4 ms·

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 a

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
  Sure, but it would be more constructive to explain why it's wrong. GP's comment has some interesting ideas and it would be better to directly refute them than just claiming they're "factually wrong".
  - klodolph 4y ago
    Sorry, thought it would be obvious. > Depression is a disease of despair, > The question is really how to address the despair. It's known that people have genetic predispositions to depression. People experience depression due to many causes. Not all causes are known and we don't have very good understanding of the mechanisms, but it's just not damn likely that we can treat this as a purely psychological / environmental issue.
- lettergram 4y ago
  No doubt, but this article is about how the SSRIs don’t seem to be effective. To be clear a disorder (ie depression disorder) can be caused by a variety of factors, including (but not limited to): genetics, environment, trauma, illness, etc. Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important. Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect. Which imo is why this is often not discussed. The vast majority of the research money is poured into drug research or clinical research around therapies. Often this overlooks other avenues — one which I mentioned.
  - amanaplanacanal 4y ago
    > this article is about how the SSRIs don’t seem to be effective. I believe they can be effective in reducing depression, it just has nothing to do with serotonin.
  - klodolph 4y ago
    > No doubt, but this article is about how the SSRIs don’t seem to be effective. Where does the article say that? > Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important. It's not for lack of trying. > Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect. That explanation doesn't have any legs. By this theory, dentists have no incentives for prophylaxis, but in practice, that's a large part of what dentists do and it's very effective. By this theory, the medical industry wouldn't choose to eradicate any infections diseases, since it can make money from treatment. It turns out we can and do eradicate infectious diseases, but it is difficult, expensive, and time-consuming. We've only successfully eradicated two infectious diseases and only one of those affects humans in the first place. If you look at other infectious diseases, there are tons of diseases which can be outright cured and tons which can't. This isn't for lack of trying, it's just that these diseases are different. You can kill bacteria with antibiotics, but if you get HIV, the best we can do is antiretroviral therapy. Treatment of symptoms with pharmaceuticals is often a rational, good decision. There are simply too many diseases for which we don't have any known cure. Depression is one of them. The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three. So we have stuff like SSRIs, which are known to work for some people.
Valakas_ 4y ago
There's one cause that is really hard to detect (unless you're informed about it) and that I suspect is behind a lot of people with depression. In fact it took me decades, and only by chance did I realise what it was: Emotional abuse / neglect, especially the one that occurs in childhood. * You feel something in life is lacking but dont know what, or blame yourself for it, or look for it in in thrill seeking activities, or through buying stuff to fulffill this emptiness, or you escape from this ever present painful feeling with addiction (hint of what that thing is: being really loved, not romantically loved, but actual unconditional love, the one that only healthy parents can give and which you feel in some way when you have a community behind you. Partial love given by a lot of people ends up almost feeling like parental unconditional love.) * Can't seem to make friends, or make friends but don't seem to connect at a deep level and end up feeling lonely anyway. * Also the cause of social anxiety. * Burnouts due to lack of boundaries (which also come from abuse). Feeling like you put others first all the time, and end up feeling somewhat fake. * (...) All of these can lead to depression. And they all have the same root-cause. And barely anybody talks about this (unless you go really looking for these communities, but unfortunately they're not really mainstream).

klodolph 4y ago

Bolts of lightning can be factually wrong, it sounds.

bwood 4y ago
Sure, but it would be more constructive to explain why it's wrong. GP's comment has some interesting ideas and it would be better to directly refute them than just claiming they're "factually wrong".
- klodolph 4y ago
  Sorry, thought it would be obvious. > Depression is a disease of despair, > The question is really how to address the despair. It's known that people have genetic predispositions to depression. People experience depression due to many causes. Not all causes are known and we don't have very good understanding of the mechanisms, but it's just not damn likely that we can treat this as a purely psychological / environmental issue.
lettergram 4y ago
No doubt, but this article is about how the SSRIs don’t seem to be effective. To be clear a disorder (ie depression disorder) can be caused by a variety of factors, including (but not limited to): genetics, environment, trauma, illness, etc. Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important. Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect. Which imo is why this is often not discussed. The vast majority of the research money is poured into drug research or clinical research around therapies. Often this overlooks other avenues — one which I mentioned.
- amanaplanacanal 4y ago
  > this article is about how the SSRIs don’t seem to be effective. I believe they can be effective in reducing depression, it just has nothing to do with serotonin.
- klodolph 4y ago
  > No doubt, but this article is about how the SSRIs don’t seem to be effective. Where does the article say that? > Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important. It's not for lack of trying. > Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders. Why would a therapist? Why would a pharmaceutical company? Recurring revenue to ease symptoms is perfect. That explanation doesn't have any legs. By this theory, dentists have no incentives for prophylaxis, but in practice, that's a large part of what dentists do and it's very effective. By this theory, the medical industry wouldn't choose to eradicate any infections diseases, since it can make money from treatment. It turns out we can and do eradicate infectious diseases, but it is difficult, expensive, and time-consuming. We've only successfully eradicated two infectious diseases and only one of those affects humans in the first place. If you look at other infectious diseases, there are tons of diseases which can be outright cured and tons which can't. This isn't for lack of trying, it's just that these diseases are different. You can kill bacteria with antibiotics, but if you get HIV, the best we can do is antiretroviral therapy. Treatment of symptoms with pharmaceuticals is often a rational, good decision. There are simply too many diseases for which we don't have any known cure. Depression is one of them. The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three. So we have stuff like SSRIs, which are known to work for some people.

Valakas_ 4y ago

There's one cause that is really hard to detect (unless you're informed about it) and that I suspect is behind a lot of people with depression. In fact it took me decades, and only by chance did I realise what it was: Emotional abuse / neglect, especially the one that occurs in childhood. * You feel something in life is lacking but dont know what, or blame yourself for it, or look for it in in thrill seeking activities, or through buying stuff to fulffill this emptiness, or you escape from this ever present painful feeling with addiction (hint of what that thing is: being really loved, not romantically loved, but actual unconditional love, the one that only healthy parents can give and which you feel in some way when you have a community behind you. Partial love given by a lot of people ends up almost feeling like parental unconditional love.) * Can't seem to make friends, or make friends but don't seem to connect at a deep level and end up feeling lonely anyway. * Also the cause of social anxiety. * Burnouts due to lack of boundaries (which also come from abuse). Feeling like you put others first all the time, and end up feeling somewhat fake. * (...) All of these can lead to depression. And they all have the same root-cause. And barely anybody talks about this (unless you go really looking for these communities, but unfortunately they're not really mainstream).