[HN Gopher] "No convincing evidence" that depression is caused b...
___________________________________________________________________
"No convincing evidence" that depression is caused by low serotonin
levels
Author : mellosouls
Score : 437 points
Date : 2022-07-20 02:39 UTC (20 hours ago)
(HTM) web link (www.bmj.com)
(TXT) w3m dump (www.bmj.com)
| ornornor wrote:
| When you look into the studies for antidepressants, the track
| record is abysmal.
|
| They're not innocuous, trigger serious side effects, some are
| hard to quit, but more importantly they only make a difference in
| people with extremely severe depression.
|
| And doctors often downplay or don't mention side effects honestly
| because they don't want patients to not take them.
|
| The studies justifying antidepressants as effective to the FDA
| are disturbingly flawed: people who were not responsive were
| excluded from the studies...
|
| Anyway, I found this website very enlightening on the topic:
| https://www.theinnercompass.org/learn-unlearn/intervention/a...
| along with several Reddit threads from peoples experience with
| various antidepressants.
|
| This is not medical advice and there are cases where
| antidepressants are necessary and make a difference. But if you
| have anything else than extreme depression and no other mental
| health conditions (schizophrenia etc), consider magic mushroomed:
| a few intentional trips can do wonders to see what's troubling
| you from a different angle and help you move forward.
| can16358p wrote:
| Any links to the Reddit threads if handy? I'm interested for
| personal issues and Reddit always comes much more useful than
| actual psychiatry in my case (not sarcasm, I frankly mean it).
| ornornor wrote:
| I used "site:Reddit.com antidepressants" or with specific
| medicine names. Use ddg for that because the site: thing
| hasn't worked on google in years and you'll get poor results.
| raducu wrote:
| The track record is not abysmal:
| https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y...
| ornornor wrote:
| > more importantly they only make a difference in people with
| extremely severe depression
|
| Which your link confirms. And your link also states that
| antidepressants were oversold, especially to people with mild
| depression, a level for which antidepressants aren't
| particularly good at treating especially in light of the side
| effects and difficulty to quit.
| PraetorianGourd wrote:
| Yeah an unregulated and uncontrolled consumption of a poorly
| dosed hallucinogenic is totally better than a double-blind
| study of SSRI/SNRI.
|
| I swear, I do not reject the possibility that hallucinogenics
| can cure depression better than existing meds, but the almost
| religious enthusiasm for such a poorly studied chemical is
| deeply concerning.
|
| And yes, before you accuse me of being a pharma shill, I know
| that the lack of serious study is due to legal restrictions and
| not scientific evidence. But that doesn't change the fact that
| they've not been studied rigorously. In my State, they are
| being actively studied, let us hold back the praise until the
| results are in.
| hirvi74 wrote:
| It's almost a self-fulfilling prophecy. If anti-depressants
| were so effective, people wouldn't be flocking to
| psychedelics for treatment.
|
| Stimulants are the most useful medication we have found for
| ADHD. Without access to them, what do people with ADHD flock
| to? Caffeine, Nicotine, Alcohol, Cannabis, etc. Substances
| that are stimulants or can have stimulating effects.
|
| I am no woo-woo person, but perhaps our bodies when flocking
| to something are trying to tell us something? Alcohol also
| works great for anxiety (and super dangerous), so we created
| benzos in alcohol's image (though I think benzos can be just
| as dangerous for some).
| LatteLazy wrote:
| Careful: whether SSRIs and SNRIs work is unrelated to whether
| hallucinogenics do or don't. hallucinogenics being shit
| doesn't make SSRI/SNRIs a good bet.
|
| Also, those exact studies you refer to show that SNRIs work
| very poorly and are very limited.
|
| Usually studies have fewer than 100 participants:
|
| * people are dropped from the study arbitrarily
|
| * they are not double blind
|
| * they are not representative of the population
| (overwhelmingly participants are white, male, well off or
| young with no other health complaints and few serious
| problems)
|
| * studies are usually very short (<100 days) for medicines
| that are prescribed for years
|
| They then find drugs are less than 15%ppts more effective
| than placebos. In exchange you get quite extreme side effects
| for a significant number of users from impotence to
| suicide...
|
| The lancet picked this up and did. meta-study. Their
| conclusions:
|
| >We identified 28 552 citations and of these included 522
| trials comprising 116 477 participants. In terms of efficacy,
| all antidepressants were more effective than placebo, with
| ORs ranging between 2*13 (95% credible interval [CrI]
| 1*89-2*41) for amitriptyline and 1*37 (1*16-1*63) for
| reboxetine. For acceptability, only agomelatine (OR 0*84, 95%
| CrI 0*72-0*97) and fluoxetine (0*88, 0*80-0*96) were
| associated with fewer dropouts than placebo, whereas
| clomipramine was worse than placebo (1*30, 1*01-1*68). When
| all trials were considered, differences in ORs between
| antidepressants ranged from 1*15 to 1*55 for efficacy and
| from 0*64 to 0*83 for acceptability, with wide CrIs on most
| of the comparative analyses. In head-to-head studies,
| agomelatine, amitriptyline, escitalopram, mirtazapine,
| paroxetine, venlafaxine, and vortioxetine were more effective
| than other antidepressants (range of ORs 1*19-1*96), whereas
| fluoxetine, fluvoxamine, reboxetine, and trazodone were the
| least efficacious drugs (0*51-0*84). For acceptability,
| agomelatine, citalopram, escitalopram, fluoxetine,
| sertraline, and vortioxetine were more tolerable than other
| antidepressants (range of ORs 0*43-0*77), whereas
| amitriptyline, clomipramine, duloxetine, fluvoxamine,
| reboxetine, trazodone, and venlafaxine had the highest
| dropout rates (1*30-2*32). 46 (9%) of 522 trials were rated
| as high risk of bias, 380 (73%) trials as moderate, and 96
| (18%) as low; and the certainty of evidence was moderate to
| very low.
