5 ms·

For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing. The "

For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing. The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects). I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Probably it's not because of the serotonin. They have weirdly different effects depending on the person. But there's something going on that we still don't understand. Both because we don't understand the whole mechanism of depression, nor WTF the SSRIs and SNRIs are doing in our mind and body. At least in my humble opinion.

sirsinsalot 4y ago
Depression, OCD, GAD, ADHD and most other neurological issues stem from complex feedback loops and deficiency in neurotransmitter systems. They're labels applied to symptoms, not causes. Like any complex system with feedback loops, sometimes intervention in the loop causes it to rebalance. Sometimes the loop break is an intervention in serotonin, sometimes dopamine, sometimes GABA. There is never a silver bullet. But there are bullets that make life manageable enough to break cyclic issues.
cameronh90 4y ago
I completely agree. I believe we have no idea how these drugs work at the moment. For one, serotonin receptors are _everywhere_, notably the gut, which also has a strong relationship with emotional state. And as you point out, they don't just affect serotonin. Given we have a whole bunch of drugs that attempt to be serotonin selective, but where each one affects different people in different ways, it seems likely to me that the non-serotonin effects are likely significant. Plus, what's the reason so many of us are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause? Why would a huge chunk of the population have a imbalance of brain chemicals? Ultimately I suspect my GAD/OCD is probably environmental, but environmental in a way that I can't easily identify or fix. Maybe it's the unnatural desk job oriented lifestyle I have, or maybe it's plastics in my blood, processed foods, lack of religion, social media or something else. Or maybe the neurotransmitters just sometimes need a kick up the arse to get them back into proper functioning. All I really know is sertraline helps me live a normal life, and for that I'm thankful.
- 4ggr0 4y ago
  > Why would a huge chunk of the population have a imbalance of brain chemicals? That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc. Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office robot who's able to work without getting too stressed out or distracted by other things. I suspect that I wouldn't need the meds if I had a different job. Which feels weird, because it sounds like I'm trying to fit into an environment, instead of being in an environment which fits me, if that makes sense. Then again, maybe everyone has to do that and it's just my biased perspective that I'm the one who's not made for it. Which sucks, because I love IT, also as a hobby. The easiest examples for that: Sometimes I do an IT project at home, maybe build a PC, configure a homelab, try out Stable Diffusion or edit videos from time to time. If I do these things at home I can easily sit in front of the computer for 5+ hours and loose track of time, but I don't seem to be able to be as focused for IT projects at work if I'm unmedicated. Unless they really interest me.
  - elemos 4y ago
    I believe the same thing. In fact, I believe people with ADD have a natural advantage in pre-modern settings. We are built to run long distances, outsmart prey, and forage. A distraction isn’t a distraction on that environment, it’s awareness and quickly thinking through possibilities and avenues of success.
    - RunSet 4y ago
      If anything it is more of an attention surplus than an attention deficit.
      - samtho 4y ago
        This is a point that Dr. Richard Barkley, one of the major researchers in ADHD in the last few decades, has stated slightly differently. In a sort of jest, he mentions that [ADD] should be called “intention deficit disorder” as there is plenty of attention to be given to things, sufferers just lack a lot intentionality behind their actions. This ultimately manifests as an executive disfunction which prevents this slice of the population from subconsciously knowing how to prioritize or assess the importance/value/urgency of stimuli.
twawaaay 4y ago
> The "depression is lack of serotonin" theories seem to have less and less base every day But that is not true. The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems. The problem with medication is that it treats the symptom (lack of serotonin) rather than the underlying problem (how did we get there in the first place?) Kinda like telling somebody to loose weight by restricting their diet before first understanding what caused them to gain fat in the first place. Is your diet composed of garbage? Why is it, is it because you can only cook garbage? Is it because you can't cook and only buy garbage? Is it because you sit whole day and don't exercise? Is it because you are getting depressed and make it up with food? The treatment should address the causes of the problem and not just the symptom.
- samtho 4y ago
  This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it is so? Maybe it’s because this person’s favorite breakfast is a bacon-maple donut which they habitually consume 5 days per week. What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower. We’ve optimized our efforts on treating symptoms and not causes. Drugs that survive regulatory scrutiny and are profitable tend to be those that treat symptoms of chronic illnesses. If you can prove that someone’s LDL goes down and they will buy it for the rest of their life, that’s a drug that will survive. They don’t have a miracle cure for this because they are withholding anything, there is just no incentive to research it and if there was, there is no good way to prove that drug X will cure non-visible condition Y without good, measurable data.
  - twawaaay 4y ago
    I think part of the reason is that there is lots of money in treating acute symptoms with medication while there isn't much in having serious talks with patients to try to debug their lifestyle problems that might be causing their health problems and then educate them on what and why they should be doing it. I also think people naturally tend towards easy and fast solutions even if those solutions are known not to work. This self imposed blissful ignorance is what causes people to keep buying weight loss supplements or go on diets even though both are known not to work while we know that for 99% of people there is a simple solution -- reduce stress, learn to like to eat healthy and exercise daily.

