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“No convincing evidence” that depression is caused by low serotonin levels

• deleted 4y ago
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• _yoqn 4y ago
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  • jahewson 4y ago
    The document you’ve linked to is whacky propaganda from the Church of Scientology.
    • _yoqn 4y ago
      There's nothing but claims backed by facts in that document. Your ad hominem attack is not a valid argument.
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• Arubis 4y ago
  So...why do SSRI users self-report efficacy?
  • BrianOnHN 4y ago
    Correlation isn't causation. The serotonin effect may be a symptom of the depression. Treating symptoms is sufficient intervention for many.
  • carabiner 4y ago
    https://en.wikipedia.org/wiki/Placebo https://en.wikipedia.org/wiki/Placebo
    • kennywinker 4y ago
      When they test drugs, they test them against a placebo.
      • hackerlight 4y ago
        Yes, but according to Irving Kirsch, the benefit of anti-depressants above placebo is very small for anyone who isn't severely depressed, and the observed small effects can plausibly be explained by patients unblinding themselves (due to the presence of other side effects in the treatment group), or by things like publication bias. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
        • deleted 4y ago
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        • rando14775 4y ago
          I'll add that side effects alone can influence depression scores. Any medication that de- or increases sleepyness will change the score of any questionaire when taken at the appropriate time of day.
      • deleted 4y ago
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    • copperx 4y ago
      In my case, at this very moment, I'm going through antidepressant withdrawal and have random crying spells. Sure, depression might not be mediated by serotonin, but these drugs have an effect on mood. It might be that there's a different mechanism of action.
  • nvrspyx 4y ago
    My guess, without digging into the study itself since I'm on mobile, is that there is no singular cause for depression. Rather, depression is simply a symptom of a wide range of causes, with one possible cause being low serotonin (or a reduced sensitivity to it). Or even, low serotonin is a symptom of the depression. Not all patients with depression find relief from SSRIs, or medications in general, but some certainly do.
    • patmorgan23 4y ago
      It could even be that increasing serotonin is helps improve the patients mood and break thought patterns/cycles than kept them in their depression.
      • lumost 4y ago
        It could be that any forced cognitive pattern change would have the same effect. Double blind trials are hard, double blind comparative trials are more or less impossible.
      • klodolph 4y ago
        The mechanism of SSRIs is not well-described as "increase serotonin".
  • simonsarris 4y ago
    If we don't understand the mechanism of action it can still cause an effect. After all SSRIs certainly cause plenty of other side effects.
  • raphlinus 4y ago
    It might be a different mechanism, like brain-derived neurotrophic factor[1]. [1]: https://www.science.org/content/blog-post/how-antidepressants-work-last https://www.science.org/content/blog-post/how-antidepressant...
    • deleted 4y ago
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  • PragmaticPulp 4y ago
    Because psychiatric drugs don't necessarily work by counteracting specific deficits in the brain. That's a myth driven by unfortunate marketing campaigns and surface-level misunderstandings of the science. This makes intuitive sense to people when discussing other topics. For example, when someone is in pain they don't need to have an "endogenous opioid deficiency" for opioid painkillers to alleviate their pain. They're just in pain, and modulating the opioid system with drugs is one way we can reduce that pain. Or COX-2 inhibitors. Or a number of other substances. Likewise, modulating the serotonin system with SSRIs is one way we can modulate depression symptoms. People don't need to have a "serotonin deficiency" to see benefits from modulating their serotonin system.
  • biophysboy 4y ago
    Depression has no common cause or common set of symptoms. I read a paper that likened it to a watershed, with tributaries feeding into a general pool of malaise. The watershed varies from person to person, and affects their internal “ecosystem” differently. Maybe it’s a bit cute, but with this understanding, I think the headline is not shocking. We will never find the one cause of depression because there isn’t one. In my opinion, our best bet is more personalized medicine: helping people identify which rivers are filling up their lake of depression. For most people it will be a weighted combination of many things, but I think there will usually be some principal components.
    • frazbin 4y ago
      The test to see how depressed a lab mouse is, is to put it in a bucket of water and see how long it struggles. True story.
      • kortex 4y ago
        One of them is, yes. There are several, and basically all of them are some variant of "how resistant to giving into despair are you? (as a rat)". Forced swim, tail suspension, light/dark exploration activity. Kinda dark, but this research saves lives, and depression is notoriously hard to study objectively.
  • WalterSear 4y ago
    > ...two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. > ...A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. > These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/
  • JaceLightning 4y ago
    It's mostly a placebo https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/
• foolfoolz 4y ago
  imagine working in a field where nothing is probably true
  • pcrh 4y ago
    Indeed. The whole profession of psychiatry suffers from poor application of scientific research, to the extent that the National Institute of Mental Health once banned reference to the Diagnostic and Statistical Manual of Mental Disorders (known as DSM-5). https://www.science.org/content/article/nimh-wont-follow-psychiatry-bible-anymore https://www.science.org/content/article/nimh-wont-follow-psy...
• refurb 4y ago
  This is completely unsurprising and indicative of how limited our understanding of the brain is. It reminds me of Pfizer's work on gabapentin. A professor from Northwestern was working on GABA antagonists (by modifying GABA itself) and eventually came up with the drug. It was hailed as a great example of "structure-based drug design". The drug was approved by the FDA and efficacious for a number of issues like neuropathic pain. The submission documents from Pfizer had all this data on the binding efficiency of the drug to GABA receptors. Except it didn't work through the GABA receptor at all. After approval, more research was done and they said it worked through glutamate channels. Then more work was done and it seems most of its effect is through calcium channels.
  • DontchaKnowit 4y ago
    Do you have links to more info on this? Sort of an armchair pharmocologist and had never heard this about gabapentin. I thought it was a straight up gaba agonist like phenibut. But makes sense that it would be different given its very unusual dose response curve/self potentiation. (Probably making anyone who actually knows what they're talking about cringe. Take it easy, lol)
    • refurb 4y ago
      Gabapentin was designed as an antagonist (the structure is basically GABA with a big bulky group on it). You can just google older papers on gabapentin. Just like most drugs it impacts a number of different receptors in the body. We still don't fully understand them all.
  • clsec 4y ago
    Don't get me started on Gabapentin! I just got off of it after 11 yrs (serious spinal cord injury - neuropathy). Initially, after my surgery, I was on 12 different drugs (not all related to my injury). Over the last 5 years I've been slowly weening myself off of them one by one trying to figure out what was causing me so many side effects. It turns out that the last thing I quit was Gabapentin, which was last month. Amazingly, all the side effects disappeared once I stopped. I'll never take it again.
• GauntletWizard 4y ago
  Depression is caused by a shitty life. Most people with depression are trapped in an abusive relationship, though often it is with themselves. They're trapped by fear of admitting failure and making changes.
  • imadierich 4y ago
    a lot of times its a abusive mindstate.... a lot of really really down bad people have went on to do great things. its all about your perspective
    • GauntletWizard 4y ago
      Absolutely. The best parts of modern psychology are CBT and finding a better mind state. The drugs sometimes help shake up your mind enough to find that.
  • etchalon 4y ago
    This is deeply untrue.