|
| https://www.thelancet.com/journals/lancet/article/PIIS0140-6.
| ..
|
| I think even assuming good faith for all those studies, those
| are poor results when you include the low acceptability. If
| you don't assume good faith you're left wondering if these
| drugs work at all.
|
| It should go without saying that NO ONE should stop or change
| their medication (especially highly addictive ones like
| these) based on a HN comment. Please speak to your doctors
| dear readers.
| taurath wrote:
| > Yeah an unregulated and uncontrolled consumption of a
| poorly dosed hallucinogenic is totally better than a double-
| blind study of SSRI/SNRI.
|
| Frankly, it could be and we'd have no way of knowing with the
| "rigor" we put through pharmacological stories, if your goal
| is effectiveness.
|
| That the entire field of psychology is sort of In conflict
| over the mechanisms, validity, and treatment models of trauma
| and dissociation, which frequently underly depression and
| anxiety symptoms.
| ornornor wrote:
| You do you of course.
|
| You can grow your own mushrooms at home fairly easily and
| then you have more control over quality/contamination etc.
| grenoire wrote:
| Correct, in theory. However, if you are just starting out
| growing you won't have the knowledge to assess quality or
| control contamination.
| mellavora wrote:
| Ok, so you have some control over quality. I'll also be
| generous and assume you have good estimate of dosages
| and/or some way to maintain consistency of dosages (anyone
| else reading this, the standard advice is to take less than
| you think you want and wait 45 min or so, then take more if
| needed to reach planned cruising altitude. This works if
| you have enough prior experience to calibrate by, otherwise
| is very difficult).
|
| How do you know which dosage is best for treating
| depression?
|
| Assuming the best treatment is a series of sessions, how do
| you know the optimal spacing of sessions, and the optimal
| dosing per session?
|
| You are correct that the trips should be intentional. Who
| sets these intentions, which intentions are the most
| helpful, how do you guide the session along the lines of
| the intentions (recalling that the session might include
| full ego death and conviction that both your mind and
| reality are distinct and permanently broken) and most
| importantly how do you structure the post-session therapy
| to integrate the learnings and actually get some personal
| growth out of this?
|
| Are there age-related differences in this? What is the
| protocol for a early 20s vs a mid-50s vs 70s/80?
|
| Also, to look at your own advice ("if you have anything
| else than extreme depression and no other mental health
| conditions") how do you actively screen for this?
|
| These are concerns which are well addressed within shamanic
| circles-- so I'm not speaking with the voice of pharma
| here.
|
| Psychedelics are powerful tools. Like any other power tool,
| they can be a great help and also fairly risky if not used
| carefully. Insert your own woodshop analogies here.
|
| And if you are going to use them anyway, without working
| with someone who knows what they are doing, please please
| please:
|
| 1) start with small doses
|
| 2) do some reading BEFORE. Minimal list: Hudson Smith,
| "Cleansing the Doors of Perception" and James Fadiman The
| Psychedelic Explorer's Guide: Safe, Therapeutic, and Sacred
| Journeys
| ornornor wrote:
| Yes I kinda assumed that if someone was considering
| giving this a shot, they'd research the subject very
| thoroughly before to get a good understanding of the
| effects, preparation, effects, doses, etc.
|
| The genera consensus seems to be that mushrooms
| (psilocybin) can't kill you. You can't OD on them. There
| is no known LD50 (that's "practical" to achieve anyway),
| they dont cause addiction, and if you take them too often
| they actually stop having an effect until you take a
| break and use again.
|
| There are risks if you have other mental health
| conditions like schizophrenia etc, but (according to my
| research), the only risk if you're otherwise healthy is
| to have a "bad trip" where you're basically experiencing
| negative feelings. By reading about the experience, you
| also learn that if you resist the bad trip it gets worse
| but if you look at it with curiosity (what is my brain
| trying to tell me?) then you'll have an easier time.
|
| About assessing te severity of your depression, there is
| a standard test (of which I forget the name) that is also
| used in the studies submitted to the FDA for approval of
| antidepressants that ask questions, you then add the
| points up, and anything above a certain number is severe
| depression. Although this is yet another flaw of the
| studies, the people running the studies don't even agree
| on the score that give you mild vs severe depression.
|
| Again, I have no medical training so this is just a
| random stranger's opinion on the internet. To anyone
| reading: educate yourself about the whole thing, see if
| you're willing to try, and make your own decisions.
| bowsamic wrote:
| There are four main risks for most people:
|
| - PTSD caused by bad trip. Bad trips are not uncommon,
| and it's not easy to let go. Part of the reason why
| psychedelics are so effective is that they basically
| force you to let go, otherwise you will have a bad trip.
| But some people can't do that, I couldn't, and you can
| end up causing long lasting psychological damage due to
| this. I had an existential crisis and became pretty
| suicidal for a few months after I had a couple of trips.
| I actually had to take up a religion to cope with it. The
| therapy services in the UK had no idea what to do to help
| me and made me feel alienated
|
| - DP/DR (depersonalisation/derealisation). Can be short
| lasting, can be long lasting, can be flashbacks, can be
| constant
|
| - HPPD (Hallucinogen persisting perception disorder).