sirsinsalot 4y ago

Depression, OCD, GAD, ADHD and most other neurological issues stem from complex feedback loops and deficiency in neurotransmitter systems. They're labels applied to symptoms, not causes. Like any complex system with feedback loops, sometimes intervention in the loop causes it to rebalance. Sometimes the loop break is an intervention in serotonin, sometimes dopamine, sometimes GABA. There is never a silver bullet. But there are bullets that make life manageable enough to break cyclic issues.

cameronh90 4y ago

I completely agree. I believe we have no idea how these drugs work at the moment. For one, serotonin receptors are _everywhere_, notably the gut, which also has a strong relationship with emotional state. And as you point out, they don't just affect serotonin. Given we have a whole bunch of drugs that attempt to be serotonin selective, but where each one affects different people in different ways, it seems likely to me that the non-serotonin effects are likely significant. Plus, what's the reason so many of us are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause? Why would a huge chunk of the population have a imbalance of brain chemicals? Ultimately I suspect my GAD/OCD is probably environmental, but environmental in a way that I can't easily identify or fix. Maybe it's the unnatural desk job oriented lifestyle I have, or maybe it's plastics in my blood, processed foods, lack of religion, social media or something else. Or maybe the neurotransmitters just sometimes need a kick up the arse to get them back into proper functioning. All I really know is sertraline helps me live a normal life, and for that I'm thankful.

4ggr0 4y ago
> Why would a huge chunk of the population have a imbalance of brain chemicals? That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc. Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office robot who's able to work without getting too stressed out or distracted by other things. I suspect that I wouldn't need the meds if I had a different job. Which feels weird, because it sounds like I'm trying to fit into an environment, instead of being in an environment which fits me, if that makes sense. Then again, maybe everyone has to do that and it's just my biased perspective that I'm the one who's not made for it. Which sucks, because I love IT, also as a hobby. The easiest examples for that: Sometimes I do an IT project at home, maybe build a PC, configure a homelab, try out Stable Diffusion or edit videos from time to time. If I do these things at home I can easily sit in front of the computer for 5+ hours and loose track of time, but I don't seem to be able to be as focused for IT projects at work if I'm unmedicated. Unless they really interest me.
- elemos 4y ago
  I believe the same thing. In fact, I believe people with ADD have a natural advantage in pre-modern settings. We are built to run long distances, outsmart prey, and forage. A distraction isn’t a distraction on that environment, it’s awareness and quickly thinking through possibilities and avenues of success.
  - RunSet 4y ago
    If anything it is more of an attention surplus than an attention deficit.
    - samtho 4y ago
      This is a point that Dr. Richard Barkley, one of the major researchers in ADHD in the last few decades, has stated slightly differently. In a sort of jest, he mentions that [ADD] should be called “intention deficit disorder” as there is plenty of attention to be given to things, sufferers just lack a lot intentionality behind their actions. This ultimately manifests as an executive disfunction which prevents this slice of the population from subconsciously knowing how to prioritize or assess the importance/value/urgency of stimuli.

twawaaay 4y ago

> The "depression is lack of serotonin" theories seem to have less and less base every day But that is not true. The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems. The problem with medication is that it treats the symptom (lack of serotonin) rather than the underlying problem (how did we get there in the first place?) Kinda like telling somebody to loose weight by restricting their diet before first understanding what caused them to gain fat in the first place. Is your diet composed of garbage? Why is it, is it because you can only cook garbage? Is it because you can't cook and only buy garbage? Is it because you sit whole day and don't exercise? Is it because you are getting depressed and make it up with food? The treatment should address the causes of the problem and not just the symptom.

samtho 4y ago
This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it is so? Maybe it’s because this person’s favorite breakfast is a bacon-maple donut which they habitually consume 5 days per week. What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower. We’ve optimized our efforts on treating symptoms and not causes. Drugs that survive regulatory scrutiny and are profitable tend to be those that treat symptoms of chronic illnesses. If you can prove that someone’s LDL goes down and they will buy it for the rest of their life, that’s a drug that will survive. They don’t have a miracle cure for this because they are withholding anything, there is just no incentive to research it and if there was, there is no good way to prove that drug X will cure non-visible condition Y without good, measurable data.
- twawaaay 4y ago
  I think part of the reason is that there is lots of money in treating acute symptoms with medication while there isn't much in having serious talks with patients to try to debug their lifestyle problems that might be causing their health problems and then educate them on what and why they should be doing it. I also think people naturally tend towards easy and fast solutions even if those solutions are known not to work. This self imposed blissful ignorance is what causes people to keep buying weight loss supplements or go on diets even though both are known not to work while we know that for 99% of people there is a simple solution -- reduce stress, learn to like to eat healthy and exercise daily.