• dotcoma 4y ago
  I thought it was widely accepted by now that the serotonin thesis was a bullshit story spread, among others, by Al Gore’s wife, maybe in good faith, maybe not. Edit: Tipper Gore; I did not remember her name (I’m not from the US). I read she was a big fan of the serotonin theory in a book (whose title I don’t remember at the moment).
  • dotcoma 4y ago
    Edit #2: The book is: Lost Connections: Uncovering the Real Causes of Depression, by Johann Hari In chapter 2: The year after I swallowed my first antidepressant, Tipper Gore -- the wife of Vice President Al Gore -- explained to the newspaper USA Today why she had recently become depressed. Just so that it's clear: I have nothing against Al Gore -- except that he lost the election.
• PragmaticPulp 4y ago
  SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time. The key thing to understand is that serotonin levels don't have to be low for SSRIs to induce positive changes. SSRIs don't just "raise serotonin levels" as many have come to believe, but rather change the dynamics of serotonin in the brain. This produces downstream changes that, over time, can contribute to lessening depressive symptoms in some patients. This makes more sense if you think about other conditions like chronic pain. Someone suffering from chronic pain doesn't have an "endogenous opioid deficiency". They're just in pain. Opioids are one medication we can use to modulate their pain. Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field.
  • zeckalpha 4y ago
    Hence the first S and the I in SSRI. A filter in certain areas increases other areas. Doesn't change overall values.
    • PragmaticPulp 4y ago
      I'm not sure what you're suggesting, but SSRIs definitely do change a number of measurable metrics of the serotonin system by prolonging the duration of serotonin in the extrasynaptic space. This is well studied. The first "S" is for selective, meaning they have minimal affinities beyond the serotonin transporter.
      • eurasiantiger 4y ago
        Where do you get that from? SSRIs act on SERT and SERT handles reuptake from the synaptic cleft, not from extracellular space which is ”vacuumed” by MAOA/B and COMT.
      • 4y ago
• walrus01 4y ago
  I have a completely unscientific, subjective theory that some significant portion of depression in the population as a whole is caused by the economic circumstances that some people live in. Things like being trapped in a dead end job to keep healthcare benefits in the USA, living in a never ending treadmill of debt.
  • triyambakam 4y ago
    I'm puzzled by those who disagree with this statement. How is it surprising that depressing circumstances would lead to depression?
    • astrange 4y ago
      Major depressive disorder isn't the same thing as feeling sad about your job.
      • UK-Al05 4y ago
        Bad jobs can cause suicide
        • WalterSear 4y ago
          Suicide is usually due to distress than clinical depression. This is why suicide hotlines work at all.
      • psyc 4y ago
        If being down about your job causes symptoms of depression that last more than 2 weeks, then it's the same thing. Psychiatrists diagnose based on symptoms. Worse, its usually what you say your symptoms are, with words and talking. They don't scan your brain. I've been seeing psychiatrists for almost 30 years. The good ones take plenty of interest in your situation, lifestyle, and other non-chemical non-medical factors. Psychiatrists don't distinguish between so-called 'situational' and 'clinical' depressions. Laypeople do that. If you get diagnosed by a clinician, that is the part that makes it clinical - it isn't a different kind of condition.
• yomkippur 4y ago
  Psilocybin has been quite promising and many people report positive changes.
  • sammalloy 4y ago
    Came here to say this. Although few people are aware of it, it is said behind closed doors that for some people, it is a cure for depression, although it’s very controversial to make that claim in public, and obviously, it needs to be used carefully and with great respect.
• ggm 4y ago
  My psychologist tells me that in his profession there is a significant gulf emerging between the ones who feel the prescribing is justified, and the ones (like him) with significant concerns: 1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it. 2. the drugs were tested inadequately across race, age, weight, sex. 3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal 4. almost all successful uses of the drugs are accompanied by CBT and like processes.
  • PragmaticPulp 4y ago
    > 1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it. "Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist might be overestimating their own knowledge of a different field (psychiatrist formally study these systems and medications, psychologists do not) and underestimating the amount of research being performed in this field. Regardless, these drugs don't really work as "boosters" like commonly thought. It's better to think of them as modulators. In fact, in conditions like anxiety SSRIs are well-known to actually reduce serotonin transmission in certain areas of the brain. The research has diverged quite a bit from the simple marketing-material models that a lot of people have about these drugs. The purpose of the drugs is to induce changes that result in positive downstream effects. It's not actually a contradiction that enhancing and inhibiting certain receptors could result in similar downstream effects. For example, a number of receptors in your brain will downregulate in response to both agonists and antagonists, even though they have opposite direct effects. Your psychologist's understanding of this topic is deeply flawed. > 2. the drugs were tested inadequately across race, age, weight, sex. SSRIs have been in widespread use since the 80s and tricyclics since the 50s. At this point, the idea that we haven't tested enough or that we haven't collected enough data is just a strawman argument proposed by people with impossibly high standards. I suspect no amount of testing would actually satisfy someone proposing this argument for drugs that have been studied for this long. > 3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard. Benzodiazepines should absolutely be prescribed for brief periods and this is reflected in their status as controlled substances and all of the prescribing literature. There are some doctors who ignore this advice and overprescribe, of course, but they are going counter to standard practice. On the other hand, medications like SSRIs can actually take weeks or months to reach full effect and many patients unnecessarily relapse by quitting them early. I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry. > 4. almost all successful uses of the drugs are accompanied by CBT and like processes The most successful uses of SSRIs are accompanied by therapy. However, we have plenty of studies where SSRIs are prescribed without any accompanying therapy and a positive result is still seen. If you're suggesting that the therapy is actually doing 100% of the work, that's easily disproven by the studies that test all combination (placebo, therapy alone, SSRI alone, therapy + SSRI). I'd recommend getting your psychiatry advice from actual psychiatrists. The number of misunderstandings and mistruths in what you've relayed here is quite high.
• imadierich 4y ago
• tested23 4y ago
  There are probably a million different causes for depression and im convinced for all but the most extreme cases that usage of anti depressants is a mistake. I think viewing depression as a disease instead of a symptom is a mistake. So many people eat food completely devoid of nutrition, stay indoors all day, have erratic sleep schedules, drink absurd amounts of alcohol and smoke weed all day. Why are we giving these people antidepressants when what they need is to go outside and walk and to take a multivitamin?
  • quacked 4y ago
    Completely agree with you, although I think that "going outside and taking a multivitamin" is an inadequate substitute for "live inside a prosperous, functional human-shaped society".
    • _yoqn 4y ago
      It's not society. It actually starts with the individual. In order to have nay kind of decent society, each individual needs to recognize that they are responsible for themselves and their own society. Going outside, exercising and consuming nourishing foods are the literal starting place. Then seek to find things you like doing and become competent in them. Find a good wife or husband. Don't cheat on them. Don't take alcohol to excess, etc. etc. The point is, you cant start from the outside and work your way down the the individual. It starts with the person.
      • DontchaKnowit 4y ago
        While this is true in terms of finding a solution to depression, I do think that the societal norms of our society are extremely conducive to these sort of depressive behaviors. E.g. many societies are setup to make these kinds of behaviors (self isolation, dopamine seeking hedonic treadmill type behavior, etc) very difficult to engage in without being chastised
        • _yoqn 4y ago
          I see your point, and my argument supports it. Who creates "societal norms" other than the individuals that make up society? It starts with individual action to reverse the dwindling spiral.
