9 ms·

SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manif

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.
  - zeckalpha 4y ago
    I don't think we're disagreeing. Increasing duration spent in one place doesn't change the total count of the molecule. SSRIs don't make the body produce more. That's okay, they work by other means.
- arsome 4y ago
  The S for Selective actually means it only works on serotonin, compared with say, an SNRI, which works on both serotonin and norepinephrine. Impacting the overall values is in fact pretty much the only thing it does.
  - eurasiantiger 4y ago
    This is true, but inaccurate, as it only accounts for the direct effects. However, increased serotonin receptor agonism also increases downstream dopamine and norepinephrine release.
  - zeckalpha 4y ago
    SRIs are a separate class of drugs: https://en.m.wikipedia.org/wiki/Serotonin_reuptake_inhibitor https://en.m.wikipedia.org/wiki/Serotonin_reuptake_inhibitor
petesergeant 4y ago
> the pop-culture misunderstandings about "low serotonin" Let’s be clear though, I had an actual licensed psychiatrist say this to me last week. It’s not like people are getting this “pop-culture” information via blog articles…
- dymk 4y ago
  It's possible the psychiatrist is using "low serotonin" as a simple shorthand meant for the layperson
  - readthenotes1 4y ago
  - techdragon 4y ago
    Or like many practicing medical professionals in many specialties where the patient demand is high enough to fill their week ... they don't have time to keep abreast of current research in their field and since they aren't required to, they just don't. There is usually some required ongoing professional development but that is in no way designed to ensure they keep up with current research consensus, more that they don't continue doing things the old way when we know about newer better ways.
    - JamesBarney 4y ago
      This psychiatrist is either an lazy, an idiot or using shorthand. Anyone who spent even in a couple hours reading about depression (one of the most common ailments) in the last decade knows that low serotonin is not the cause of depression.
      - techdragon 4y ago
        I’d agree with your assessment. It was just an opportune time to mention that they may not be familiar with recent research results. But you’re absolutely right, they should know this one.
deleted 4y ago
[deleted]
jazzyjackson 4y ago
> the pop-culture misunderstandings You mean the TV commercials that played about 6 times per hour in the 00s explaining that depression is caused by a chemical imbalance ?
- pessimizer 4y ago
  A pill with a smiley face.
Mo3 4y ago
Funnily enough the one I used to take (Escitalopram) apparently has been found to begin permanently altering brain function after only a few hours of first ingestion. I was pretty happy with it. No pun intended
- ratww 4y ago
  Also a happy customer of that one. It worked great for me even with a low dosage and didn’t otherwise negatively impact anything else.
  - coffee_beqn 4y ago
    How long were you on and what made you go off it? Four months in I’m feeling better now but I don’t think I want to take it forever
    - Mo3 4y ago
      Not comment OP but I got off recently after about 1.5 years - still very happy :) Although admittedly I did have some infrequent spouts of rebound symptoms for a few weeks, but those were pretty manageable. Also, kind of happy to be off it right now honestly, heat is something that doesn’t go along well at all with SSRIs.
    - ratww 4y ago
      For me it was around the same time Mo3 mentioned they took, maybe a bit more than one year and a half. It's been long, so I don't remember precisely. However I was in a quite sorry state before... I was having several panic attacks a week. My therapy alone was also not working well, I was doing twice a week. After starting it, everything started falling into place. I never had a panic attack again. I never had any downside whatsoever from taking them (didn't know they don't go well with summer!), including the regular complaints, it wasn't really a burden on me other than having to buy them monthly and take them every day.
      - janeerie 4y ago
tsimionescu 4y ago
> 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. The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that his training explicitly made this claim, that his textbooks make this claim, and that he himself was later passing it down to other students. Other sources quoted by the news article are similar to your own claims. Overall, it sounds like there are camps in psychiatry that have indeed long abandoned this theory, but others who still hold onto it. Furthermore, the meta analysis being talked about in the article does make the additional claim that SSRIs are perhaps not necessary for the treatment of depression. I don't believe they are right, but it's also misleading to suggest that theur research is entirely in line with psychiatric orthodoxy.
- PragmaticPulp 4y ago
