5 ms·

I've lost the thought around this part: > For example, consider a person who says, “now I understand why I have such negative thoughts, can’t get to sleep, an

by maratc 5y ago

I've lost the thought around this part: > For example, consider a person who says, “now I understand why I have such negative thoughts, can’t get to sleep, and have difficulty getting going…I’ve got depression.” This person might believe that the explanation of her symptoms is depression, but in fact, the diagnosis of depression is just a categorisation of exactly these symptoms. The diagnosis of depression usually revolves around changes in body chemistry and the functioning of the brain. It is an issue as real as diabetes is. To explain my point further, consider the following: > For example, consider a person who says, “now I understand why I have such frequent urination, increased thirst and increased appetite. I’ve got diabetes.” This person might believe that the explanation of her symptoms is diabetes, but in fact, the diagnosis of diabetes is just a categorisation of exactly these symptoms. There is no diabetes Gremlin, either. All this not to say that the accusations of fraud are either based or baseless. EDIT: I know we can't test (blood etc.) for depression — yet. There's still a question of whether "it's all in your head" or "your biology is a bit off". See also [0]. [0] https://en.wikipedia.org/wiki/Biopsychiatry_controversy https://en.wikipedia.org/wiki/Biopsychiatry_controversy

andi999 5y ago
Totally weird, also if the article were true, it would suggest going out, trying to think positively were effective treatments of depression (which they are at most for light cases)
Sharlin 5y ago
No no no no. The diagnosis of depression absolutely does not revolve around "changes in body chemistry and the functioning of the brain", except insofar as "functioning of the brain" equals the symptoms reported by the patient! There are no known physical or chemical tests for depression. Even if we have some vague theories about "chemical imbalance in the brain", for the most part the neurological or biochemical mechanisms of depression are a mystery.
- marginalia_nu 5y ago
  What irks me about this is every human experience is reflected in "changes in body chemistry and the functioning of the brain". But that's about as useful as saying that a car breaks down due to mechanical changes. It's not wrong, but it's pretty useless.
  - pessimizer 5y ago
    It's a false explanation, like explaining how a sleeping pill works by saying that it contains a sleep-causing agent.
- maratc 5y ago
  > There are no known physical or chemical tests for depression. The absence of evidence is not an evidence of absence. It is true that so far, we don't have physical or chemical tests for depression. This doesn't prove that the chemistry or the brains or neurotransmitters are functioning the same way in depressed and non-depressed people, it just says the science still can't tell.
  - Sharlin 5y ago
    Yes, but for now what we call "depression" is those patient-reported symptoms – it cannot be any other way because at the neurochem level there may not even be any single thing that could be called "depression"! The term may not be useful except for denoting a certain syndrome, ie. a set of symptoms. Just like there's no single thing that causes the upper respiratory syndrome that we call "common cold".
  - pessimizer 5y ago
    Which is entirely irrelevant. The relevant part is that depression is diagnosed based on reported symptoms, not physically detected. The fact that it is not physically detected is not evidence that it can't possibly be physically detected, just a statement that it isn't.
    - maratc 5y ago
      My issue with TLA is that it states that "There is no depression Gremlin". I disagree: I think that there may be depression Gremlin, we're just unable to reliably discover it yet.
      - learc83 5y ago