• lettergram 4y ago
  One of the most interesting things I heard recently that really hit me like a bolt of lightning… Depression is a disease of despair, and all these treatments are really just treating the symptoms. In other words, people experience despair because of some underlying situation - examples: death of child, lonely, broken home. “Normal” things, and we try to treat it with pharmaceuticals. It would be like treating depression with cocaine or marijuana (they actually did and still do this btw) - might make you feel good temporarily; but it’ll never stop the despair. The question is really how to address the despair. People often visit a therapist; I can see that helping some. But to many, they can’t seem to find the cause. It reminds me of the post the other day about how people live over 100 [1]. It’s all about community: > Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy. > Loved ones first. Successful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love. (They’ll be more likely to care for aging parents when the time comes.) > Right tribe. The world’s longest lived people chose—or were born into—social circles that supported healthy behaviors, Okinawans created moais—groups of 5 friends that committed to each other for life. Research from the Framingham Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors. Yes some people have real hormone or other biological issues. But 99% of people likely need to address the root cause. I’d put money depression is on the rise as our communities are collapsing due to the industrial / technological nature of our world. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125071/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125071/
  • klodolph 4y ago
    Bolts of lightning can be factually wrong, it sounds.
    • bwood 4y ago
• tus666 4y ago
• ldjkfkdsjnv 4y ago
  Too tired to type a cogent paragraph. Just that I have seen lives ruined by SSRIs.
  • _yoqn 4y ago
    Your comment is the most sensible I hav seen so far. I have seen lives utterly decimated by SSRIS. Suicides and murders caused by its side effects. Violent and suicidal tendencies are on the warning labels on many of these drugs.
  • throw__away7391 4y ago
    Same here. I've seen multiple people after getting along fine for years get prescribed these meds, and within two years end up completely unable to function, hold a job, maintain composure during a conversation (breaking down in tears or becoming violently angry), cook their own food, etc. and need to talk to a therapist multiple times a week. I'm sure "they're doing it wrong", but these were fully licensed doctors, prescribing drugs in an approved manner.
    • asveikau 4y ago
      Are you sure it isn't the condition that they were seeking treatment for that contributed to these things? I'll give an example, I read once that about 60% of people with bipolar disorder are unemployed. It isn't the diagnosis that does that. So I just read that comment as "they sought treatment and ever since they were a wreck". Seems like the causality could go the other way.
      • staticman2 4y ago
        There's some very scary anecdotes out there. I saw one on an obscure subreddit for people suffering from negative antidepressant drug symptoms where a person said they went to the hospital immediately after taking an SSRI due to an adverse reaction and they have had trouble concentrating on things since. If the person is correct and not dusional they had a statistically unlikely reaction to the drug- presumably too rare to show up in the drug approval process- and it ruined their life.
• locusofself 4y ago
  Anecdata, but I was often depressed for most of my adjust life. Around 5-6 years ago (age 33 at the time), I started taking 20mg Citalopram. I have experienced almost no depression since I started taking this medication, I'm far more focused and productive than I have ever been. It could be a factor of age and getting married as well, and just settling into my life. But my depression felt like something out of my control.
  • mccorrinall 4y ago
    Same here, but with Fluoxetine (Prozac). However, I don’t think exactly that fluoxetine made me less depressed. It only made me more „aggressive“ and more risk taking, and the antidepressing effect came from the positive results of taking such risks. I just „don’t care“ about failures as much as I used to. E.g. I finally started talking to girls, because I wouldn’t care about rejection that much. => Got into my first relationship and was happy. Also, I started working on my passion project full time and I recently registered a company for it. Two years ago I would have not thought about doing this, as working for an employer is way „safer“. But I don’t care about failing anymore.
    • MarcelOlsz 4y ago
      Shit I need pills that do the opposite lol.
      • CAP_NET_ADMIN 4y ago
        I have ADHD, frequently exhibited risky behaviour, ADHD medication (MPH) reduced this effect for me, I'm more conscious and think things through before they happen.
  • cameronh90 4y ago
    Sertraline has almost entirely fixed my panic disorder. It had no obvious cause and months of therapy had no impact. Within a few days of taking sertraline, it was essentially cured. I still get anxious from time to time but I'm able to live a completely normal life again. I had a few side effects (GI especially) for a few weeks but now the only side effect I have is I yawn a lot more, which is pretty tame. I'm a big believer in the gut-brain connection and wonder if maybe it was something to do with the drug's GI effects that helped, but ultimately I have no idea and it doesn't really matter.
• Uptrenda 4y ago
  There are many people who are anti-psychiatry who would probably still benefit immensely from treatment. My worry is that such people will look at this and say: "see look, the psychiatrists got it wrong. I was right to question treatment all along; Anti-depressants don't work." But the message here isn't that SSRIs don't work for depression. It's that depression is a complex illness and can't be reduced to a single chemical deficiency. Anti-depressants mechanism of action is more complex than 'corrects a chemical deficiency.' I hope such people considering treatment know that while theories may change as we learn more: medications still have to be evaluated against real-world results. So the effectiveness of a drug remains the same.
  • KennyBlanken 4y ago
    It's less a specific study and more that almost none of their research is reproducible and there have been a number of serious breaches of trust, like Prozac being widely prescribed to kids and turning out to be horrifically bad for them.
• paulpauper 4y ago
  It's sorta fascinating how anti depressants work yet no one really know how or why they work.
  • philliphaydon 4y ago
    We know how and why SSRIs work in regards to serotonin. We don’t understand why some people produce little or absorb serotonin too quickly requiring SSRIs drugs to manage it.
    • mjfl 4y ago
      right because what serotonergic synapses do is they tickle the other neurons to make them happier right?
      • philliphaydon 4y ago
        We know that a group of people who suffer from depression have lower serotonin levels when compared to someone who is considered... not depressed. And we know that SSRI's prohibit or prevent the bodies ability absorb serotonin allowing it to accumulate and be more effective and pull it in line with someone who is not depressed, resulting in the depressed person becoming less or not depressed. So. I'm unsure how my statement is untrue in response to the parent statement stating we have no idea how they work.
        • mjfl 4y ago
          > We know that a group of people who suffer from depression have lower serotonin levels when compared to someone who is considered... not depressed. I thought the whole point of the article was that there is no solid evidence of a relationship between serotonin levels and depression?
          • philliphaydon 4y ago
            The article seems to say that lower levels of serotonin is not the /cause/ of the depression. But it doesn't change the fact that most studies seem to conclude that one of the things we can determine in people who suffer from depression is that they have lower levels of serotonin, and in some of those cases SSRIs help. Not all forms of depression are caused by serotonin, and anti-depressants may not always be the solution. Again, my point is we know how SSRIs work and what they do. What we do not know is why some people have lower levels of serotonin or why they absorb it too quickly compared to... non depressed people. The issue with depression is that its a huge complicated thing that we know a lot about, but at the same time, we also know very little. I would agree that we over perscribe medication for depression as we do for MANY different things. In Asia, antibiotics is handed out like candy when people are sick. You have the common cold, boom you get antibiotics, despite the fact that colds are caused by virus, and antibiotics only helps with bacterial infections not viral invections. The US has a major problem with big phama where people can be perscribed medicine for many things, and then have side-affects resulting in more things being perscribed. Painkills for injury > painkillers causing depression > Prozac, Prozac causes insomnia > sleeping pills, sleeping pills causes you to lose sexual drive > viagra, viagra causes you to gain weight > apatite suppresents. It goes on and on.
