4 ms·

You nicely comment on an important point. To non-psychiatrists depression is a synonym for sadness. To a psychiatrist depression is more about the functional

You nicely comment on an important point. To non-psychiatrists depression is a synonym for sadness. To a psychiatrist depression is more about the functional impairment (social occupational effects). How sad you are is only a tiny part of how clinically "depressed" you are! Check out how depression is graded in research and clinical practice. * https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d https://www.mdcalc.com/calc/10043/hamilton-depression-rating... * https://www.mdcalc.com/calc/4058/montgomery-asberg-depression-rating-scale-madrs https://www.mdcalc.com/calc/4058/montgomery-asberg-depressio... * https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9 https://www.mdcalc.com/calc/1725/phq9-patient-health-questio... (sadness isn't even the first question for the PHQ9!) You could have a wildly effective antidepressants that doesn't make you happy, or you could be crushingly sad and not depressed (subclinical depression).[0] [0] https://pubmed.ncbi.nlm.nih.gov/18688776/ https://pubmed.ncbi.nlm.nih.gov/18688776/

echlebek 4y ago
What if they weren't sad? What if they were depressed, but the cause of their depression was situational rather than a chemical imbalance? Isn't that possible?
- spoiler 4y ago
  Didn't recent research show that's it's usually not a simple case of "chemical imbalance". So, antidepressants on their own won't do much. Maybe getting kicked out of this "unhealthy homeostasis" by medications helps some people find new ways of coping/perceiving their life, but AFAIK that's not the default case. So, they should be administered with therapy (and no, I don't consider therapy seeing them once every two months to renew your subscription lol)
  - psychphysic 4y ago
    No one in recent history thought it was a chemical imbalance. But there was a recent paper on it yes. Here's a real mind bender. In social anxiety (at least), people on the same antidepressants will have detectable differences in neurochemicals based on if they were told the pills would work, or won't work. Mind bender. https://www.nature.com/articles/s41398-021-01682-3 https://www.nature.com/articles/s41398-021-01682-3
thrownawaydad 4y ago
This is an excellent point. Thanks for the links. I will note that the first says I'm normal even though I sometimes feel like "life is not worth living" and my condition has definitely had a significant negative effect on my productivity. Life-long and probably life-changing. As an N=1 report, I've been taking the Zembrin supplement (per the Astral Codex guy) for about a year, and it does _seem_ to knock out the sadness component. But this leaves the "unproductive" component, which is sometimes just a small drag, and at other times leaves me almost catatonic. Alcohol mostly fixes that, but has other problems, and I've lately quit. No specific advice other than to just keep reading and experimenting. And if you're in a bad life situation, try to get out of it.
wincy 4y ago
Hey thanks for that! I tried to remember what I was like ten years ago and was definitely “severely depressed”, the first link said that. I was constantly agitated and anxious, had insomnia, would call people crying at 3am, and was obsessed with thinking I had some terrible illness all the time. Despite some mild anxiety the same rubric says I’m normal now, so that’s nice. The Adderall doesn’t really improve my mood so much as it lets me accomplish the things I need to do in a day, so instead of having a bad feeling in the pit of my stomach like the sword of Damocles over my head, I can relax. Most interesting to me is how I was completely self absorbed and only had myself to worry about, and now that I have a wife and kids, I was less depressed in the years we didn’t know if our young daughter would make it to adulthood due to illness. My remembered experience is that my mid-20s when I was flunking out of college and playing WoW 60+ hours a week was a way more painful time in my life.

echlebek 4y ago

What if they weren't sad? What if they were depressed, but the cause of their depression was situational rather than a chemical imbalance? Isn't that possible?

spoiler 4y ago
Didn't recent research show that's it's usually not a simple case of "chemical imbalance". So, antidepressants on their own won't do much. Maybe getting kicked out of this "unhealthy homeostasis" by medications helps some people find new ways of coping/perceiving their life, but AFAIK that's not the default case. So, they should be administered with therapy (and no, I don't consider therapy seeing them once every two months to renew your subscription lol)
- psychphysic 4y ago
  No one in recent history thought it was a chemical imbalance. But there was a recent paper on it yes. Here's a real mind bender. In social anxiety (at least), people on the same antidepressants will have detectable differences in neurochemicals based on if they were told the pills would work, or won't work. Mind bender. https://www.nature.com/articles/s41398-021-01682-3 https://www.nature.com/articles/s41398-021-01682-3

thrownawaydad 4y ago

This is an excellent point. Thanks for the links. I will note that the first says I'm normal even though I sometimes feel like "life is not worth living" and my condition has definitely had a significant negative effect on my productivity. Life-long and probably life-changing. As an N=1 report, I've been taking the Zembrin supplement (per the Astral Codex guy) for about a year, and it does _seem_ to knock out the sadness component. But this leaves the "unproductive" component, which is sometimes just a small drag, and at other times leaves me almost catatonic. Alcohol mostly fixes that, but has other problems, and I've lately quit. No specific advice other than to just keep reading and experimenting. And if you're in a bad life situation, try to get out of it.

wincy 4y ago

Hey thanks for that! I tried to remember what I was like ten years ago and was definitely “severely depressed”, the first link said that. I was constantly agitated and anxious, had insomnia, would call people crying at 3am, and was obsessed with thinking I had some terrible illness all the time. Despite some mild anxiety the same rubric says I’m normal now, so that’s nice. The Adderall doesn’t really improve my mood so much as it lets me accomplish the things I need to do in a day, so instead of having a bad feeling in the pit of my stomach like the sword of Damocles over my head, I can relax. Most interesting to me is how I was completely self absorbed and only had myself to worry about, and now that I have a wife and kids, I was less depressed in the years we didn’t know if our young daughter would make it to adulthood due to illness. My remembered experience is that my mid-20s when I was flunking out of college and playing WoW 60+ hours a week was a way more painful time in my life.