  To be clear: The serotonin deficiency hypothesis has been floated for a long time as one of the possible underlying changes involved in depression etiology. It’s not even a stretch, given that we can find upregulations of the serotonin transporter in response to chronic unpredictable mild stress, the fact that 5-HTP (serotonin precursors) supplementation can boost mood, and the fact that many drugs of abuse operate through serotonin receptors to alter mood. However, like I said in my post above, we’ve know for decades that it’s not the explanation because SSRIs boost extrasynaptic serotonin levels within hours but their therapeutic efficacy is famously delayed by weeks. I suppose it’s possible that the author had some weird textbook that misrepresented the state of research, or that he misunderstood the relative confidence and significant of each theory presented. However, the state of research didn’t even believe that the serotonin hypothesis of depression was the full, accurate explanation when SSRIs were introduced for the reasons I stated above and more.
  - hn8305823 4y ago
    I've tried lots of natural anti-depressant remedies. Background: I've suffered with major depression my entire life with frequent suicidal ideation and several near-suicides. It's fairly seasonal and wile it happens throughout the year the worst time is in the winter near the solstice. I've also struggled with difficulty falling asleep since very young childhood, though that has gotten somewhat better with age (over 50 now). ** warning ** If you are on any prescription anti-depressants, don't stop taking them or modify your routine without talking to your doctor first. 5-HTP: nasty side effects from unwanted metabolism in the gut and excess serotonin levels in the brain that border on serotonin syndrome sometimes. After the initial 8 hours or so of bad side effects the anti-depressant effects last for about two days followed by a very hard crash on day 3. During the 2 "good" days the quality of the effect is a bit "off" and gives me an unusually "comfortable feeling" that is while much better than depression is not the most productive or normal feeling (see melatonin below for contrast). Be extremely careful with 5-HTP, serious serotonin syndrome can easily develop, especially if you are on other anti-depressants and can be fatal. I don't take 5-HTP anymore because of these side effects and better options (below). THC: Very effective during use (edibles = 4-6 hours), but tolerance levels build requiring higher doses. mild anti-depressant effects trail off gradually after day or two and quality is generally good. Of course cannabis has some side effects: short term memory impairment, general slight cognitive reduction but I have found these side effects can be virtually eliminated with L-Dopa (see below) L-Dopa: Taken with vitamin B-6, this is one of the few things I have found that enhances the cannabis experience rather than taking away from it. This increases dopamine levels in the brain which enhances the high and for me also seems to miraculously eliminate the side effects of cannabis (maybe this is due to offsetting dopamine depletion by THC?). I have also found that L-Dopa even seems to increase general cognitive functioning beyond undoing the effects of THC (maybe reversing age related degredation? It makes my brain feel like it did when I was 18). L-Dopa does have serious side effects however: It dramatically and seriously increases anxiety/paranoia for several hours so I only take it with cannabis edibles and even then not every time, no more than once per week. It's very important to know how to manage paranoia since THC also frequently triggers paranoia and the L-Dopa seems to amplify that. My method is to consciously and affirmatively "acknowledge and disregard" any paranoid or anxiety related thoughts. I have found that once I consciously identify and acknowledge certain thoughts are caused by the drugs/supplements and are not real (or as important as they seem), they disappear and everything is ok. Melatonin: This is by far the best anti-depressant I have ever used. Essentially no side effects other than putting you to sleep 30 mins after use, which when taken before bed is a huge plus (I have had difficulty falling asleep my entire life). Anti-depressant effects last for a few days, gradually trailing off without the hard crash of 5-HTP. The quality of the effect is also excellent (much better than 5-HTP). The best way I can describe it is "feeling healthy, energetic yet relaxed, and normal" most of the time. It's like a miracle drug, at least for me. I take 5mg every 3-4 days as needed.
bergenty 4y ago
I think you’re throwing the baby out with the bath water here. Sure depression may not be linked to low serotonin levels but it almost certainly some chemical imbalance of some variety.
- bencollier49 4y ago
  Metabolism and stress hormones both seem to play a role. It's going to be a very complex thing - the best treatment for a lot of brain conditions is just exercise.
  - belorn 4y ago