• narrator 4y ago
  The crisis in mental health is that suicide levels have been rising since 2000. This is good evidence that the new drugs are worse than the old drugs. If you look at consumers rating of drugs they're on, mao inhibitor anti-depressants like nardil have very high ratings, especially compared to SSRIs. Unfortunately, the drug companies don't like competing with generics, so it goes that the newest drug is considered the best drug.
  • robocat 4y ago
    > The crisis in mental health is that suicide levels have been rising since 2000. This is good evidence that the new drugs are worse than the old drugs. Or this is good evidence that cellphone usage is causing suicide (~1/3 of people in US had cellphones in 2000, ~100% do now). Your causality is poorly explained.
  • actually_a_dog 4y ago
    > This is good evidence that the new drugs are worse than the old drugs. That's incorrect. There's good evidence that economics, in combination with lack of funding for suicide prevention programs is driving the increase in suicide rates. See https://www.bbc.com/news/world-us-canada-44416727 https://www.bbc.com/news/world-us-canada-44416727
• mathgladiator 4y ago
  As a member of the anti-psychiatry side after seeing primary care doctors wreck my mother... I think we will see a sea change in how we approach this with things like psychedelics. I recently got treated with six weeks of Ketamine, and it works. If you ever thought about rebooting your brain, then I recommend it. However, you really have to surrender yourself to the experience; it is a very intentional act.
  • PragmaticPulp 4y ago
    Ketamine treatment is interesting, but it's not really a replacement for SSRIs. The anti-depressant effects of Ketamine are unfortunately relatively short-lived. Tolerance also seems to develop to the effects over time. There are some adventurous providers experimenting with frequent ketamine dosing over long periods of time, but the results haven't really been great from what I've seen. Also, a psychedelic experience is definitely not necessary for ketamine's antidepressant effects. In fact, the more responsible providers and studies are careful to keep peak plasma levels low enough to avoid this, and it works just fine. A lot of unscrupulous providers are using excessively high doses to induce psychedelic experiences, but this isn't actually supported by the evidence. SSRIs and other traditional antidepressants will continue to be mainstays of long-term depression treatment if for no reason other than their sustainability and long-term efficacy is so much better than ketamine.
    • jb1991 4y ago
      How about psilocybin? One recent article posted here suggested something like one dose every six months had measurable impact on depression.
      • asdff 4y ago
        I support psychadelic legalization but at the same time I wonder how much of the antidepressive effect of psychadelics is just from giving space for thought in your day to day life. For exmaple, the modern human wakes up, starts scrolling instagram, goes to work, goes home, continues scrolling instagram, then sleeps. There is no period of reflection or introspective thought, since every mundane activity where you could be reflecting internally, e.g. washing the dishes or walking to the train, is consumed by a podcast you have playing from your airpods. For some people, taking a psychadelic drug is the only time they give themselves to do nothing but think internally for a few hours. I wonder if they would get the same benefit just setting aside regular designated meditation time where their thoughts aren't being interloped by all these forces in modern society that vie for our attention.
• chx 4y ago
  There's a significant population of science denying cranks and so those who want to raise legit concerns about the quality and alas, often motivation of medical studies are easily grouped with those. But: 1. There's no such thing as good / bad cholesterol. This is complete baloney and Pfizer lost a staggering amount of money when a drug raising good cholesterol got as far as human trials -- and failed them. There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. There's growing amount evidence though that cholesterol is a symptom and not a cause. 2. The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Last year there was a study pretty much confirming it is overdiagnosed in children. But even worse, whether ADHD is even a thing or multiple conditions wrongly bundled under a single name is basically an open question. We basically put labels on children with "problematic behaviors" like "autistic spectrum disorder" and "ADHD" and then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things? 3. I would bet dollars to doughnuts in a few decades we will look at all current nutrition advice to something akin of medieval quackery. How is this not self evident: genes obviously affect how foodstuff interact with our bodies thus any sweeping generalization is inherently suspect or most likely complete baloney. Like, how can anyone seriously think only lactose intolerance is an inherited genetic trait. I would need to dig into my notes if someone needs them but a group of statisticians at a university started to look into medical studies and then FOIA the raw data and found like 80% of them cherry picking the data. The incentives are not exactly at the right place.
  • eyelidlessness 4y ago
    > The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Go on… (I’m adult diagnosed, for disclosure, but please do go on and tell me how suspect my diagnosis was, how I shouldn’t have been diagnosed as a child, how my medication is harmful. Go on and tell me about my life which you know better than I do.)
    • pindab0ter 4y ago
• pddpro 4y ago
  Anecdote but I always noticed change in sleep patterns after starting antidepressants. Actually, terminal insomnia (you wake up and then are unable to fall asleep) are characteristic of chronic depression. Add to this that SSRI causes increase in sleep hours (maybe even quality?) and then you have a theory about how it might just have been due to lack of sleep after all?
  • cpncrunch 4y ago
    Given the placebo effect is 75% of the effect of antidepressants, and placebos have a large effect on sleep, I would say that the placebo effect is the first thing that should be considered.
• smolder 4y ago
  I'm going to go out on a limb and guess the prominence of depression is largely caused by a broken interface with the world at large. The traps created by modern society wherein you struggle for other people's benefit are better designed than ever before. What our social machine procedurally treats as progress is advances in subjugation. Depression may often be an artifact of "efficiency" with respect to extracting value from the population at large. We might need to dial back the exploitation of the currently-exploitable class to have a sustainable society, assuming pills don't work. In different terms, maybe we have too many rich people (exploiters) in a situation where it's clearly very foolish to keep growing in number (and productivity) to support them. Maybe we just need to rebalance our economy to make it work better for those currently exploited and endemically depressed people.
  • tptacek 4y ago
    You're right: you've gone way out on a limb.
    • emodendroket 4y ago
      I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.
      • tptacek 4y ago
        All sorts of non-absurd-seeming notions turn out to be wrong, which is why people train for many years to conduct medical research.
        • emodendroket 4y ago
          How would you "medically disprove" the notion that some people are unhappy because the circumstances of their lives are bad rather than biological defects?
• jwmoz 4y ago
  Right, so who’s correct?
• deleted 4y ago
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• tyronehed 4y ago
• eixiepia 4y ago
  What are the views on SSRIs prescribed for OCD and anxiety? The dosage for these conditions is much larger than for depression, often ten times or more.
• edkennedy 4y ago
  Much more comprehensive article on the study that is not behind paywall here: https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0 (Also it skips the editorialized title and presents the data)
• SubiculumCode 4y ago
  It is depressing reading the comments here from people who know nothing of this field, yet feel like they are qualified to spout tons of unsubstantiated nonsense on a forum where we are encouraged to only engage in the conversation when we actually know something.
  • bowsamic 4y ago
    I’m not sure what you can expect since this problem affects so many of us in such a huge way and yet no one has answers or even stable advice
• current_thing 4y ago
  https://m.youtube.com/watch?v=tFgF1JPNR5E&t=9m35s https://m.youtube.com/watch?v=tFgF1JPNR5E&t=9m35s Tom Cruise was right then.
