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Actually, it is because research on antidepressants which unambiguously make you feel better - namely, dopamine reuptake inhibitors - was outlawed. What we're

Actually, it is because research on antidepressants which unambiguously make you feel better - namely, dopamine reuptake inhibitors - was outlawed. What we're left with are the ones that only work in a mild, sometimes-sort of way. And don't buy the notion that the purpose of an antidepressant is to "correct chemical imbalances." No such imbalances have ever been identified: http://www.etfrc.com/ChemicalImbalances.htm http://www.etfrc.com/ChemicalImbalances.htm "How are the chemical imbalances which are the supposed basis for the prescription of "antidepressants" diagnosed? Is exploratory neurosurgery performed, using some technique that allows the surgeon to quantify synaptic transmitter levels? No, the very idea is absurd. Is a spinal tap, then, done to at least measure, on a gross scale, the distribution of neurotransmitter metabolites? Of course not – how many people have undergone spinal taps before receiving a prescription for Effexor®? Is blood at least drawn, to test something? No. This diagnosis – the diagnosis of the most subtle of chemical disorders in the most complex organ in the body – is made on the basis of the patient's report of feeling sad and lethargic. Try to imagine a hematologist diagnosing leukemia this way to get a sense of just how ridiculous this idea is." "The principal reason for rejecting biopsychiatry (aside from the fact that intellectual honesty demands its rejection) is that it locates the cause of psychic suffering in people's "bad brains," and excludes the conditions of modern life, or anything else, from consideration as the cause of such pain." The purpose of an antidepressant is to improve mood. No more, no less. And the degree of doublespeak doctors find necessary to dance around our society's puritanical views on pleasure just to be permitted to market the current, wimpy antidepressants - is staggering.