| Described as anywhere between "visual snow" and "you
| never came down from the trip". No one knows why this
| happens or who it happens to, if it occurs differently
| with different psychs. Many people commit suicide over
| this one, since it can basically cause psychosis as some
| people never stop having intense hallucinatory effects
| for months or even years. If they can't come to terms
| with it it can be extremely disorientating and
| alienating. Andrew Callaghan of Channel 5 news / All Gas
| No Brakes has this. Kind of frightening since it's most
| trippers' worst nightmare to never come down from the
| trip, but that's actually a thing that happens to some
| people
|
| - Flashbacks, which I would say are different to the
| other three, in that they are a sudden return to the
| tripping state of mind randomly, but not necessarily
| visual or DP/DR. I think this one is the least explored
| and least well known about
| ldjkfkdsjnv wrote:
| Too tired to type a cogent paragraph. Just that I have seen lives
| ruined by SSRIs.
| matthewmacleod wrote:
| Haven't you also seen lives saved by them? Because I sure have.
| gillytech wrote:
| Your comment is the most sensible I hav seen so far. I have
| seen lives utterly decimated by SSRIS. Suicides and murders
| caused by its side effects. Violent and suicidal tendencies are
| on the warning labels on many of these drugs.
| petesergeant wrote:
| Comments like this caused me to not try them for waaay too
| long. Many many many lives have been positively transformed by
| them, too
| wobblykiwi wrote:
| They have been saving mine. My anxiety has been improving
| tremendous amounts since starting both an SSRI and therapy a
| few months ago. Therapy came a couple months after starting an
| SSRI, but I was already feeling a tangible improvement before
| even starting that.
| almostthrewit wrote:
| This is a dangerous thing to spread, in my opinion. I have
| struggled with depression and anxiety for years, but during
| COVID it hit me like nothing I have ever experienced before. I
| would have probably died during COVID without finding a doctor
| to prescribe me medicine. And I don't think it would have been
| suicide. I would have probably become dehydrated and/or starved
| or become mal-nutritioned because it was a literal war to eat.
| I was having to wash down food with water after chewing it
| enough to swallow. (Note that I never had COVID, which would
| have been impossible having barely left my house during the
| first 9 months of 2020.) I couldn't sleep and would wake up
| wide awake and stressed at 4-5am. I couldn't relax. Was having
| panic attacks. It was pure and quite literal torture. My body
| and mind was literally on fire with stress activity. I honestly
| probably should have been hospitalized long before I finally
| got help.
|
| While not fun working through the gamut of medicines, some of
| them finally pulled me through it all. It took almost a year to
| fully recover with dedication to the medicine and modifications
| of it and therapy.
|
| If I didn't have a good family and primary care doctor, I
| guarantee I would have died in some manner unless hospitalized.
|
| People need to realize there is danger to their words.
| Psychiatry is nowhere near perfect, but people are trying. It
| is an incredibly difficult thing to understand. But I feel
| people who speak against medicine have never truly experienced
| deep depression or anxiety. A panic attack can hit you sitting
| on the couch, and then by literally doing nothing, your heart
| rate can reach 200bpm and massive amounts of hormones making
| your chest and skin feel like it's burning, and next thing
| you're calling an ambulance because you think you aren't
| breathing.
| padolsey wrote:
| Too tired to type a cogent paragraph. Just that I have seen
| lives saved by SSRIs.
| throw__away7391 wrote:
| Same here. I've seen multiple people after getting along fine
| for years get prescribed these meds, and within two years end
| up completely unable to function, hold a job, maintain
| composure during a conversation (breaking down in tears or
| becoming violently angry), cook their own food, etc. and need
| to talk to a therapist multiple times a week.
|
| I'm sure "they're doing it wrong", but these were fully
| licensed doctors, prescribing drugs in an approved manner.
| asveikau wrote:
| Are you sure it isn't the condition that they were seeking
| treatment for that contributed to these things?
|
| I'll give an example, I read once that about 60% of people
| with bipolar disorder are unemployed. It isn't the diagnosis
| that does that.
|
| So I just read that comment as "they sought treatment and
| ever since they were a wreck". Seems like the causality could
| go the other way.
| mccorrinall wrote:
| While I only had positive experiences with SSRI so far, I
| can definitely say that substances can cause suicidal
| thoughts. When I took xanax, I had a lot of suicidal
| thoughts and really had to fight to not kill myself. It's
| just like being on autopilot and having to fight against
| autopilot who wants to crash your car into a wall.
|
| I could imagine that SSRI can activate this autopilot for
| some people and worsens their negative thoughts.
| staticman2 wrote:
| There's some very scary anecdotes out there. I saw one on
| an obscure subreddit for people suffering from negative
| antidepressant drug symptoms where a person said they went
| to the hospital immediately after taking an SSRI due to an
| adverse reaction and they have had trouble concentrating on
| things since.
|
| If the person is correct and not dusional they had a
| statistically unlikely reaction to the drug- presumably too
| rare to show up in the drug approval process- and it ruined
| their life.
| locusofself wrote:
| Anecdata, but I was often depressed for most of my adjust life.
| Around 5-6 years ago (age 33 at the time), I started taking 20mg
| Citalopram. I have experienced almost no depression since I
| started taking this medication, I'm far more focused and
| productive than I have ever been. It could be a factor of age and
| getting married as well, and just settling into my life. But my
| depression felt like something out of my control.
| cameronh90 wrote:
| Sertraline has almost entirely fixed my panic disorder.
|
| It had no obvious cause and months of therapy had no impact.
| Within a few days of taking sertraline, it was essentially
| cured. I still get anxious from time to time but I'm able to
| live a completely normal life again. I had a few side effects
| (GI especially) for a few weeks but now the only side effect I
| have is I yawn a lot more, which is pretty tame.
|
| I'm a big believer in the gut-brain connection and wonder if
| maybe it was something to do with the drug's GI effects that
| helped, but ultimately I have no idea and it doesn't really
| matter.
| jinder wrote:
| You're correct - it appears to work via the gut-brain axis,
| see my comment above.