    The key word when using exercise to treat stress is that it need to be voluntary (ie, something that the person want to do). Forcing oneself to exercise has the opposite result with increased corticosterone levels. Exercise is great if and only if the individual is doing something they enjoy.
- sneak 4y ago
  That's vague enough to be a totally useless description. Dehydration is also a "chemical imbalance of some variety".
  - bergenty 4y ago
    I think that’s part of the point. Whatever it is, it’s a chemical imbalance. Just need to find which one. In the case of dehydration it’s water.
    - s1artibartfast 4y ago
      I think the point is anything can be a chemical process because we are chemical beings. Drowning or having your leg cut off leads to a chemical imbalance, but chemistry isn't always the most productive lens to analyze the problem
      - 4y ago
heavyset_go 4y ago
To add to this, SSRI onset efficacy corresponds with the downregulation of serotonin receptors in the brain. "Low serotonin" isn't what's being treated or changed, but the number of receptors and their activation rates. SSRIs can reduce emotional lability, which makes sense when you figure that downregulation and increased activation of serotonin receptors is a relatively stable system compared to an unmedicated brain with many receptors and widely fluxuating activation rates and lowered activation periods as serotonin gets recycled quickly without its transporter being inhibited.
- valec 4y ago
  i think it corresponds most exactly with the desensitization of dendritic autoreceptors
  - heavyset_go 4y ago
    Yeah, downregulation is one of the last steps in desensitization.
spaceman_2020 4y ago
Sertraline suplementation wiped out depression almost completely from my system within two months. I had been depressed earlier for half a decade. Its been nearly 8 years since I took sertraline (stopped within 3 months) and I haven't had a depressive episode since.
- agumonkey 4y ago
  Was your ailment caused by events ? or something that creeped up invisibly ? I'm often worried about neurochemical solutions if some part of your brain is still associating events/memories/ideas with pain.
  - spaceman_2020 4y ago
    It was likely a combination of several things. I had moved to a new country after high school for college. The college also happened to be in an extremely cold part of the country, and I joined in the winter semester. Culture shock, being alone in a new country, seasonal affective disorder (I come from a warm tropical country), being in a long distance relationship - they all likely contributed. I also made some pretty bad career moves immediately afterwards, which likely didn’t help.
marincounty 4y ago
I'm pretty sure I'm hell banned, but forget about all the chemicals of the brain. Read anything by Irving Kirsch. He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All. He found they basically don't work better than Placebo. Personally, I think the "Happy" drugs have been the biggest con job the American suffering have ever endured. At least we know opioids work--for awhile. Antidepesssnts just make Dr. Wealthy more wealthy. My hope is most of these wonder drugs are sued into history, along with those mandatory doctor office visits. Ask yourself this--why do Psychiatrists have the highest rate of suicide if these drugs work? I'm glad we have residents whom picked an easy speciality upon graduation, but these drugs have such low efficy rates they should be illegal, or over the counter, with the exception of a few. Trazadone can be nasty. A bad reaction is cured by a needle to the middle part of the brain. Most are easy on the body, but don't do anything besides make an Artist (Medicine is an art, and Psychiatrists are the milking to the bone.) wealthy. God help our suffering Americans.
- skjoldr 4y ago
  You shouldn't talk about drugs you have zero experience with either as a doctor or as a patient. SSRIs do work.
  - epups 4y ago
    Only for severe depression, if you take into account all clinical trials - including the ones buried by pharma companies. This is the work by Irving Kirsch being referenced here, and it's excellent.
    - butlerm 4y ago
      Spraying water on your house usually doesn't accomplish very much unless your house is on fire. But if your house really is on fire, it is likely the only thing that works.
carlmr 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. This for me doesn't seem logical. It could be that a long term imbalance makes you depressed, and reverting that imbalance takes time to affect the thought processes towards the positive. Only because the reaction is delayed, it doesn't mean it's not causal.
- malfist 4y ago
  There's a lot of evidence around hippocampus size in depressed patients. They tend to be smaller than average. After 6 months to a year of treatment with antidepressants the hippocampus grows to a larger size. It's speculated that hippocampus size might be one of the driving components of depression, but who knows. Mental illness is complex.