tokenadult 17y ago
AFTER EDIT: research on antidepressants which unambiguously make you feel better - namely, dopamine reuptake inhibitors - was outlawed Do you have a citation for a law or policy statement that shows that there is indeed such an outlawing? I see Google Scholar citations that suggest that research is ongoing, and there is more planned. http://www.ajp.psychiatryonline.org/cgi/content/abstract/163/9/1594 http://www.ajp.psychiatryonline.org/cgi/content/abstract/163... /AFTER EDIT There are more than 100 countries in the world, and they would have to be united in banning a certain direction of research for there to be no research on that subject. But dopamine reuptake inhibitors, based on ongoing research in various places, are a risky approach to treating major mood disorders. "DRIs are notorious for their high abuse potential and ability to cause addiction and dependence. Pure DRIs such as cocaine and combination releasers such as amphetamine and methamphetamine are widely abused throughout the world." http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor "NDRIs approved to treat depression "Here is the only NDRI that has been approved by the Food and Drug Administration specifically to treat depression, with its generic, or chemical, name followed by available brand names in parentheses: * Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)" . . . . "Safety concerns with NDRIs "Bupropion can increase blood pressure in some people, so regular monitoring is important. The risk of developing high blood pressure may increase if you also use nicotine replacement therapy, such as a nicotine patch, to help you stop smoking. "There's a small chance that taking bupropion can cause a seizure if you've had previous seizures, a head injury or a nervous system tumor, or if you've had an eating disorder, such as bulimia or anorexia. Because of that, don't take this medication if you have a history of seizures or eating disorders or if you're abruptly discontinuing use of alcohol or sedatives. Be sure to tell your doctor about your past medical issues. "Also, because of potentially dangerous medication interactions, be sure your doctor knows about any current or previous use of monoamine oxidase inhibitors (MAOIs). Tell your doctor also if you have severe liver cirrhosis, because Wellbutrin can cause liver problems. In addition, don't take Zyban while you're being treated with any form of Wellbutrin." http://www.mayoclinic.com/health/antidepressants/MH00068 http://www.mayoclinic.com/health/antidepressants/MH00068
- asciilifeform 17y ago
  Notice how Wellbutrin - the 1970s state of the art - is what we're stuck with. Precisely because research has been curtailed - yes, internationally. Progress stands still. Also compare the side effects you listed with those of the wildly popular SSRIs. And yes, any hypothetical drug which reliably makes you feel better will be addictive in some sense of the word. Deal with it, and move on with life. Addiction is only the bugaboo it is claimed to be when the thing you are addicted to is actually harmful. Most people don't consider themselves "drug addicts" for using caffeine, for example. The focus should be on developing drugs which do the mood-lifting job, don't produce tolerance, and don't damage your internal organs. There is no evil spirit which manipulates the universe to make this goal impossible. It is simply considered undesirable by our Puritan rulers (and the outposts they have built inside our own heads.) Reply to Edit: > Do you have a citation for a law or policy statement that shows that there is indeed such an outlawing? I see Google Scholar citations that suggest that research is ongoing, and there is more planned. Check out the Federal Analogues Act (US) and its foreign equivalents. Any drug which is chemically similar (with a very liberal definition of "chemically similar" that provokes howls of laughter from chemists) to a currently banned drug is instantly placed into "Schedule I" - "no medicinal use" - and is outlawed, in such a way as to make research nearly impossible and certainly unprofitable. But the real problem lies with our society's perception that a drug which gives you pleasure is an unambiguous and unmitigated evil all in itself, regardless of whether it has harmful side effects. Few of the research drugs in the papers you've seen will be permitted on the market, for this reason. Certainly none of the ones which actually work will be. By deliberately marketing antidepressants which only work subtly and sometimes, the pharmaceutical industry continues to uphold the ruse that they are actually treating an ordinary disease, like leukemia. But we know how to build antidepressants which work on everyone. It isn't being done because if it were, the smoke would clear, and we would be forced to admit that we are actually treating unhappiness. Unhappiness caused by stimuli which ought to make a sane person unhappy.
  - tokenadult 17y ago
    But we know how to build antidepressants which work on everyone. It took me a while in my offline personal life for the very evident counterexample to come to mind. In fact, it is well known that human mood can go wrong in two ways: by being too low (depression) but also by being too high (mania). To date, there isn't any medication that reliably raises the mood of individuals in normal mood states without subjecting some of those individuals to severe risk of psychotic mania. Anyone proposing policy reform as to this issue should be aware of this fact. Here are some reading references for HN participants who would like to know more about the medical research on mood disorders: Depression: Causes and Treatment, 2nd Edition http://www.amazon.com/Depression-Treatment-Aaron-T-Beck/dp/0812219643 http://www.amazon.com/Depression-Treatment-Aaron-T-Beck/dp/0... (a very recent book, by the inventor of cognitive therapy) or http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-Depression/dp/0195135792/ http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec... (a very authoritative textbook with extensive references to primary research literature).
Alex3917 17y ago
"No such imbalances have ever been identified" This guy would disagree: http://george-eby-research.com/html/depression-anxiety.html http://george-eby-research.com/html/depression-anxiety.html
- asciilifeform 17y ago
  A shortage of certain vitamins (B6, for instance, a precursor to serotonin) will often cause depression. There is, however, no evidence that most depression responds to vitamin supplementation. I fully expect that the reason for this is dead-simple: the modern 9-to-5 treadmill way of life is often the cause, rather than any "disease" in the traditional sense of the word. Your brain is responding correctly to external stimuli. And there is no shortage of crackpot sites claiming miracle depression cures, just like for any other disease where the medical establishment has proven itself utterly worthless.
  - Alex3917 17y ago
    "The modern 9-to-5 treadmill way of life is often the cause, rather than any "disease" in the traditional sense of the word. Your brain is responding correctly to external stimuli." Definitely true. Has anyone written a book about this yet? I know there are books that tangentially touch on it, like bowling alone, but I wonder if there is enough research to do the subject justice.
    - asciilifeform 17y ago
      Well, not exactly book-length, but: "The Worst Mistake In The History Of The Human Race" (Jared Diamond) http://www.environnement.ens.fr/perso/claessen/agriculture/mistake_jared_diamond.pdf http://www.environnement.ens.fr/perso/claessen/agriculture/m... The problem cannot be solved by returning to the past: going back to a hunter-gatherer lifestyle would doom 95+% of everyone currently living to starvation. But before a problem can be solved, people have to admit that it exists.
      - Alex3917 17y ago
m_eiman 17y ago
"The purpose of an antidepressant is to improve mood." I'd say that their effect is that they reduce the amplitude of emotions, so to speak. You get sad, but not -as- sad; however you also don't get as happy as you might have been otherwise. This is a reason that some people don't like taking such drugs: they feel it takes away their emotions and transform their personalities.
- asciilifeform 17y ago
  > they reduce the amplitude of emotions SSRIs appear to have this effect in many people, but it is not universal to all antidepressants. See my other comments in this thread.
anigbrowl 17y ago
Not to get into an argument not medically qualified, but as some who has extensive experience with both recreational and clinical drug use, asciilifeform makes some good points here. Yes, it's absurd that psychiatry often doesn't involve any blood tests, which really makes to hard to take seriously as a medical discipline. I've had both good and bad psychiatrists, but it's hard to escape the conclusion that 'fill this prescription, tell me how it's working in a month' is not much more than licensed drug dealing. SSRIs and suchlike are designed to build up their effect over time rather than supplying instant chemical gratification, which is a good idea, but as medical tools I think they're fairly half-assed. Between study, experience, and practice at observing my reactions, I feel moderately competent to monitor my own brain chemistry, at least as well as any lay person can. Mapping out the metabolic curve of a drug in the body isn't so terribly hard and SSRIs feel very much like the chemical equivalent of treating the symptom rather than the cause. In short, they seem to flatten affect, such that the amplitude of yuor mood swings is reduced and you don't care how you're feeling to the same degree as normal. On several occasions I've taken a course, been quit disappointed, and come off them - subsequent improvement, if any, has more to do with increased self-regard for having taken action to address the problem. I do feel, strongly, that dopamine deficiency is part of my particular problem - and as pointed out, the clinical options there are somewhat limited. It's on reason I still smkoe; nicotine is a very effective dopamine agonist. Unfortunately, it's brought me to first-stage emphysema and every time I light up my lungs ask me why there isn't a better way. Although I have been diagnosed with moderately several Adult ADHD (via interviews and tests...another example of the medical catching-up psychiatry needs), my doctor's been rather reluctant to break out the Adderall or suchlike because he worries there might be a potential for abuse. At his hourly rate, I don't argue, but frankly I'm OK with it because it can hardly be worse than tarring my lungs. My past experience with illegal stimulants like cocaine is that they're quite enjoyable but don't exercise any significant compulsion on me. I took the latter semi-regularly for a while but got bored with staying in and having the same wired conversation with my roommate, so I just dropped it. Just my anecdotal perspective. I find it depressingly easy to understand why so many people wind up 'on drugs'. They work, but it's infra dig to start your clinical approach from there.

