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On an academic level, we have reined in much of the excess enthusiasm in antidepressants that was courtesy of 90s-era pharmaceutical reps and ad men, but I don'

On an academic level, we have reined in much of the excess enthusiasm in antidepressants that was courtesy of 90s-era pharmaceutical reps and ad men, but I don't think this revision ever occurred in the cultural consciousness at large.

D-Machine 1mo ago
Yup, I would agree. The meta-research / methodological research and awareness here is really quite impressive, even though its conclusions are a bit grim and not well-known.
- jakebol 1mo ago
  A good book on this is Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. Describing the history of how many of these classes of drugs came about is pretty eye opening, I would say the book is pretty nuanced in its conclusions. https://www.goodreads.com/en/book/show/40180010-mind-fixers https://www.goodreads.com/en/book/show/40180010-mind-fixers The title is a play on the Pulitzer prize winning article from the 80's. https://web.archive.org/web/20041125092022/http://www.bylinefranklin.com/writing/mindfixers.htm https://web.archive.org/web/20041125092022/http://www.byline...
zer00eyz 1mo ago
Have we reigned in the number of perscriptions? Because the 1 in 10 stat I find seems a bit low, at least in my circle, and those are the ones who are open about it. And the people I know have been on them approximately a decade. What baffles me is that a fair number of them triggered their own depressive episodes, and likely did need therapy and something at the time - but have all long since move past those "moments".
- D-Machine 1mo ago
  I am not sure, but recommendations to prescribe in mild cases have quietly been reigned in a bit by e.g. NICE https://www.nice.org.uk/guidance/ng222/chapter/Recommendations https://www.nice.org.uk/guidance/ng222/chapter/Recommendatio....
Rendello 1mo ago
See also: The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence (2022). It's worth reading the introduction and results in full, but here are two important quotes (footnote markers removed): > Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without, and methods to reduce serotonin availability using tryptophan depletion do not consistently lower mood in volunteers. High quality, well-powered genetic studies effectively exclude an association between genotypes related to the serotonin system and depression, including a proposed interaction with stress. > The chemical imbalance theory of depression is still put forward by professionals, and the serotonin theory, in particular, has formed the basis of a considerable research effort over the last few decades. The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities, and this belief shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood. The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue anti-depressant medication and may discourage people from dis-continuing treatment, potentially leading to lifelong dependence on these drugs. https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0
- zdragnar 1mo ago
  The conclusions in that were not universally accepted, and some critiques were rather damning: https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theory-of-depression-a-systematic-umbrella-review-of-the-evidence https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theor... Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certain it is not a placebo effect.
  - D-Machine 1mo ago

D-Machine 1mo ago

Yup, I would agree. The meta-research / methodological research and awareness here is really quite impressive, even though its conclusions are a bit grim and not well-known.

jakebol 1mo ago
A good book on this is Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. Describing the history of how many of these classes of drugs came about is pretty eye opening, I would say the book is pretty nuanced in its conclusions. https://www.goodreads.com/en/book/show/40180010-mind-fixers https://www.goodreads.com/en/book/show/40180010-mind-fixers The title is a play on the Pulitzer prize winning article from the 80's. https://web.archive.org/web/20041125092022/http://www.bylinefranklin.com/writing/mindfixers.htm https://web.archive.org/web/20041125092022/http://www.byline...

zer00eyz 1mo ago

Have we reigned in the number of perscriptions? Because the 1 in 10 stat I find seems a bit low, at least in my circle, and those are the ones who are open about it. And the people I know have been on them approximately a decade. What baffles me is that a fair number of them triggered their own depressive episodes, and likely did need therapy and something at the time - but have all long since move past those "moments".

D-Machine 1mo ago
I am not sure, but recommendations to prescribe in mild cases have quietly been reigned in a bit by e.g. NICE https://www.nice.org.uk/guidance/ng222/chapter/Recommendations https://www.nice.org.uk/guidance/ng222/chapter/Recommendatio....

Rendello 1mo ago

See also: The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence (2022). It's worth reading the introduction and results in full, but here are two important quotes (footnote markers removed): > Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without, and methods to reduce serotonin availability using tryptophan depletion do not consistently lower mood in volunteers. High quality, well-powered genetic studies effectively exclude an association between genotypes related to the serotonin system and depression, including a proposed interaction with stress. > The chemical imbalance theory of depression is still put forward by professionals, and the serotonin theory, in particular, has formed the basis of a considerable research effort over the last few decades. The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities, and this belief shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood. The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue anti-depressant medication and may discourage people from dis-continuing treatment, potentially leading to lifelong dependence on these drugs. https://www.nature.com/articles/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0

zdragnar 1mo ago
The conclusions in that were not universally accepted, and some critiques were rather damning: https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theory-of-depression-a-systematic-umbrella-review-of-the-evidence https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theor... Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certain it is not a placebo effect.
- D-Machine 1mo ago