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.
- zeckalpha 4y ago
  I don't think we're disagreeing. Increasing duration spent in one place doesn't change the total count of the molecule. SSRIs don't make the body produce more. That's okay, they work by other means.
arsome 4y ago
The S for Selective actually means it only works on serotonin, compared with say, an SNRI, which works on both serotonin and norepinephrine. Impacting the overall values is in fact pretty much the only thing it does.
- eurasiantiger 4y ago
  This is true, but inaccurate, as it only accounts for the direct effects. However, increased serotonin receptor agonism also increases downstream dopamine and norepinephrine release.
- zeckalpha 4y ago
  SRIs are a separate class of drugs: https://en.m.wikipedia.org/wiki/Serotonin_reuptake_inhibitor https://en.m.wikipedia.org/wiki/Serotonin_reuptake_inhibitor

petesergeant 4y ago

> the pop-culture misunderstandings about "low serotonin" Let’s be clear though, I had an actual licensed psychiatrist say this to me last week. It’s not like people are getting this “pop-culture” information via blog articles…

dymk 4y ago
It's possible the psychiatrist is using "low serotonin" as a simple shorthand meant for the layperson
- readthenotes1 4y ago
- techdragon 4y ago
  Or like many practicing medical professionals in many specialties where the patient demand is high enough to fill their week ... they don't have time to keep abreast of current research in their field and since they aren't required to, they just don't. There is usually some required ongoing professional development but that is in no way designed to ensure they keep up with current research consensus, more that they don't continue doing things the old way when we know about newer better ways.
  - JamesBarney 4y ago
    This psychiatrist is either an lazy, an idiot or using shorthand. Anyone who spent even in a couple hours reading about depression (one of the most common ailments) in the last decade knows that low serotonin is not the cause of depression.
    - techdragon 4y ago
      I’d agree with your assessment. It was just an opportune time to mention that they may not be familiar with recent research results. But you’re absolutely right, they should know this one.

deleted 4y ago

[deleted]

jazzyjackson 4y ago

> the pop-culture misunderstandings You mean the TV commercials that played about 6 times per hour in the 00s explaining that depression is caused by a chemical imbalance ?

pessimizer 4y ago
A pill with a smiley face.

Mo3 4y ago

Funnily enough the one I used to take (Escitalopram) apparently has been found to begin permanently altering brain function after only a few hours of first ingestion. I was pretty happy with it. No pun intended

ratww 4y ago
Also a happy customer of that one. It worked great for me even with a low dosage and didn’t otherwise negatively impact anything else.
- coffee_beqn 4y ago
  How long were you on and what made you go off it? Four months in I’m feeling better now but I don’t think I want to take it forever
  - Mo3 4y ago
    Not comment OP but I got off recently after about 1.5 years - still very happy :) Although admittedly I did have some infrequent spouts of rebound symptoms for a few weeks, but those were pretty manageable. Also, kind of happy to be off it right now honestly, heat is something that doesn’t go along well at all with SSRIs.
  - ratww 4y ago
    For me it was around the same time Mo3 mentioned they took, maybe a bit more than one year and a half. It's been long, so I don't remember precisely. However I was in a quite sorry state before... I was having several panic attacks a week. My therapy alone was also not working well, I was doing twice a week. After starting it, everything started falling into place. I never had a panic attack again. I never had any downside whatsoever from taking them (didn't know they don't go well with summer!), including the regular complaints, it wasn't really a burden on me other than having to buy them monthly and take them every day.
    - janeerie 4y ago

tsimionescu 4y ago

> 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. The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that his training explicitly made this claim, that his textbooks make this claim, and that he himself was later passing it down to other students. Other sources quoted by the news article are similar to your own claims. Overall, it sounds like there are camps in psychiatry that have indeed long abandoned this theory, but others who still hold onto it. Furthermore, the meta analysis being talked about in the article does make the additional claim that SSRIs are perhaps not necessary for the treatment of depression. I don't believe they are right, but it's also misleading to suggest that theur research is entirely in line with psychiatric orthodoxy.