tokenadult 17y ago

AFTER EDIT: research on antidepressants which unambiguously make you feel better - namely, dopamine reuptake inhibitors - was outlawed Do you have a citation for a law or policy statement that shows that there is indeed such an outlawing? I see Google Scholar citations that suggest that research is ongoing, and there is more planned. http://www.ajp.psychiatryonline.org/cgi/content/abstract/163/9/1594 http://www.ajp.psychiatryonline.org/cgi/content/abstract/163... /AFTER EDIT There are more than 100 countries in the world, and they would have to be united in banning a certain direction of research for there to be no research on that subject. But dopamine reuptake inhibitors, based on ongoing research in various places, are a risky approach to treating major mood disorders. "DRIs are notorious for their high abuse potential and ability to cause addiction and dependence. Pure DRIs such as cocaine and combination releasers such as amphetamine and methamphetamine are widely abused throughout the world." http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor "NDRIs approved to treat depression "Here is the only NDRI that has been approved by the Food and Drug Administration specifically to treat depression, with its generic, or chemical, name followed by available brand names in parentheses: * Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)" . . . . "Safety concerns with NDRIs "Bupropion can increase blood pressure in some people, so regular monitoring is important. The risk of developing high blood pressure may increase if you also use nicotine replacement therapy, such as a nicotine patch, to help you stop smoking. "There's a small chance that taking bupropion can cause a seizure if you've had previous seizures, a head injury or a nervous system tumor, or if you've had an eating disorder, such as bulimia or anorexia. Because of that, don't take this medication if you have a history of seizures or eating disorders or if you're abruptly discontinuing use of alcohol or sedatives. Be sure to tell your doctor about your past medical issues. "Also, because of potentially dangerous medication interactions, be sure your doctor knows about any current or previous use of monoamine oxidase inhibitors (MAOIs). Tell your doctor also if you have severe liver cirrhosis, because Wellbutrin can cause liver problems. In addition, don't take Zyban while you're being treated with any form of Wellbutrin." http://www.mayoclinic.com/health/antidepressants/MH00068 http://www.mayoclinic.com/health/antidepressants/MH00068