        The point isn’t that depression has no biological cause. The point is that there are probably numerous biological causes. To strain the analogy, there are probably dozens of different depression gremlins. Maybe even a depression goblin, and a depression troll. Saying that you have “depression” doesn’t give you an understanding of what’s causing it. We have a baby with colic. What does that mean? It means the baby cries 3 hours per day for 3 days a week for at least 3 weeks with no other explanation. That’s it. It’s not something you can point to and say oh that explains it. That’s the cause. It literally just means there is no explanation.
kingkawn 5y ago
It’s a long way of saying that naming the symptoms does nothing to reveal the cause or even necessarily the treatment.
ubercore 5y ago
I think you're misreading what the article is saying. It's not saying depression isn't real, it's saying that depression as a label exist outside the diagnostic criteria for it. We can't actually test neurotransmitter levels, we don't have a blood test for depression.
n8cpdx 5y ago
Diabetes is measurable through blood sugar, insulin, a1c, and other direct chemical tests. It is easily treated (to maintain blood sugar, not cure, unfortunately) through direct chemical application (insulin). Depression can’t easily be measured by any chemical test, existing chemical treatments aren’t effective, and CBT (talking to someone) is similarly effective to chemicals. The chemicals we do have don’t just treat depression, they treat a whole bunch of things (anxiety, OCD, etc) and come with a whole bunch of whacky side effects, which suggests they aren’t particularly well-targeted. They also sometimes make young people want to kill themselves, which is maybe not the best side effect for a depressed person to experience. Tldr: “depression is just a chemical imbalance” is basically a meme, and I haven’t seen any evidence that it is anything more than pseudoscience. Just looking at the condition and it’s place in society is almost enough to disprove the “just a chemical imbalance” thought. Even the DSM V has no chemical criteria for diagnosing depression: https://floridabhcenter.cbcs.usf.edu/wp-content/uploads/2021/03/MDD_Adult-Guidelines-2019-2020.pdf https://floridabhcenter.cbcs.usf.edu/wp-content/uploads/2021...
- maratc 5y ago
  > Tldr: “depression is just a chemical imbalance” is basically a meme The alternative depression meme is "it's all in your head", which is about as useful as telling a diabetes patient "it's all in your pancreas". I still struggle to understand which of the two memes is closer to truth.
  - Sankozi 5y ago
    There is a stigma with having "head problems". I think it is more useful to fight with that stigma than to ignore existence of problems like depression or psychosomatic disorders.
rrmm 5y ago
The symptoms of depression and criteria are contained in the DSM. They don't involve brain chemistry or functioning (per se), e.g. "Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide." The underlying reasons for those symptoms may involve chemical imbalances, but those aren't established or tested for. They don't take a CSF sample or do an MRI for a diagnosis.
johnchristopher 5y ago
> The diagnosis of depression usually revolves around changes in body chemistry and the functioning of the brain. It is an issue as real as diabetes is. To explain my point further, consider the following: I have never heard of anyone getting a depression diagnosis based on changes in their body chemistry or the functioning of the brain. It's always set after a talk about feelings, situation, emotions and "what's going on ?". Exceptions are from articles dealing with electrical shock therapies that regularly hit the front page.
learc83 5y ago
We don’t understand the biological processes behind depression, and there is no lab test used to diagnose depression. It is just as the passage says, a categorization of symptoms. That doesn’t mean there aren’t biological processes at work, but we don’t understand them enough to diagnose depression at that level. We aren’t even really sure why most depression treatments work. Contrast that to diabetes. You don’t get diagnosed with diabetes because you have increased thirst and urination. You are diagnosed with diabetes because your fasting blood sugar level was too high. And the treatments are any number of relatively well understood methods of regulating your blood sugar.
- maratc 5y ago