PragmaticPulp 4y ago
To be clear: The serotonin deficiency hypothesis has been floated for a long time as one of the possible underlying changes involved in depression etiology. It’s not even a stretch, given that we can find upregulations of the serotonin transporter in response to chronic unpredictable mild stress, the fact that 5-HTP (serotonin precursors) supplementation can boost mood, and the fact that many drugs of abuse operate through serotonin receptors to alter mood. However, like I said in my post above, we’ve know for decades that it’s not the explanation because SSRIs boost extrasynaptic serotonin levels within hours but their therapeutic efficacy is famously delayed by weeks. I suppose it’s possible that the author had some weird textbook that misrepresented the state of research, or that he misunderstood the relative confidence and significant of each theory presented. However, the state of research didn’t even believe that the serotonin hypothesis of depression was the full, accurate explanation when SSRIs were introduced for the reasons I stated above and more.
- hn8305823 4y ago
  I've tried lots of natural anti-depressant remedies. Background: I've suffered with major depression my entire life with frequent suicidal ideation and several near-suicides. It's fairly seasonal and wile it happens throughout the year the worst time is in the winter near the solstice. I've also struggled with difficulty falling asleep since very young childhood, though that has gotten somewhat better with age (over 50 now). ** warning ** If you are on any prescription anti-depressants, don't stop taking them or modify your routine without talking to your doctor first. 5-HTP: nasty side effects from unwanted metabolism in the gut and excess serotonin levels in the brain that border on serotonin syndrome sometimes. After the initial 8 hours or so of bad side effects the anti-depressant effects last for about two days followed by a very hard crash on day 3. During the 2 "good" days the quality of the effect is a bit "off" and gives me an unusually "comfortable feeling" that is while much better than depression is not the most productive or normal feeling (see melatonin below for contrast). Be extremely careful with 5-HTP, serious serotonin syndrome can easily develop, especially if you are on other anti-depressants and can be fatal. I don't take 5-HTP anymore because of these side effects and better options (below). THC: Very effective during use (edibles = 4-6 hours), but tolerance levels build requiring higher doses. mild anti-depressant effects trail off gradually after day or two and quality is generally good. Of course cannabis has some side effects: short term memory impairment, general slight cognitive reduction but I have found these side effects can be virtually eliminated with L-Dopa (see below) L-Dopa: Taken with vitamin B-6, this is one of the few things I have found that enhances the cannabis experience rather than taking away from it. This increases dopamine levels in the brain which enhances the high and for me also seems to miraculously eliminate the side effects of cannabis (maybe this is due to offsetting dopamine depletion by THC?). I have also found that L-Dopa even seems to increase general cognitive functioning beyond undoing the effects of THC (maybe reversing age related degredation? It makes my brain feel like it did when I was 18). L-Dopa does have serious side effects however: It dramatically and seriously increases anxiety/paranoia for several hours so I only take it with cannabis edibles and even then not every time, no more than once per week. It's very important to know how to manage paranoia since THC also frequently triggers paranoia and the L-Dopa seems to amplify that. My method is to consciously and affirmatively "acknowledge and disregard" any paranoid or anxiety related thoughts. I have found that once I consciously identify and acknowledge certain thoughts are caused by the drugs/supplements and are not real (or as important as they seem), they disappear and everything is ok. Melatonin: This is by far the best anti-depressant I have ever used. Essentially no side effects other than putting you to sleep 30 mins after use, which when taken before bed is a huge plus (I have had difficulty falling asleep my entire life). Anti-depressant effects last for a few days, gradually trailing off without the hard crash of 5-HTP. The quality of the effect is also excellent (much better than 5-HTP). The best way I can describe it is "feeling healthy, energetic yet relaxed, and normal" most of the time. It's like a miracle drug, at least for me. I take 5mg every 3-4 days as needed.

bergenty 4y ago

I think you’re throwing the baby out with the bath water here. Sure depression may not be linked to low serotonin levels but it almost certainly some chemical imbalance of some variety.