asciilifeform 17y ago
Notice how Wellbutrin - the 1970s state of the art - is what we're stuck with. Precisely because research has been curtailed - yes, internationally. Progress stands still. Also compare the side effects you listed with those of the wildly popular SSRIs. And yes, any hypothetical drug which reliably makes you feel better will be addictive in some sense of the word. Deal with it, and move on with life. Addiction is only the bugaboo it is claimed to be when the thing you are addicted to is actually harmful. Most people don't consider themselves "drug addicts" for using caffeine, for example. The focus should be on developing drugs which do the mood-lifting job, don't produce tolerance, and don't damage your internal organs. There is no evil spirit which manipulates the universe to make this goal impossible. It is simply considered undesirable by our Puritan rulers (and the outposts they have built inside our own heads.) Reply to Edit: > Do you have a citation for a law or policy statement that shows that there is indeed such an outlawing? I see Google Scholar citations that suggest that research is ongoing, and there is more planned. Check out the Federal Analogues Act (US) and its foreign equivalents. Any drug which is chemically similar (with a very liberal definition of "chemically similar" that provokes howls of laughter from chemists) to a currently banned drug is instantly placed into "Schedule I" - "no medicinal use" - and is outlawed, in such a way as to make research nearly impossible and certainly unprofitable. But the real problem lies with our society's perception that a drug which gives you pleasure is an unambiguous and unmitigated evil all in itself, regardless of whether it has harmful side effects. Few of the research drugs in the papers you've seen will be permitted on the market, for this reason. Certainly none of the ones which actually work will be. By deliberately marketing antidepressants which only work subtly and sometimes, the pharmaceutical industry continues to uphold the ruse that they are actually treating an ordinary disease, like leukemia. But we know how to build antidepressants which work on everyone. It isn't being done because if it were, the smoke would clear, and we would be forced to admit that we are actually treating unhappiness. Unhappiness caused by stimuli which ought to make a sane person unhappy.
- tokenadult 17y ago
  But we know how to build antidepressants which work on everyone. It took me a while in my offline personal life for the very evident counterexample to come to mind. In fact, it is well known that human mood can go wrong in two ways: by being too low (depression) but also by being too high (mania). To date, there isn't any medication that reliably raises the mood of individuals in normal mood states without subjecting some of those individuals to severe risk of psychotic mania. Anyone proposing policy reform as to this issue should be aware of this fact. Here are some reading references for HN participants who would like to know more about the medical research on mood disorders: Depression: Causes and Treatment, 2nd Edition http://www.amazon.com/Depression-Treatment-Aaron-T-Beck/dp/0812219643 http://www.amazon.com/Depression-Treatment-Aaron-T-Beck/dp/0... (a very recent book, by the inventor of cognitive therapy) or http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-Depression/dp/0195135792/ http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec... (a very authoritative textbook with extensive references to primary research literature).