  • sigg3 4y ago
    Tom Cruise is a leading member in the fascist cult Church of Scientology, who is on record saying they can bring back people from the dead and levitate.
    • bowsamic 4y ago
      And? People also listen to Buddhists about depression, and Buddhists believe that enlightened people can fly! EDIT: I'm rate limited so I can't reply to the child comments: I think a majority of Buddhists believe that Buddhas and bodhisattvas have special powers. It is in a majority of the traditional scriptures, from both Mahayana and before. I don't think the authoritarian nature of scientology changes the situation. Scientologists were being mocked for believing in such things, but that is not far from the beliefs of most Buddhists which people will happily listen to. I mean, you will likely even listen to His Holiness the Dalai Lama, who is literally a prophesied reincarnation of the bodhisattva Avalokiteshvara (Guanyin in Chinese, Kannon in Japanese) My point isn't that people can be right about some things and wrong about others, it's that people mock their disliked religious figures on one basis, but their mocking also applies just as much to their favourite religious figures, however they don't realise it because they are usually ignorant to many aspects of it. Everyone loves Buddhism, but go and criticise other religions for reasons that apply just as much to Buddhism, they are just ignorant that it also applies to Buddhism. I am a devout Buddhist, and believe in these traditional things, such as Buddhas flying or having their own Buddha lands or faith in my rebirth in a western Pure Land. I emphasise it because you probably don't know of these things
      • ok_dad 4y ago
        What do Buddhists have to do with Tom Cruise? Is he a leading member of a Buddhist organization?
• barbs 4y ago
  For good in-depth investigative journalist approach to the topic, I highly recommend the book "Lost Connections" by Johaan Hari. The author himself was diagnosed with depression and prescribed SSRIs for the longest time. Through talking with experts and understanding the roots of depression (in short, a lack of connection with the world and community), he now no longer takes them.
• sidcool 4y ago
  I am torn between two schools of thought on depression and anxiety. Some say it is a purely biochemical issue. Others say it's more of a psychological one and can be addressed with therapy and exercise alone.
  • padolsey 4y ago
    Why not both? We always seem to try to dichotomize and categorize incredibly complex systems for some reason. Surely there are many components to the symptom clusters of depression and anxiety. Life circumstances can matter, exercise can matter, neurological dispositions can matter. All at once.
• ornornor 4y ago
  When you look into the studies for antidepressants, the track record is abysmal. They’re not innocuous, trigger serious side effects, some are hard to quit, but more importantly they only make a difference in people with extremely severe depression. And doctors often downplay or don’t mention side effects honestly because they don’t want patients to not take them. The studies justifying antidepressants as effective to the FDA are disturbingly flawed: people who were not responsive were excluded from the studies… Anyway, I found this website very enlightening on the topic: https://www.theinnercompass.org/learn-unlearn/intervention/antidepressants https://www.theinnercompass.org/learn-unlearn/intervention/a... along with several Reddit threads from peoples experience with various antidepressants. This is not medical advice and there are cases where antidepressants are necessary and make a difference. But if you have anything else than extreme depression and no other mental health conditions (schizophrenia etc), consider magic mushroomed: a few intentional trips can do wonders to see what’s troubling you from a different angle and help you move forward.
  • can16358p 4y ago
    Any links to the Reddit threads if handy? I'm interested for personal issues and Reddit always comes much more useful than actual psychiatry in my case (not sarcasm, I frankly mean it).
    • ornornor 4y ago
      I used “site:Reddit.com antidepressants” or with specific medicine names. Use ddg for that because the site: thing hasn’t worked on google in years and you’ll get poor results.
  • PraetorianGourd 4y ago
    Yeah an unregulated and uncontrolled consumption of a poorly dosed hallucinogenic is totally better than a double-blind study of SSRI/SNRI. I swear, I do not reject the possibility that hallucinogenics can cure depression better than existing meds, but the almost religious enthusiasm for such a poorly studied chemical is deeply concerning. And yes, before you accuse me of being a pharma shill, I know that the lack of serious study is due to legal restrictions and not scientific evidence. But that doesn’t change the fact that they’ve not been studied rigorously. In my State, they are being actively studied, let us hold back the praise until the results are in.
• gloosx 4y ago
  So maybe low serotonin levels are caused by depression? My naive understanding is that these amines play a critical role in our emotional response, social interactions and other complex psyche, so as a consequence, depressed person suffers decline in these functions, as well as a whole higher nervous system suffers regression. I always had a feeling that SSRIs are treating consequence, not the cause. Maybe I'm too naive and my understanding is very poor, I just architect systems in the end, so I'm looking at this problem like at a bug in the very root of an unimaginably complex system, while treating it by boosting one or another amine is looking like the most ugly hotfix.
  • neuroma 4y ago
    As we're dealing in analogies... Better think the serotonin/ monoamine hypothesis of depression is akin to saying a server load balancing failure is because of "electricity imbalance". Whilst electrons are undeniably involved, the explanation is not useful, and distracts from better truths. We have such a scarcity of safe and effective tools to probe and influence the human brain. Herein lies the hope that the diseases we invent might be treated neatly by the tools we posses. Yet, given the origin of disease and the tools are sparsely interlinked, it is too often just a fantasy. Yet to "do nothing" is usually not acceptable and so we persist, and iteration or invention become the next hope.
    • malf 4y ago
      “electricity imbalance” may be a myth, but a short electricity “fast” (HYTTIOAOA) is still a useful fix for many problems.
  • taurath 4y ago
    That’s my understanding and feeling as well. Psychiatric medication imo should be used to help stabilize for psychological work, not create a new chemical baseline.
• deleted 4y ago
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• fithisux 4y ago
  Like Vitamin D? Just take your pills and make us rich? If you don't get better is because you need more pills. Legal substitutions Pills <-> Credit Cards <-> Vaccines <-> Supplements <-> Technocrats <-> Religion
• Linda703 4y ago
  [dead]
• eyelidlessness 4y ago
  There’s no convincing evidence that discussing medical aspects of mental health is productive on HN. Currently my comment that I’m alive has been downvoted at least half a dozen times because I had the temerity to still be alive, be glad to say so, be grateful for my psychiatric care, and reject that any of that is “suspect”. This isn’t the place to discuss psychiatry. Talk to your doctor.
  • Etheryte 4y ago
    Have you considered that your comment may have been downvoted because you come across unnecessarily hostile, not because of some absurd attack on your person? Similarly, any space is a good space to discuss and spread awareness on mental health — even if only one person finds an idea to help them, whatever their situation may be, it's already a massive positive.
    • irjustin 4y ago
      > because you come across unnecessarily hostile And possibly justified. A lot of us are armchair psychiatrist from reading articles. OP that you're replying to lives this type of medication and attributes being alive right now to it while a lot of us who have only read articles sit and debate. A number of these comments can come across as "just eat healthier" to an overweight person or "don't be sad".
      • deleted 4y ago
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      • im3w1l 4y ago
        About 15% of American adults are currently on antidepressants. I tried but failed to find how many people ever used it. But it goes without saying that it should be be even higher. In other words, antidepressant use is very common and many people will be drawing on personal experience. That might not feel comfortable divulging that about themselves.