bencollier49 4y ago
Metabolism and stress hormones both seem to play a role. It's going to be a very complex thing - the best treatment for a lot of brain conditions is just exercise.
- belorn 4y ago
  The key word when using exercise to treat stress is that it need to be voluntary (ie, something that the person want to do). Forcing oneself to exercise has the opposite result with increased corticosterone levels. Exercise is great if and only if the individual is doing something they enjoy.
sneak 4y ago
That's vague enough to be a totally useless description. Dehydration is also a "chemical imbalance of some variety".
- bergenty 4y ago
  I think that’s part of the point. Whatever it is, it’s a chemical imbalance. Just need to find which one. In the case of dehydration it’s water.
  - s1artibartfast 4y ago
    I think the point is anything can be a chemical process because we are chemical beings. Drowning or having your leg cut off leads to a chemical imbalance, but chemistry isn't always the most productive lens to analyze the problem
    - 4y ago

heavyset_go 4y ago

To add to this, SSRI onset efficacy corresponds with the downregulation of serotonin receptors in the brain. "Low serotonin" isn't what's being treated or changed, but the number of receptors and their activation rates. SSRIs can reduce emotional lability, which makes sense when you figure that downregulation and increased activation of serotonin receptors is a relatively stable system compared to an unmedicated brain with many receptors and widely fluxuating activation rates and lowered activation periods as serotonin gets recycled quickly without its transporter being inhibited.

valec 4y ago
i think it corresponds most exactly with the desensitization of dendritic autoreceptors
- heavyset_go 4y ago
  Yeah, downregulation is one of the last steps in desensitization.

spaceman_2020 4y ago

Sertraline suplementation wiped out depression almost completely from my system within two months. I had been depressed earlier for half a decade. Its been nearly 8 years since I took sertraline (stopped within 3 months) and I haven't had a depressive episode since.

agumonkey 4y ago
Was your ailment caused by events ? or something that creeped up invisibly ? I'm often worried about neurochemical solutions if some part of your brain is still associating events/memories/ideas with pain.
- spaceman_2020 4y ago
  It was likely a combination of several things. I had moved to a new country after high school for college. The college also happened to be in an extremely cold part of the country, and I joined in the winter semester. Culture shock, being alone in a new country, seasonal affective disorder (I come from a warm tropical country), being in a long distance relationship - they all likely contributed. I also made some pretty bad career moves immediately afterwards, which likely didn’t help.

marincounty 4y ago

I'm pretty sure I'm hell banned, but forget about all the chemicals of the brain. Read anything by Irving Kirsch. He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All. He found they basically don't work better than Placebo. Personally, I think the "Happy" drugs have been the biggest con job the American suffering have ever endured. At least we know opioids work--for awhile. Antidepesssnts just make Dr. Wealthy more wealthy. My hope is most of these wonder drugs are sued into history, along with those mandatory doctor office visits. Ask yourself this--why do Psychiatrists have the highest rate of suicide if these drugs work? I'm glad we have residents whom picked an easy speciality upon graduation, but these drugs have such low efficy rates they should be illegal, or over the counter, with the exception of a few. Trazadone can be nasty. A bad reaction is cured by a needle to the middle part of the brain. Most are easy on the body, but don't do anything besides make an Artist (Medicine is an art, and Psychiatrists are the milking to the bone.) wealthy. God help our suffering Americans.

skjoldr 4y ago
You shouldn't talk about drugs you have zero experience with either as a doctor or as a patient. SSRIs do work.
- epups 4y ago
  Only for severe depression, if you take into account all clinical trials - including the ones buried by pharma companies. This is the work by Irving Kirsch being referenced here, and it's excellent.
  - butlerm 4y ago
    Spraying water on your house usually doesn't accomplish very much unless your house is on fire. But if your house really is on fire, it is likely the only thing that works.

carlmr 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. This for me doesn't seem logical. It could be that a long term imbalance makes you depressed, and reverting that imbalance takes time to affect the thought processes towards the positive. Only because the reaction is delayed, it doesn't mean it's not causal.

malfist 4y ago
There's a lot of evidence around hippocampus size in depressed patients. They tend to be smaller than average. After 6 months to a year of treatment with antidepressants the hippocampus grows to a larger size. It's speculated that hippocampus size might be one of the driving components of depression, but who knows. Mental illness is complex.