to engage in therapy, or admit they're depressed. This was very common in the last couple decades prior to the turn of the century, when mental illness was much more stigmatized than it is now.

ericsoderstrom 5y ago
Isn't that marketing?

bserge 5y ago

Well, that sure works the other way, too: stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well. To make it worse, doctors just get on the SSRI bandwagon and consider it a cure-all with zero consideration for anything else, making a sizeable minority of people suffer even more and longer. Yeah, biopsychosocial. Good luck finding a doctor who will actually help you find the root cause when you're on standard insurance and can't afford the best private ones (or worse, it's actually illegal to bypass the system).

alecst 5y ago
> stop calling it a mental issue that can be resolved with willpower or attitude when it's clear that for many people, medication works and it works well. He didn't say that though. In fact OP would agree with you that calling it a matter of willpower is an oversimplification. That was the whole point of his biopsychosocial thing. Anyway the drugs sometimes work and sometimes don't. Hitting a CRT TV sometimes makes the picture come back. That doesn't mean a TV has a hitting deficiency. It's not clear why it works. SSRIs sometimes work and sometimes don't. But depressives don't have a serotonin deficiency. It's not clear why they work.