  • _moof 4y ago
• am63517 4y ago
  This study shows (decide how convincingly) what has been suspected anyway. The causal direction of “chemical imbalance leads to depression” is just not a sensible assumption. SSRI are of course able to alleviate the symptoms as are other drugs or treatment that are not associated with serotonin. Tricyclic antidepressants, sleep deprivation, transcranial magnet stimulation, ketamine, exercise and many more. Also the efficacy of these other treatments does not depend on the performance in the Forced Swim Test. The multitude of different antidepressant approaches, the different and heterogeneous animal modeling leads me to believe that what we describe as major depression is a pathological alteration in the brain subnetwork activations, probably between frontal brain areas and formatio reticularis/pons. SSRI are a roundabout way of influencing network changes that take time to develop. And these chances happen to work via Sertonin paths but serotonin is not necessarily the cause of “depressed” state of the brain network. Disc: Only peripherally me area of expertise. No sources because mobile
• cbxyp 4y ago
  SSRI's are without a doubt the leading cause of divorce and mass shootings in America. The quacks in the medical profession handing them out like candy to people whom it is clearly contraindicated in, without any followup study and usually without any competent analysis of what the drugs are doing to these peoples behavior and brains. Getting my girlfriend off of SSRI's completely changed her life, as she was indicated bi-polar, and yet over 10 mental crisis hospitalizations with specialist psychiatry teams failed to notice the direct contraindication and continued recommending use of SSRIs. The kind of mental breakdowns she was having as a direct result of SSRI use is the type of behavior that in a male could lead to a mass shooting or other particularly crazy behavior. Uncontrollable flights of emotions and repeating panicked behavior. After seeing her be "treated" by numerous psychiatrists who failed to take note or recommend cessation despite SSRI usage being clearly contraindicated on her pre-existing diagnosis, the last crisis we simply took her to another hospital, they concurred on cessation of SSRIs and all of these problems ceased. Of course, it's not possible to sue the previous doctors or hospital due to the laws that protect the industry.
  • chalst 4y ago
    > without a doubt Not a mark of wisdom to use these words about such topics. I agree that SSRIs and bipolar are a tricky mix, but they work for some patients.
    • cbxyp 4y ago
      Divorce: https://pubmed.ncbi.nlm.nih.gov/23931947/ https://pubmed.ncbi.nlm.nih.gov/23931947/ Mass shootings / violence: https://www.psychreg.org/antidepressants-ssri-mass-shootings/ https://www.psychreg.org/antidepressants-ssri-mass-shootings... While they may provide benefit to some patients, the sheer volume of prescriptions and the quite clearly linked effect leads me to stand by my original statement - without a doubt, they are a leading cause of both.
      • chalst 4y ago
        The existence of studies attesting to a link does not demonstrate causation beyond reasonable doubt.
• deleted 4y ago
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• operator-name 4y ago
  I do not have full access to the comments published on the BMJ, but the study is openly available at https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0
• rozab 4y ago
  See also "Serotonin and Depression" from David Healy (2015) https://www.bmj.com/content/350/bmj.h1771 https://www.bmj.com/content/350/bmj.h1771 https://davidhealy.org/so-long-and-thanks-for-all-the-serotonin/ https://davidhealy.org/so-long-and-thanks-for-all-the-seroto...
• ChildOfChaos 4y ago
  The book lost connections is a really good read on this. It points out the problems in modern society and our lives that lead to depression rather than it just being something that can be solved with a pill. Things like our lack of connection to meaningful work, our lack of connection to each other and our lack of connection to nature all play a big part.
  • richardatlarge 4y ago
    I recommend “The Cult of Pharmacology,” which long ago characterized this serotonin theory as bio-babble reductionism
  • falafelite 4y ago
    I found the author to have cherry-picked and poorly-cited information earlier on in the book when talking about antidepressants, and then a complete lack of rigor when discussing the various lost connections. I think he has a point, but I just didn't find it very well done, and as another comment here has quoted: > Other clinicians say, however, that the notion of depression being because of a simple chemical imbalance is outmoded anyway, and that antidepressants remain a useful option for patients alongside other approaches including talking therapies. It is also notable that the author has had plagiarism issues and other questionable behaviors in the past: https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism_and_fabrication_scandal https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism_and_fab...
  • 127 4y ago
    There's also the driving our novelty seeking brains into overdrive with all kinds of artificial stimulants, including this very forum.
  • n0tth3dro1ds 4y ago
    Sounds like Kaczynski’s “power process” in Industrial Society
• nth_order 4y ago
  Yeah, but thats hardly news, we have known that for decades. Otherwise direct serotonin releasers would be the most useful ADs. But these mostly give people nausea and serotonin syndrome. ADs work mostly by being FIASMAs, reducing inflammation and oxidative stress, increasing neurogenesis and neuroplasticity, increasing the activity of other monoaminergic systems, and the serotonergic portion is mostly explained by downregulation of 5-HT1A autoreceptors due to chronicly high extrasynaptic 5-HT levels. This also explains the delayed action of ADs. At least this is my knowledge from when I last researched this topic in depth. But that would be a little bit too much for the general public, so it is simplified, to this annoying effect that everyone talks of "low serotonin levels" where in fact the underlying systems are way more complex.
  • ZeroGravitas 4y ago
    And now the opposite happens with headlines that imply "your medication is suddenly revealed to be useless" when in fact we've been aware that we don't know how it works for a while, but we're still reasonably sure it helps, which perhaps explains the increase in prescription more than the "serotonin is the only thing that matters" theory which the experts ruled out a while ago.
    • virtuallynathan 4y ago
      They barely work better than placebo, from what I saw in my reading of the literature.
      • bratsche 4y ago
        I’ve tried a number of antidepressant drugs and so far not been able to notice much difference with any of them.
      • slibhb 4y ago
        Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...
• fragcula 4y ago
  > Other clinicians say, however, that the notion of depression being because of a simple chemical imbalance is outmoded anyway, and that antidepressants remain a useful option for patients alongside other approaches including talking therapies. This is the key line in the summary. The concept of attacking an idea no one really believes is really a straw man. More importantly the modern practice of medicine is "evidence based medicine", not "mechanism based medicine". That means treatments are tested as to if they work, not how they work. Ideally in multiple well run double blinded randomised controlled trials with at least some against treatment as usual. Unlike the past when we thought more about how they might work, theorising something is off about someone's humors and adjusting with leeches. Anyone looking for a truly mind bending result should look at Hjorth et al. 2021 [0], the study recruited people with social phobia and gave them all an SSRI (escitalopram). Half were told they were getting a sham active placebo and "should not expect to get better", half were told "you're getting the known effective treatment". Headline result being told you are being treated leads to 4x as much response with brain changes in the dopamin networks. In the meanwhile, rather than worry about how antidepressants work, why not take a look at electroconvulsive therapy which has proven time and again to be the most effective treatment for depression. Yet we have no idea how it works, other than knowing a decent seizure in those without epilepsy makes you less sad? What on earth. [0] https://www.nature.com/articles/s41398-021-01682-3 https://www.nature.com/articles/s41398-021-01682-3
  • varispeed 4y ago
    > are tested as to if they work, not how they work Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests... Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...