| mccorrinall wrote:
| Same here, but with Fluoxetine (Prozac). However, I don't think
| exactly that fluoxetine made me less depressed. It only made me
| more ,,aggressive" and more risk taking, and the antidepressing
| effect came from the positive results of taking such risks. I
| just ,,don't care" about failures as much as I used to.
|
| E.g. I finally started talking to girls, because I wouldn't
| care about rejection that much. => Got into my first
| relationship and was happy.
|
| Also, I started working on my passion project full time and I
| recently registered a company for it. Two years ago I would
| have not thought about doing this, as working for an employer
| is way ,,safer".
|
| But I don't care about failing anymore.
| MarcelOlsz wrote:
| Shit I need pills that do the opposite lol.
| CAP_NET_ADMIN wrote:
| I have ADHD, frequently exhibited risky behaviour, ADHD
| medication (MPH) reduced this effect for me, I'm more
| conscious and think things through before they happen.
| raducu wrote:
| It's not just anecdotal evidence, the whole anti-antidepressant
| hype seems to re-emerge every few years, like a plague. After
| trying a few different anti-depressant the vast majority of
| people do improve. And the people bashing antidepressants fail
| to come up with any proven alternatives.
|
| Is there a conspiracy shutting down depression curing
| alternatives all around the world?
| eixiepia wrote:
| What are the views on SSRIs prescribed for OCD and anxiety? The
| dosage for these conditions is much larger than for depression,
| often ten times or more.
| barbs wrote:
| For good in-depth investigative journalist approach to the topic,
| I highly recommend the book "Lost Connections" by Johaan Hari.
|
| The author himself was diagnosed with depression and prescribed
| SSRIs for the longest time. Through talking with experts and
| understanding the roots of depression (in short, a lack of
| connection with the world and community), he now no longer takes
| them.
| sebastianconcpt wrote:
| And testosterone levels?
| foolfoolz wrote:
| imagine working in a field where nothing is probably true
| pcrh wrote:
| Indeed. The whole profession of psychiatry suffers from poor
| application of scientific research, to the extent that the
| National Institute of Mental Health once banned reference to
| the Diagnostic and Statistical Manual of Mental Disorders
| (known as DSM-5).
|
| https://www.science.org/content/article/nimh-wont-follow-psy...
| paulpauper wrote:
| It's sorta fascinating how anti depressants work yet no one
| really know how or why they work.
| philliphaydon wrote:
| We know how and why SSRIs work in regards to serotonin. We
| don't understand why some people produce little or absorb
| serotonin too quickly requiring SSRIs drugs to manage it.
| mjfl wrote:
| right because what serotonergic synapses do is they tickle
| the other neurons to make them happier right?
| philliphaydon wrote:
| We know that a group of people who suffer from depression
| have lower serotonin levels when compared to someone who is
| considered... not depressed. And we know that SSRI's
| prohibit or prevent the bodies ability absorb serotonin
| allowing it to accumulate and be more effective and pull it
| in line with someone who is not depressed, resulting in the
| depressed person becoming less or not depressed.
|
| So. I'm unsure how my statement is untrue in response to
| the parent statement stating we have no idea how they work.
| mjfl wrote:
| > We know that a group of people who suffer from
| depression have lower serotonin levels when compared to
| someone who is considered... not depressed.
|
| I thought the whole point of the article was that there
| is no solid evidence of a relationship between serotonin
| levels and depression?
| philliphaydon wrote:
| The article seems to say that lower levels of serotonin
| is not the /cause/ of the depression. But it doesn't
| change the fact that most studies seem to conclude that
| one of the things we can determine in people who suffer
| from depression is that they have lower levels of
| serotonin, and in some of those cases SSRIs help.
|
| Not all forms of depression are caused by serotonin, and
| anti-depressants may not always be the solution.
|
| Again, my point is we know how SSRIs work and what they
| do. What we do not know is why some people have lower
| levels of serotonin or why they absorb it too quickly
| compared to... non depressed people.
|
| The issue with depression is that its a huge complicated
| thing that we know a lot about, but at the same time, we
| also know very little.
|
| I would agree that we over perscribe medication for
| depression as we do for MANY different things. In Asia,
| antibiotics is handed out like candy when people are
| sick. You have the common cold, boom you get antibiotics,
| despite the fact that colds are caused by virus, and
| antibiotics only helps with bacterial infections not
| viral invections.
|
| The US has a major problem with big phama where people
| can be perscribed medicine for many things, and then have
| side-affects resulting in more things being perscribed.
| Painkills for injury > painkillers causing depression >
| Prozac, Prozac causes insomnia > sleeping pills, sleeping
| pills causes you to lose sexual drive > viagra, viagra
| causes you to gain weight > apatite suppresents. It goes
| on and on.
| tomsto wrote:
| This.
|
| I wonder if a big part of the problem is that depression
| and other mental illnesses are slightly unusual in that
| they are categorised based on symptoms rather than
| underlying biology, which are poorly understood. As a
| diagnosis it's about as useful as 'chest pains'
|
| Maybe (I am not a clinical psychiatrist) there are 1, 10,
| or 100 very different underlying causes which would
| indicate different treatment if only they were better
| understood. But nonetheless the existing classification /
| ontology is established and will be hard to displace.
| narrator wrote:
| The crisis in mental health is that suicide levels have been
| rising since 2000. This is good evidence that the new drugs are
| worse than the old drugs. If you look at consumers rating of
| drugs they're on, mao inhibitor anti-depressants like nardil have
| very high ratings, especially compared to SSRIs. Unfortunately,
| the drug companies don't like competing with generics, so it goes
| that the newest drug is considered the best drug.
| actually_a_dog wrote:
| > This is good evidence that the new drugs are worse than the
| old drugs.