  > We aren’t even really sure why most depression treatments work. SSRIs and SNRIs and many others all seem to have a theory behind them, based on biology.
  - roywiggins 5y ago
    The theory is "more serotonin and then something something less depression." SSRIs definitely increase the amount of serotonin in the brain. Why and how and if that's what helps is a mystery. > Why boosting brain communication can help alleviate symptoms of depression, however, is unclear, she says. > “We know to some extent what [these drugs are] doing, but we don’t necessarily know why this works for depression or anxiety,” says Edwards. > Antidepressants quickly increase concentrations of these neurotransmitters shortly after someone starts taking the medication, says Christin Drake, a clinical psychiatrist at NYU Langone Health. But patients generally don’t start to feel the benefits for several weeks. The reason for this lag time, and what’s happening during this gap, is not clear. https://www.discovermagazine.com/health/how-antidepressants-work-is-a-mystery-scientists-still-dont-understand https://www.discovermagazine.com/health/how-antidepressants-... Part of the reason you can tell that we don't really know very much at all about the mechanism of action is that individual patients often have to take a little grand tour of the available medications before they find one that even works on them. Why does this SSRI work for Patient Bob and that SNRI doesn't? Nobody really knows, it's just informed guesswork.
el_nahual 5y ago
This is just wrong. Depression is a descriptive condition, not a prescrtive one. Many psychiatrists--the quack ones--will use the language of "chemical imbalance" as a sort of "appeal to authority" fallacy. It should be obvious that this is a fallacy because: A) at no point have they actually measured the patient's brain chemistry (and it's not obvious what it would even mean to do this? an imbalance where? compared to what?) B) the doctor diagnosed the depression doing exactly what TFA did: matched a set of symptoms to a list. One of the harshest criticisms of the DSM-V -- the latest version of this descriptive manual--is that it grossly expands the symptoms that qualify as depression (to include things like bereavement, for example). The "chemical imbalance" theory was based on the success of SSRIs to treat depression. These are chemicals that inhibit the reuptake of serotonin, which results in overproduction of that neurotransmitter. "Ah, so depression is a lack of serotonin" Counterfactual evidence is conveniently ignored. For example, the fact that antipsychotics, which block the reception of serotonin (and so are basically the opposite of SSRIs), are also powerful antidepressants! It's also a nonsense theory to anyone with an undergraduate knowledge of neuroscience. There is no "happiness" neurotransmitter. Serotonin is simply an inhibitory neurotransmitter, which reduces the odds of a neuron 'firing'. Which neuron? Part of what network? Wait, what? In the immortal words of Paul Dirac "it's not even wrong." In fact, most of the most promising new therapies for depression have nothing to do with serotonin: psylocibin (many orders of magnitude more effective than SSRIs), ketamine and transcranial magnetic stimulation are examples. Of course, the mind is a side effect of physiology: there must be some biological explanation to depression. But that doesn't mean that it's the same explanation for everyone, or that it has anything to do with a "chemical imbalance" of one neurotransmitter vs another.
- maratc 5y ago
  I'm not arguing, but for a person suffering from depression, who of the following is right? A. People saying "It's all in your head" and reducing depression to a non-biological condition (which is not very helpful at best), or B. Doctors saying "Here, have a pill" and reducing depression to a biological condition? I think that we still don't know, and maybe it's a bit of both, or maybe neither. But TLA seems to go with the first group, hence my comment.
randomNumber7 5y ago
There is a physical part of depression, even if the root cause comes from the psyche. This makes it hard to get out (vicious cycle). Thats why even a psychologist will use medicaments when treating someone with a serious depression.