    • boesboes 4y ago
      > shipping code that I don't know how it works, but it passes tests We call that machine learning
      • 4y ago
• jinder 4y ago
  SSRIs appear to work through the vagus nerve in a similar way to psychobiotics. Their direct effects on neurotransmitters are probably an unwanted side-effect: Oral selective serotonin reuptake inhibitors activate vagus nerve dependent gut-brain signalling (2019): https://www.nature.com/articles/s41598-019-50807-8 https://www.nature.com/articles/s41598-019-50807-8 Identification of SSRI-evoked antidepressant sensory signals by decoding vagus nerve activity (2021): https://www.nature.com/articles/s41598-021-00615-w https://www.nature.com/articles/s41598-021-00615-w
  • jinder 4y ago
    To add to my comment, this explains why SSRIs take some time to work - it's the signalling through the vagus nerve that takes time to impact the brain. Other compounds such as curcumin and famotidine (H2 antihsitamine) have also been found to work via this mechanism. For many many years scientists had dismissed curcumin as having no effect because it's not bioavailable - recent research has shown that it doesn't need to be if it directly activates your nervous system! There's a lot more research that needs to be done here, and I think promising therapeutics for impacting brain function are coming our way as researchers learn more. If you consider the brain a state machine, inputs from the nerves - through gut-brain axis, through your eyes and ears (socialising, environmental cues, sounds of safety vs sounds of threat), through your skin (touch) etc all impact the state. This state can range from safety to fight-or-flight (anxiety) to shutdown (depression). This is hugely simplified (for example neuroinflammation, endotoxins/LPS etc can impact this also) but I've found it very useful for regulating my own state and understanding why I feel happy, agitated, low etc.
  • konfusinomicon 4y ago
    recently procured an acupressure spiky foot ball that was originally designed to combat depression by stimulating the vagus through the foot. I don't consider myself depressed by any means, but after a few minutes of rolling my feet aggressively over the ball and targeting a few key areas, I generally feel much better and can actually sense that my body is less stressed. everyone should have one or 2 of them
    • 4y ago
• fredgrott 4y ago
  The problem with these studies is.... That they focus on one sub-system instead of how the sub-systems interact together. My bias, I solved my ADHD control problems by researching how serotonin, dopamine, adenosine, ne, and cdb together regulate both the increases and decreases in dopamine and all the cofactors needed to increase dopamine production. The move from one system to full systems based understanding in the Biology and neurology space started in the 1970s as Chaos theory took hold. But it takes awhile to become fully entrenched in each science discipline. One cannot say that serotonin by itself controls depression as CBD is also involved! Runners know this as runners high is the result of high CDB neurotransmitter levels! Another fun fact, Cacao and Cocoa have anandamide which is the THC-less way to get that runner high! Sorry, was a Biology and Chemistry major once...I really cannot get it out my system.
• thelittleone 4y ago
  I highly recommend the book "plant medicines and the imaginal realm". I've worked extensively with indigenous curanderos (healers) many of who view depression as a sickness undigested emotions and past trauma. This sickness negatively affects perception of their present moment. In plant medicine ceremony, when past trauma is processed it's frequently accompanied with throwing up which is called "purging" or "getting well". Outside of ceremony plants are often prescribed as a purgative which are often drunk accompanied by copious water. Purging may happen in both directions. There is so much to experience in that field, so many lines of beautiful inquiry and in ceremony often a feeling of eternal present moment. The book puts forward how depression and other sickness come from an altered perception that can be restored by plant medicines.
• daniel-cussen 4y ago
  Suicidalism and depression come from having a bad life, basically. All these quacks are trying to find what little chemical they can pepper on or what little product they can market. And society and especially psychiatrizing parents or bosses keep looking for the one magic trick that fixes this strange illness. Just make their life better! The actual circumstances, stop oppressing them! Admit your subterfuge and your child or employee will not suicide. But admitting the subterfuge would sometimes amount to suicide.
  • king_magic 4y ago
    I have (and have always had) an awesome life. I’ve still struggled with depression.
    • daniel-cussen 4y ago
      EDIT: Had and have always had an awesome life? The fuck? Sounds counterfactual. Yeah a perfect life with no problems. Wouldn't the depression make it not awesome? But to narrow down, shrinks dream of some like sweetener or artificial coloring they can add to all the shit the give someone to make it taste good. A spoonful of sugar makes the medicine go down! No it doesn't. It tastes bad because it's poison. That is the point of taste. And the best medicine tastes really good, Paltomiel, aspirin doesn't taste particularly bad, there's another one but it doesn't taste bad just really bitter, ah...alkaloids taste uh...well they reconfigure your notion of sweet=good bitter=bad, then there's dex, blood sugar, now sugar tastes like treacle. But the whole thing of medicine tasting bad is just like toothpaste tasting bad (sodium flouride), it tastes bad because it is bad for you, you should avoid it, get a toothpaste that doesn't have fluoride in it. Of course little children have no way of stopping their parents from forcing them to use this toothpaste, so they complain. And the parents say no complaints, backed by violence. Coercion. To the shrinks that said that to me, I say, you take all the shit since it tastes so good, give me your pay for doing your job for you, and yeah the seasoning...you'll need it.
      • daniel-cussen 4y ago
        EDIT to king_magic: man I don't know what your deal is. I bet it's really good on paper. Just not as good in living it out, hence depression. . I wish I could press a button on the user interface to talk to someone in person. Real life. You and I. Real Meat. In person. king_magic and daniel-cussen.
• deleted 4y ago
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• sebastianconcpt 4y ago
  And testosterone levels?
• ernestoperez 4y ago
  Prof Montcrieff is Professor of Critical and Social Psychiatry. I wonder how her patients are doing, if she currently has a clinical practice.
• VLM 4y ago
  There's two separate medical systems, one focused on making money and boosting financials where science does not matter, and the other focused on medical science where at least theoretically the financials do no not matter. Its up to the end user to figure out which system they're interfacing with and act accordingly. Hint, antidepressants make a lot of money for the correct people... People who make treatment decisions based on financials and kickbacks are not going to care about all this "science" and "logic" and "statistics" stuff where their wallet is concerned.
  • jugg1es 4y ago
    I understand where your cynicism comes from but I think it might be overblown in this case. These drugs do help people and psychiatrists want to help. The fact is that we just don't know that much about how higher cognition works. I have a neurobiology degree and was very surprised how little we actually know. We don't know how to really measure things like depression, so we rely on animal models and medieval tests such as "Lets throw this mouse into a bucket and see how long it takes for it to give up treading water". When we are able to take 'in situ' measures in a live person without risking their life, we may start to make progress on better treatments.
  • SkyPuncher 4y ago
    > People who make treatment decisions based on financials and kickbacks are not going to care about all this "science" and "logic" and "statistics" stuff where their wallet is concerned. Can you elaborate on who these people are? You're casting a wide net here. My partner works in mental health. The reality I've observed is mental health is incredibly challenging. Much of it is highly situational and requires hours and hours of extremely time consuming, labor intensive therapy to even begin creating a meaningful treatment plan. If mental health had unlimited time, many providers would love to be able to provide this level of care. In practice, medications are a highly cost-effective means of improving people's mental health. They can increase people's baseline significantly with therapy (time and cost) focusing on rounding out the rough parts. Many patients are not interested in the therapy component if they can get "80%" better with some medication. IMO, this is why we're seeing such a boom in "pill mill" mental health startups. A large portion of the affected population is content being "mostly better, quickly" rather than "fully better, slower".