|
| That's incorrect. There's good evidence that economics, in
| combination with lack of funding for suicide prevention
| programs is driving the increase in suicide rates. See
| https://www.bbc.com/news/world-us-canada-44416727
| robocat wrote:
| > The crisis in mental health is that suicide levels have been
| rising since 2000. This is good evidence that the new drugs are
| worse than the old drugs.
|
| Or this is good evidence that cellphone usage is causing
| suicide (~1/3 of people in US had cellphones in 2000, ~100% do
| now).
|
| Your causality is poorly explained.
| [deleted]
| thelittleone wrote:
| I highly recommend the book "plant medicines and the imaginal
| realm".
|
| I've worked extensively with indigenous curanderos (healers) many
| of who view depression as a sickness undigested emotions and past
| trauma. This sickness negatively affects perception of their
| present moment.
|
| In plant medicine ceremony, when past trauma is processed it's
| frequently accompanied with throwing up which is called "purging"
| or "getting well".
|
| Outside of ceremony plants are often prescribed as a purgative
| which are often drunk accompanied by copious water. Purging may
| happen in both directions.
|
| There is so much to experience in that field, so many lines of
| beautiful inquiry and in ceremony often a feeling of eternal
| present moment.
|
| The book puts forward how depression and other sickness come from
| an altered perception that can be restored by plant medicines.
| refurb wrote:
| This is completely unsurprising and indicative of how limited our
| understanding of the brain is.
|
| It reminds me of Pfizer's work on gabapentin. A professor from
| Northwestern was working on GABA antagonists (by modifying GABA
| itself) and eventually came up with the drug. It was hailed as a
| great example of "structure-based drug design".
|
| The drug was approved by the FDA and efficacious for a number of
| issues like neuropathic pain. The submission documents from
| Pfizer had all this data on the binding efficiency of the drug to
| GABA receptors.
|
| _Except it didn 't work through the GABA receptor at all_.
|
| After approval, more research was done and they said it worked
| through glutamate channels. Then more work was done and it seems
| most of its effect is through calcium channels.
| DontchaKnowit wrote:
| Do you have links to more info on this? Sort of an armchair
| pharmocologist and had never heard this about gabapentin. I
| thought it was a straight up gaba agonist like phenibut. But
| makes sense that it would be different given its very unusual
| dose response curve/self potentiation.
|
| (Probably making anyone who actually knows what they're talking
| about cringe. Take it easy, lol)
| refurb wrote:
| Gabapentin was designed as an antagonist (the structure is
| basically GABA with a big bulky group on it).
|
| You can just google older papers on gabapentin. Just like
| most drugs it impacts a number of different receptors in the
| body. We still don't fully understand them all.
| clsec wrote:
| Don't get me started on Gabapentin! I just got off of it after
| 11 yrs (serious spinal cord injury - neuropathy). Initially,
| after my surgery, I was on 12 different drugs (not all related
| to my injury). Over the last 5 years I've been slowly weening
| myself off of them one by one trying to figure out what was
| causing me so many side effects. It turns out that the last
| thing I quit was Gabapentin, which was last month. Amazingly,
| all the side effects disappeared once I stopped. I'll never
| take it again.
| mathgladiator wrote:
| As a member of the anti-psychiatry side after seeing primary care
| doctors wreck my mother... I think we will see a sea change in
| how we approach this with things like psychedelics.
|
| I recently got treated with six weeks of Ketamine, and it works.
| If you ever thought about rebooting your brain, then I recommend
| it. However, you really have to surrender yourself to the
| experience; it is a very intentional act.
| PragmaticPulp wrote:
| Ketamine treatment is interesting, but it's not really a
| replacement for SSRIs. The anti-depressant effects of Ketamine
| are unfortunately relatively short-lived. Tolerance also seems
| to develop to the effects over time. There are some adventurous
| providers experimenting with frequent ketamine dosing over long
| periods of time, but the results haven't really been great from
| what I've seen.
|
| Also, a psychedelic experience is definitely _not_ necessary
| for ketamine 's antidepressant effects. In fact, the more
| responsible providers and studies are careful to keep peak
| plasma levels low enough to avoid this, and it works just fine.
| A lot of unscrupulous providers are using excessively high
| doses to induce psychedelic experiences, but this isn't
| actually supported by the evidence.
|
| SSRIs and other traditional antidepressants will continue to be
| mainstays of long-term depression treatment if for no reason
| other than their sustainability and long-term efficacy is so
| much better than ketamine.
| armatav wrote:
| So unbelievably unread and wrong.
|
| Ketamines anti-depressant effects are some of the longest
| lasting in pharmaceutical history.
|
| Tolerance is carefully managed by your infusion provider to
| not build up.
|
| The long term efficacy is insanely good - which is why we
| approved it in the first place.
|
| The psychedelic experience is necessary to approach the more
| permanent end of the spectrum - this is by the "evidence"
| that you are not reading.
|
| SSRIs continue to be a mainstay because they aren't $800 per
| session with insurance and have an extreme margin. They are
| far, far, far lower efficacy.
|
| What are you doing my man? You just straight lied in almost
| every sentence.
| dang wrote:
| Please don't break the site guidelines like this,
| regardless of how wrong someone else is or you feel they
| are. It makes the thread significantly worse.
|
| Also, posting this way discredits your position, which in
| the case that you happen to be right, is quite a bad thing.
|
| If you wouldn't mind reviewing
| https://news.ycombinator.com/newsguidelines.html and taking
| the intended spirit of the site more to heart, we'd be
| grateful.
| jb1991 wrote:
| How about psilocybin? One recent article posted here
| suggested something like one dose every six months had
| measurable impact on depression.