by maratc 5y ago

andi999 5y ago

Totally weird, also if the article were true, it would suggest going out, trying to think positively were effective treatments of depression (which they are at most for light cases)

Sharlin 5y ago

No no no no. The diagnosis of depression absolutely does not revolve around "changes in body chemistry and the functioning of the brain", except insofar as "functioning of the brain" equals the symptoms reported by the patient! There are no known physical or chemical tests for depression. Even if we have some vague theories about "chemical imbalance in the brain", for the most part the neurological or biochemical mechanisms of depression are a mystery.

marginalia_nu 5y ago
What irks me about this is every human experience is reflected in "changes in body chemistry and the functioning of the brain". But that's about as useful as saying that a car breaks down due to mechanical changes. It's not wrong, but it's pretty useless.
- pessimizer 5y ago
  It's a false explanation, like explaining how a sleeping pill works by saying that it contains a sleep-causing agent.
maratc 5y ago
> There are no known physical or chemical tests for depression. The absence of evidence is not an evidence of absence. It is true that so far, we don't have physical or chemical tests for depression. This doesn't prove that the chemistry or the brains or neurotransmitters are functioning the same way in depressed and non-depressed people, it just says the science still can't tell.
- Sharlin 5y ago
  Yes, but for now what we call "depression" is those patient-reported symptoms – it cannot be any other way because at the neurochem level there may not even be any single thing that could be called "depression"! The term may not be useful except for denoting a certain syndrome, ie. a set of symptoms. Just like there's no single thing that causes the upper respiratory syndrome that we call "common cold".
- pessimizer 5y ago
  Which is entirely irrelevant. The relevant part is that depression is diagnosed based on reported symptoms, not physically detected. The fact that it is not physically detected is not evidence that it can't possibly be physically detected, just a statement that it isn't.
  - maratc 5y ago
    My issue with TLA is that it states that "There is no depression Gremlin". I disagree: I think that there may be depression Gremlin, we're just unable to reliably discover it yet.
    - learc83 5y ago
      The point isn’t that depression has no biological cause. The point is that there are probably numerous biological causes. To strain the analogy, there are probably dozens of different depression gremlins. Maybe even a depression goblin, and a depression troll. Saying that you have “depression” doesn’t give you an understanding of what’s causing it. We have a baby with colic. What does that mean? It means the baby cries 3 hours per day for 3 days a week for at least 3 weeks with no other explanation. That’s it. It’s not something you can point to and say oh that explains it. That’s the cause. It literally just means there is no explanation.

kingkawn 5y ago

It’s a long way of saying that naming the symptoms does nothing to reveal the cause or even necessarily the treatment.

ubercore 5y ago

I think you're misreading what the article is saying. It's not saying depression isn't real, it's saying that depression as a label exist outside the diagnostic criteria for it. We can't actually test neurotransmitter levels, we don't have a blood test for depression.

n8cpdx 5y ago

Diabetes is measurable through blood sugar, insulin, a1c, and other direct chemical tests. It is easily treated (to maintain blood sugar, not cure, unfortunately) through direct chemical application (insulin). Depression can’t easily be measured by any chemical test, existing chemical treatments aren’t effective, and CBT (talking to someone) is similarly effective to chemicals. The chemicals we do have don’t just treat depression, they treat a whole bunch of things (anxiety, OCD, etc) and come with a whole bunch of whacky side effects, which suggests they aren’t particularly well-targeted. They also sometimes make young people want to kill themselves, which is maybe not the best side effect for a depressed person to experience. Tldr: “depression is just a chemical imbalance” is basically a meme, and I haven’t seen any evidence that it is anything more than pseudoscience. Just looking at the condition and it’s place in society is almost enough to disprove the “just a chemical imbalance” thought. Even the DSM V has no chemical criteria for diagnosing depression: https://floridabhcenter.cbcs.usf.edu/wp-content/uploads/2021/03/MDD_Adult-Guidelines-2019-2020.pdf https://floridabhcenter.cbcs.usf.edu/wp-content/uploads/2021...

maratc 5y ago
> Tldr: “depression is just a chemical imbalance” is basically a meme The alternative depression meme is "it's all in your head", which is about as useful as telling a diabetes patient "it's all in your pancreas". I still struggle to understand which of the two memes is closer to truth.
- Sankozi 5y ago
  There is a stigma with having "head problems". I think it is more useful to fight with that stigma than to ignore existence of problems like depression or psychosomatic disorders.

rrmm 5y ago

The symptoms of depression and criteria are contained in the DSM. They don't involve brain chemistry or functioning (per se), e.g. "Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide." The underlying reasons for those symptoms may involve chemical imbalances, but those aren't established or tested for. They don't take a CSF sample or do an MRI for a diagnosis.

johnchristopher 5y ago

> The diagnosis of depression usually revolves around changes in body chemistry and the functioning of the brain. It is an issue as real as diabetes is. To explain my point further, consider the following: I have never heard of anyone getting a depression diagnosis based on changes in their body chemistry or the functioning of the brain. It's always set after a talk about feelings, situation, emotions and "what's going on ?". Exceptions are from articles dealing with electrical shock therapies that regularly hit the front page.