• throwawayacc2 4y ago
  I have a theory which I can’t substantiate, just anecdotes and conversations I had throughout the years. But, I’m convinced a lot of depression/anxiety stems from thinking too much and that in turn is caused by an ever complex word with looser and looser guidelines or norms. I’m not making judgements weather this is necessarily good or bad but rather observing. In the past, even as recent as the 50s but certainly before the 20th century, a persons course in life was mostly determined at birth. You’re born, you play, you grow up, work the fields or a job, get married, have kids of your own and die. Society was more rigid and pretty much funnelled you through a “tried and tested path”, for good or for worse. And the lack of information made things “simpler” in a way in the sense you had a small number of people to get input from. Take child rearing for example. Many modern people worry so much and research ways to “optimise” their children for example ( I’m thinking of a lot of questions I saw on the parenting stack overflow ) whereas in the last, you’d just ask your own parents. And, since they were older, the assumption was they knew what they where talking about, even if it was not necessarily true. Same with health, same with sexuality, relationships, a lot of things. Essentially lack of information and a rigid social structure meant fewer choices which meant less thinking. And less thinking meant less depression and anxiety. Now when you have a world of information at your hands, you have way more things to think about, to worry about and to look for information on how to fix or improve. I’m not sure medication, even “working” one is a sustainable solution to what appears to me to be an environmental problem rather than a biological one.
  • multiplegeorges 4y ago
    > And less thinking meant less depression and anxiety. That's a pretty big claim. I know you're just putting out your own personal theory and you're not trying to declare you have the "answer", but I don't see how that follows. A first step is establishing that depression is more prevalent now than in the 50s. You'd have to account for the lack of diagnosis then and find some other indicator of the true rate of depression. Not an easy task, for sure, but my first thought is that depression just went untreated then and people became resigned to their lot in life and suffered.
    • deleted 4y ago
      [deleted]
• MrYellowP 4y ago
  Depression isn't caused by chemical imbalances or whatever other causes outside of ones responsibility. It's caused by ones life. The people one shares his life with, the environment, ones approach towards life itself. When you suffer from depression, you suffer from your existence. Either because it is shit, or because you make it shit and don't know better. It's amazing how far we've come with ignoring that there are a lot of things well within our control when it comes to mental health, as long as we stop pretending they're not. I'm not saying that everyone has the chance to change his life. I'm saying that there's too much of a lack of self responsibility in favour of dependence on "luck" and "external factors" which "require" medication, because "there's nothing you can do." I'm not blaming anyone but myself for my state and I certainly don't try to pretend that it's outside of my control. It isn't. I know that, because I can manage it all by myself, without depending on anything. It doesn't change my life and I'm still working on that, but if i blamed some random ass excuse of a chemical imbalance for something that's actually my own fucking fault, then I'll just stay like this forever.
• ComputerCat 4y ago
  I can't access the full text but this is really interesting. I think with how fast paced all the advancements in the scientific community are it's crucial that things we thought we understood are continuously re-assessed and analyzed.
• InfiniteRand 4y ago
  In a lot of ways the study of mental illness is like the war against cancer, you can expect perpetual expectations of miracle cures being made while slow progress happens in the background and major reverses of assumptions sporadically occur, and therapeutically specific variants make big progress while the majority of the disease is treated by blunt tools which do offer some help but at a considerable cost
  • hirvi74 4y ago
    Same with Alzheimers. We finally have medications to remove the plaques of tau proteins, and... it didn't do shit.
• phkahler 4y ago
  Nobody checks your serotonin levels prior to prescribing an SSRI. The drugs do help some people but the reality is that nobody really understands how it all works.
• 0xMatt 4y ago
  Low testosterone and too little exercise, just my opinion.
• roody15 4y ago
  Think we have known this for a while. For example Wellbutrin (Bupropion) works well for many people and it doesn’t work on serotonin levels at all. In fact it causes an increase of dopamine uptake in the brain. Think increasing the dopamine levels causes a variety of changes to complex systems in the brain that are not really fully understood. SSRi’s also cause changes to underlying systems in the brain that are not as simple as you are “low” on serotonin. My two cents
  • y-c-o-m-b 4y ago
    I'm on Wellbutrin (lowest dose) and it works great. I have no side effects whatsoever. Been on it since 2019. It's kept my depression in check and even helps with my ADHD a little. They say you can't drink alcohol with it, but I binge drink every weekend (I really love alcohol) with no problems. SSRIs were an absolute train-wreck to be on; they made me angry and violent. I was on them for 10 years and I honestly don't believe it ever helped against depression. If I missed 1 day, I'd get the infamous "brain zaps". It took me about 3 months to taper off the damn things and it was a brutal 3 months. The last one was in October 2012 and I will never take them again. I did not experience any increase in depression either, so that makes a stronger case for them basically be worthless for me.
    • ssvss 4y ago
      How long did it take for Wellbutrin to work for you. I was on it for 2 months, it didn`t help, so I stopped.
      • y-c-o-m-b 4y ago
        It only took about a week. It wasn't a massive difference in mood, just a small boost, which is all I needed to get by.
    • ffwacom 4y ago
      >but I binge drink every weekend (I really love alcohol) with no problems this is almost certainly the cause of your 'depression'
• jonnycomputer 4y ago
  Some expert reactions to paper: https://www.sciencemediacentre.org/expert-reaction-to-a-review-paper-on-the-serotonin-theory-of-depression/ https://www.sciencemediacentre.org/expert-reaction-to-a-revi...
• hestefisk 4y ago
  So does this mean SSRIs don’t work?
• standardly 4y ago
  "I think depression is really caused by X, and anti-depressants are really just a placebo" It's tough to quantify the efficacy of AD's, especially given the differences in individual neurochemistry, but claiming they don't work at all, or that depression isn't even real, is plain ignorant. Everyone should be forced to watch Dr. Sapolsky's lecture before commenting on depression: https://www.youtube.com/watch?v=NOAgplgTxfc https://www.youtube.com/watch?v=NOAgplgTxfc
• smm11 4y ago
  I believe Vitamin D, sunshine itself, and not endlessly 'sitting around' can do wonders, too.
  • missedthecue 4y ago
    I wonder if the number of people regularly smoking pot and the number of people describing themselves as depressed have anything to do with each other. Both are lines straight up and to the right over the past 40 years.
• pizzathyme 4y ago
  Based on this, can anyone explain what treatment should be pursued if they are suffering with debilitating depression? I have a family member on SSRIs and therapy.
• mbrochh 4y ago
  Stop eating carbs, go out and get sunlight. Do mild but regular exercise. I got at least three people of AD medication with this and feel much better myself.
• n4r9 4y ago
  May be a little late to the party on this one, but this is a good summary of expert responses to the review article: https://www.sciencemediacentre.org/expert-reaction-to-a-review-paper-on-the-serotonin-theory-of-depression/?utm_source=pocket_mylist&ck_subscriber_id=962296342 https://www.sciencemediacentre.org/expert-reaction-to-a-revi...