| asdff wrote:
| I support psychadelic legalization but at the same time I
| wonder how much of the antidepressive effect of
| psychadelics is just from giving space for thought in your
| day to day life. For exmaple, the modern human wakes up,
| starts scrolling instagram, goes to work, goes home,
| continues scrolling instagram, then sleeps. There is no
| period of reflection or introspective thought, since every
| mundane activity where you could be reflecting internally,
| e.g. washing the dishes or walking to the train, is
| consumed by a podcast you have playing from your airpods.
| For some people, taking a psychadelic drug is the only time
| they give themselves to do nothing but think internally for
| a few hours. I wonder if they would get the same benefit
| just setting aside regular designated meditation time where
| their thoughts aren't being interloped by all these forces
| in modern society that vie for our attention.
| mathgladiator wrote:
| For my first infusion, I didn't wear an eye-mask and I
| was kind of incapacitated as I watched people come and
| check on my vitals. I felt this deep sense of caring that
| we are all in this world together and love is the most
| important thing.
|
| It's not just time to reflect, but also a new perspective
| which is hard to allow to enter the mind due to all the
| anxieties of the world.
| jb1991 wrote:
| I agree with your general point, but psilocybin does a
| heck of a lot more than give you space to think. It
| temporarily (or, as studies suggest, perhaps more long-
| term) also changes quite a bit about _how_ you think.
| mathgladiator wrote:
| I'm finding the biggest impact from the psychedelic
| experience as a spiritual awakening, and the biggest thing I
| feel is that I'm no longer in the nihilism trap.
| _moof wrote:
| I hope it sticks for you. For me it wore off completely
| after only three weeks.
| padolsey wrote:
| Can you articulate how your brain allowed you to escape
| from that trap? Did K affect you on some low-level
| inarticulable level? Sincerely curious. Nihilism is a
| struggle for me!
| mathgladiator wrote:
| So, what I can surmise is that I felt a deep connection
| to the universe. You _feel_ the ramifications of not only
| being a part of the universe, but also the part of the
| universe trying to understand it.
|
| I'd say I was an atheist before, but now I feel there is
| something and that something is curious. It's like
| consciousness is independent of the universe, and didn't
| create the universe. Instead, it's trying to figure out
| the puzzle. So, this tiny spark of faith cures nihilism
| because I'm part of the consciousness, and as long I as
| wake up and solve by piece of the puzzle, there is
| meaning in that.
| randomopining wrote:
| 100% same feelings. But really it was never as much like
| this with K as it was much moreso with the shrooms.
|
| I can totally see why K is an immediate relief for people
| who are immensely depressed. Within 1 hour it basically
| rips you away from your sense of self, that you were so
| unnecessarily attached to and that had all the depressive
| emotions with it.
|
| Shrooms seem like they produce a guttal connective
| feeling to your surroundings and the natural world around
| you. Longer lasting imo.
| padolsey wrote:
| That's beautiful. Thank you.
| walrus01 wrote:
| By far one of the weirdest things I saw recently was ketamine
| clinic advertising on various forms of social media. Very
| slickly produced.
| 0xMatt wrote:
| Low testosterone and too little exercise, just my opinion.
| Linda703 wrote:
| [deleted]
| edkennedy wrote:
| Much more comprehensive article on the study that is not behind
| paywall here: https://www.nature.com/articles/s41380-022-01661-0
|
| (Also it skips the editorialized title and presents the data)
| SubiculumCode wrote:
| It is depressing reading the comments here from people who know
| nothing of this field, yet feel like they are qualified to spout
| tons of unsubstantiated nonsense on a forum where we are
| encouraged to only engage in the conversation when we actually
| know something.
| bowsamic wrote:
| I'm not sure what you can expect since this problem affects so
| many of us in such a huge way and yet no one has answers or
| even stable advice
| smm11 wrote:
| I believe Vitamin D, sunshine itself, and not endlessly 'sitting
| around' can do wonders, too.
| missedthecue wrote:
| I wonder if the number of people regularly smoking pot and the
| number of people describing themselves as depressed have
| anything to do with each other. Both are lines straight up and
| to the right over the past 40 years.
| throwawayacc2 wrote:
| I have a theory which I can't substantiate, just anecdotes and
| conversations I had throughout the years. But, I'm convinced a
| lot of depression/anxiety stems from thinking too much and that
| in turn is caused by an ever complex word with looser and looser
| guidelines or norms.
|
| I'm not making judgements weather this is necessarily good or bad
| but rather observing.
|
| In the past, even as recent as the 50s but certainly before the
| 20th century, a persons course in life was mostly determined at
| birth.
|
| You're born, you play, you grow up, work the fields or a job, get
| married, have kids of your own and die. Society was more rigid
| and pretty much funnelled you through a "tried and tested path",
| for good or for worse. And the lack of information made things
| "simpler" in a way in the sense you had a small number of people
| to get input from. Take child rearing for example. Many modern
| people worry so much and research ways to "optimise" their
| children for example ( I'm thinking of a lot of questions I saw
| on the parenting stack overflow ) whereas in the last, you'd just
| ask your own parents. And, since they were older, the assumption
| was they knew what they where talking about, even if it was not
| necessarily true. Same with health, same with sexuality,
| relationships, a lot of things.
|
| Essentially lack of information and a rigid social structure
| meant fewer choices which meant less thinking. And less thinking
| meant less depression and anxiety.
|
| Now when you have a world of information at your hands, you have
| way more things to think about, to worry about and to look for
| information on how to fix or improve.
|
| I'm not sure medication, even "working" one is a sustainable
| solution to what appears to me to be an environmental problem
| rather than a biological one.
| retrac wrote:
| > by an ever complex word with looser and looser guidelines or
| norms
|
| That reminds me of one of those weird little findings. People
| with depression appear to more accurately estimate their
| control (or lack of control) over a situation, than people who
| are not depressed. Perhaps non-depressed people are just
| delusionally optimistic about the chances of things going
| wrong. (If true "overthinking" is probably related in some way
| to this.)