learc83 5y ago

We don’t understand the biological processes behind depression, and there is no lab test used to diagnose depression. It is just as the passage says, a categorization of symptoms. That doesn’t mean there aren’t biological processes at work, but we don’t understand them enough to diagnose depression at that level. We aren’t even really sure why most depression treatments work. Contrast that to diabetes. You don’t get diagnosed with diabetes because you have increased thirst and urination. You are diagnosed with diabetes because your fasting blood sugar level was too high. And the treatments are any number of relatively well understood methods of regulating your blood sugar.

maratc 5y ago
> We aren’t even really sure why most depression treatments work. SSRIs and SNRIs and many others all seem to have a theory behind them, based on biology.
- roywiggins 5y ago
  The theory is "more serotonin and then something something less depression." SSRIs definitely increase the amount of serotonin in the brain. Why and how and if that's what helps is a mystery. > Why boosting brain communication can help alleviate symptoms of depression, however, is unclear, she says. > “We know to some extent what [these drugs are] doing, but we don’t necessarily know why this works for depression or anxiety,” says Edwards. > Antidepressants quickly increase concentrations of these neurotransmitters shortly after someone starts taking the medication, says Christin Drake, a clinical psychiatrist at NYU Langone Health. But patients generally don’t start to feel the benefits for several weeks. The reason for this lag time, and what’s happening during this gap, is not clear. https://www.discovermagazine.com/health/how-antidepressants-work-is-a-mystery-scientists-still-dont-understand https://www.discovermagazine.com/health/how-antidepressants-... Part of the reason you can tell that we don't really know very much at all about the mechanism of action is that individual patients often have to take a little grand tour of the available medications before they find one that even works on them. Why does this SSRI work for Patient Bob and that SNRI doesn't? Nobody really knows, it's just informed guesswork.

el_nahual 5y ago

This is just wrong. Depression is a descriptive condition, not a prescrtive one. Many psychiatrists--the quack ones--will use the language of "chemical imbalance" as a sort of "appeal to authority" fallacy. It should be obvious that this is a fallacy because: A) at no point have they actually measured the patient's brain chemistry (and it's not obvious what it would even mean to do this? an imbalance where? compared to what?) B) the doctor diagnosed the depression doing exactly what TFA did: matched a set of symptoms to a list. One of the harshest criticisms of the DSM-V -- the latest version of this descriptive manual--is that it grossly expands the symptoms that qualify as depression (to include things like bereavement, for example). The "chemical imbalance" theory was based on the success of SSRIs to treat depression. These are chemicals that inhibit the reuptake of serotonin, which results in overproduction of that neurotransmitter. "Ah, so depression is a lack of serotonin" Counterfactual evidence is conveniently ignored. For example, the fact that antipsychotics, which block the reception of serotonin (and so are basically the opposite of SSRIs), are also powerful antidepressants! It's also a nonsense theory to anyone with an undergraduate knowledge of neuroscience. There is no "happiness" neurotransmitter. Serotonin is simply an inhibitory neurotransmitter, which reduces the odds of a neuron 'firing'. Which neuron? Part of what network? Wait, what? In the immortal words of Paul Dirac "it's not even wrong." In fact, most of the most promising new therapies for depression have nothing to do with serotonin: psylocibin (many orders of magnitude more effective than SSRIs), ketamine and transcranial magnetic stimulation are examples. Of course, the mind is a side effect of physiology: there must be some biological explanation to depression. But that doesn't mean that it's the same explanation for everyone, or that it has anything to do with a "chemical imbalance" of one neurotransmitter vs another.

maratc 5y ago
I'm not arguing, but for a person suffering from depression, who of the following is right? A. People saying "It's all in your head" and reducing depression to a non-biological condition (which is not very helpful at best), or B. Doctors saying "Here, have a pill" and reducing depression to a biological condition? I think that we still don't know, and maybe it's a bit of both, or maybe neither. But TLA seems to go with the first group, hence my comment.

randomNumber7 5y ago

There is a physical part of depression, even if the root cause comes from the psyche. This makes it hard to get out (vicious cycle). Thats why even a psychologist will use medicaments when treating someone with a serious depression.