Alex3917 17y ago

"No such imbalances have ever been identified" This guy would disagree: http://george-eby-research.com/html/depression-anxiety.html http://george-eby-research.com/html/depression-anxiety.html

asciilifeform 17y ago
A shortage of certain vitamins (B6, for instance, a precursor to serotonin) will often cause depression. There is, however, no evidence that most depression responds to vitamin supplementation. I fully expect that the reason for this is dead-simple: the modern 9-to-5 treadmill way of life is often the cause, rather than any "disease" in the traditional sense of the word. Your brain is responding correctly to external stimuli. And there is no shortage of crackpot sites claiming miracle depression cures, just like for any other disease where the medical establishment has proven itself utterly worthless.
- Alex3917 17y ago
  "The modern 9-to-5 treadmill way of life is often the cause, rather than any "disease" in the traditional sense of the word. Your brain is responding correctly to external stimuli." Definitely true. Has anyone written a book about this yet? I know there are books that tangentially touch on it, like bowling alone, but I wonder if there is enough research to do the subject justice.
  - asciilifeform 17y ago
    Well, not exactly book-length, but: "The Worst Mistake In The History Of The Human Race" (Jared Diamond) http://www.environnement.ens.fr/perso/claessen/agriculture/mistake_jared_diamond.pdf http://www.environnement.ens.fr/perso/claessen/agriculture/m... The problem cannot be solved by returning to the past: going back to a hunter-gatherer lifestyle would doom 95+% of everyone currently living to starvation. But before a problem can be solved, people have to admit that it exists.
    - Alex3917 17y ago

m_eiman 17y ago

"The purpose of an antidepressant is to improve mood." I'd say that their effect is that they reduce the amplitude of emotions, so to speak. You get sad, but not -as- sad; however you also don't get as happy as you might have been otherwise. This is a reason that some people don't like taking such drugs: they feel it takes away their emotions and transform their personalities.

asciilifeform 17y ago
> they reduce the amplitude of emotions SSRIs appear to have this effect in many people, but it is not universal to all antidepressants. See my other comments in this thread.

anigbrowl 17y ago

Not to get into an argument not medically qualified, but as some who has extensive experience with both recreational and clinical drug use, asciilifeform makes some good points here. Yes, it's absurd that psychiatry often doesn't involve any blood tests, which really makes to hard to take seriously as a medical discipline. I've had both good and bad psychiatrists, but it's hard to escape the conclusion that 'fill this prescription, tell me how it's working in a month' is not much more than licensed drug dealing. SSRIs and suchlike are designed to build up their effect over time rather than supplying instant chemical gratification, which is a good idea, but as medical tools I think they're fairly half-assed. Between study, experience, and practice at observing my reactions, I feel moderately competent to monitor my own brain chemistry, at least as well as any lay person can. Mapping out the metabolic curve of a drug in the body isn't so terribly hard and SSRIs feel very much like the chemical equivalent of treating the symptom rather than the cause. In short, they seem to flatten affect, such that the amplitude of yuor mood swings is reduced and you don't care how you're feeling to the same degree as normal. On several occasions I've taken a course, been quit disappointed, and come off them - subsequent improvement, if any, has more to do with increased self-regard for having taken action to address the problem. I do feel, strongly, that dopamine deficiency is part of my particular problem - and as pointed out, the clinical options there are somewhat limited. It's on reason I still smkoe; nicotine is a very effective dopamine agonist. Unfortunately, it's brought me to first-stage emphysema and every time I light up my lungs ask me why there isn't a better way. Although I have been diagnosed with moderately several Adult ADHD (via interviews and tests...another example of the medical catching-up psychiatry needs), my doctor's been rather reluctant to break out the Adderall or suchlike because he worries there might be a potential for abuse. At his hourly rate, I don't argue, but frankly I'm OK with it because it can hardly be worse than tarring my lungs. My past experience with illegal stimulants like cocaine is that they're quite enjoyable but don't exercise any significant compulsion on me. I took the latter semi-regularly for a while but got bored with staying in and having the same wired conversation with my roommate, so I just dropped it. Just my anecdotal perspective. I find it depressingly easy to understand why so many people wind up 'on drugs'. They work, but it's infra dig to start your clinical approach from there.