|
| > When participants were asked to press a button and rate the
| control they perceived they had over whether or not a light
| turned on, depressed individuals made more accurate ratings of
| control than non-depressed individuals.[5] Among participants
| asked to complete a task and rate their performance without any
| feedback, depressed individuals made more accurate self-ratings
| than non-depressed individuals.[6][7][8][9] For participants
| asked to complete a series of tasks, given feedback on their
| performance after each task, and who self-rated their overall
| performance after completing all the tasks, depressed
| individuals were again more likely to give an accurate self-
| rating than non-depressed individuals.[10][11][12][13][14][15]
|
| https://en.wikipedia.org/wiki/Depressive_realism
| 999900000999 wrote:
| Lost Connections is a great book on this.
|
| Most people used to be apart of some form of community. You
| made friends, made dinner together, found love , etc. In this
| community.
|
| Now their's none of that. Everyone is a disposable
| interchangeable part. Instead of getting a stable job, and
| having a foundation, now we're all gig workers. Or short-term
| contractors. Back in the day, you'd work the same job most of
| your life, and that's one of the ways you made friends.
|
| Back when I lived in LA, I was lucky enough to be a part of a
| fantastic apartment community. We cooked, and watched sports
| together. While I had to leave for other reasons, I definitely
| miss these guys.
|
| The internet's a poor substitute, even at a bar my behavior is
| restricted by social norms. In real life I've never had anyone
| call me a slur, or personally attack me.
|
| Online it's absolutely relentless, I don't use social media or
| online dating for this reason.
| martopix wrote:
| I actually read a book that made a similar claim, although I
| can't remember the title right now. It essentially said that
| depression as we know it is an illness for the contemporary
| world for the reasons you list. However, it made the point that
| there were "different" mental health problems in the past,
| which had to do more with the conflict against the more rigid
| social structure -- same but opposite to how today we suffer
| from the lack of direction that you describe well.
| theptip wrote:
| It's really complex. For a partial survey of that complexity,
| see this SSC: https://slatestarcodex.com/2017/06/13/what-is-
| depression-any....
|
| Part of the problem in describing/treating this condition is
| that depression is a huge constellation of overlapping causal
| mechanisms. You may be describing one set of mechanisms but
| it's certainly not the only one.
| multiplegeorges wrote:
| > And less thinking meant less depression and anxiety.
|
| That's a pretty big claim. I know you're just putting out your
| own personal theory and you're not trying to declare you have
| the "answer", but I don't see how that follows.
|
| A first step is establishing that depression is more prevalent
| now than in the 50s. You'd have to account for the lack of
| diagnosis then and find some other indicator of the true rate
| of depression.
|
| Not an easy task, for sure, but my first thought is that
| depression just went untreated then and people became resigned
| to their lot in life and suffered.
| [deleted]
| Zigurd wrote:
| This is called nostalgia.
|
| History was not neater, nor more uniform. The typical departure
| point in 1950s conformism, with the assumption that prior
| history must have been even more conformist.
|
| But that's not how most of history treated gender roles,
| marriage, work, etc.
| sinecure wrote:
| This is essentially what Ted Kaczynski (the Unabomber)
| theorized and wrote about in his manifesto, that
| industrialization and its abundance of comforts and options
| have destroyed human happiness and that we would all be better
| off if we lived simple hunter gatherer lives and knew nothing
| of modernity or technology. That the hunter who catches a deer
| and feeds his tribe is immensely more happy and fulfilled than
| the stock broker who navigates high finance and city life, but
| can't seem to get that promotion or afford that vacation house
| his boss has.
|
| Essentially the awareness of everyone else's lifestyle and
| prosperity, amplified by the advent of print newspaper and now
| social media, is the key destroyer of joy.
|
| The peasant works his farm and feeds his family and raises his
| kids. He knows he will not become king. He barely knows what
| the king's lifestyle is. In modern America we are blasted with
| thousands of kingly lifestyles 24/7 and are constantly asked,
| why aren't we living like that? Why do I have to work? Why
| can't I date the supermodel? Why do I have to struggle with
| rent?
|
| Our minds have not evolved to deal with this super-stimulus nor
| the self comparison of endless idealized lifestyles we cannot
| all realistically achieve.
| themedes wrote:
| Interesting concept, I must admit it seems a plausible
| explanation. I also notice that Anxiety sufferers often
| overthink things (its much more complex I know).
|
| I guess information size is still exploding in volume and
| depth, but perhaps in quite a few hundred years this will slow
| and we catch up through several generations. Maybe then
| depression or anxiety will be filtered out of subsequent
| generations as we cope better?
|
| Personally I suspected a lot of it was down to poor
| nutrition/diet, exercise, night shift work, overall sleeping
| less and exposure to screens/information. The main factor I
| think is food e.g. sweeteners, sugars, e-number chemicals,
| preservatives, and salt all altering our body chemistry.
| rustybelt wrote:
| Similarly, I don't think we're equipped for the level of
| exposure to life-altering tragedy that mass/social media makes
| available. I swear my wife subscribes to a dedicated "small
| child dies in horrible freak accident" facebook feed. She is
| constantly sharing these types of stories with me from around
| the world. Logically, I know that these are actually extremely
| rare events, but the constant exposure still makes us both more
| anxious about the safety of our own children.
| Taylor_OD wrote:
| Good lord. I try to tell folks all the time that to some
| extend you have to ignore news. Big world events are going to
| find their way to you. Russian invading Ukraine is going to
| end up being something you hear about regardless if you
| follow the news at all.
|
| The tragic stories of children getting bombed in Ukraine? The
| photos? The gory details? That likely is only waiting for you
| if you go searching for it.
|
| I'm not advocating being ignorant. I'm advocating limited the
| amount if tragedy you seek out on a daily basis. It isnt good
| for ones head. It certainly doesnt make anyones life better.
| hammyhavoc wrote:
| I dunno about that. I know several doom-and-gloom mongers
| who seem to get off on sharing the woes of the world in
| group conversations. As a result, I've barely used Facebook
| or any kind of social media since the pandemic began. Quite
| literally, haven't used it this year except to post an
| interview.
| wizofaus wrote:
| Discuss: HN qualifies as "social media". Why or why not?
| froglets wrote:
| My theory is that depression is situational and doing things
| changes our situation, hopefully to one that is less
| depressing. Thinking about things isn't very helpful if you
| don't actually do anything. Medications can help people think
| less and do more, and do seem to be one of many correlates of
| depression.
| grumple wrote:
| > I have a theory which I can't substantiate, just anecdotes
| and conversations I had throughout the years. But, I'm
| convinced a lot of depression/anxiety stems from thinking too
| much and that in turn is caused by an ever complex word with
| looser and looser guidelines or norms.
|
| This is not a new theory. It's called negative self talk, and
| fixing that is one of the core approaches in treatment of
| anxiety and depression.
| hn8305823 wrote:
| The good news is you don't seem to suffer from serious
| depression.
|
| If you did then you would know it is a very real _physical_
| problem that positive thinking can 't really overcome. Not just
| physically in terms of brain chemistry but you often literally
| sink into your chair as if you were physically exhausted and
| don't want to move.
|
| Depression enforces negative thought templates. No matter how
| good your life is going you will usually see the negative side
| of things and be depressed mentally _and_ physically.
|
| In a healthy person this is not the case. Your mood will vary
| widely by the situation you are in but most of the time
| positive thought templates will prevail and allow you to see
| the best even in difficult situations. It also gives you the
| mental/psycological energy needed to tackle difficult
| challenges/problems. In a fully depressed state you have no
| such energy no matter what your willpower is.
|
| A healthy person has the mental and physical energy to tackle
| the day even when it involves hard/tedious or unpleasant work.
|
| One paradoxical thing about depression is that it can sometimes
| actually feel _good_ , in a comforting "oh it's that familiar
| feeling again" way. Usually that is just when you feel the
| onset of symptoms before the bad feelings/thoughts/feelings.
| s1artibartfast wrote:
| I would generalize that even further to an abundance of
| possibility. In terms of anxiety, possibility, however remote,
| contributes to decision paralysis and over analysis.
|
| In terms of depression, an abundance of possibility leads to
| disappointment, deferred action, and deferred acceptance.
|
| I can only speak for myself, but a preoccupation with trying to
| optimize my life in the face of infinite possibility has led to
| a tremendous amount of anxiety and at times depression. For
| lack of a better term, it is an Omnivore's Dilemma of the Soul.
| DigiDigiorno wrote:
| ". . . I'm convinced a lot of depression/anxiety stems from
| thinking too much . . ."
|
| Sertraline (Zoloft) is used to treat both depression and/or
| OCD. The dosages overlap too (OCD usually is a higher dosage I
| believe). It is also used to treat anxiety.
|
| I suspect there is a causal chain that goes like: compulsively
| thinking > anxiety > depression/suicide. I'm not sure how
| preventing reuptake of serotonin prevents compulsive thinking,
| but I suspect the mechanism is closer to preventing the
| thinking aspect and the other feelings are further down the
| causal chain.
|
| I am not an expert and I have only read a couple papers due to
| someone in my life taking Sertraline and having it reduce their
| OCD. (I thought it was only for depression based on my lay
| opinion)
|
| If anyone has read anything interesting about the thinking
| aspect, please share links!
| Sohcahtoa82 wrote:
| I wonder how many people think they have depression, but are
| actually simply suffering from despair.
|
| Medication won't help you if you're living paycheck-to-
| paycheck, dealing with landlords constantly increasing rents
| while wages are stagnant, worried that getting sick and missing
| a couple days of work will result in losing your place to live.
| operator-name wrote:
| I do not have full access to the comments published on the BMJ,
| but the study is openly available at
| https://www.nature.com/articles/s41380-022-01661-0
| GauntletWizard wrote:
| Depression is caused by a shitty life. Most people with
| depression are trapped in an abusive relationship, though often
| it is with themselves. They're trapped by fear of admitting
| failure and making changes.
| etchalon wrote:
| This is deeply untrue.
| imadierich wrote:
| a lot of times its a abusive mindstate.... a lot of really
| really down bad people have went on to do great things. its all
| about your perspective
| GauntletWizard wrote:
| Absolutely. The best parts of modern psychology are CBT and
| finding a better mind state. The drugs sometimes help shake
| up your mind enough to find that.
| nth_order wrote:
| Yeah, but thats hardly news, we have known that for decades.
| Otherwise direct serotonin releasers would be the most useful
| ADs. But these mostly give people nausea and serotonin syndrome.
| ADs work mostly by being FIASMAs, reducing inflammation and
| oxidative stress, increasing neurogenesis and neuroplasticity,
| increasing the activity of other monoaminergic systems, and the
| serotonergic portion is mostly explained by downregulation of
| 5-HT1A autoreceptors due to chronicly high extrasynaptic 5-HT
| levels. This also explains the delayed action of ADs.
|
| At least this is my knowledge from when I last researched this
| topic in depth.
|
| But that would be a little bit too much for the general public,
| so it is simplified, to this annoying effect that everyone talks
| of "low serotonin levels" where in fact the underlying systems
| are way more complex.
| harborseal wrote:
| Yes, but people are still being told by their psychiatrists
| that depression is caused by low serotonin levels as if it were
| an objective fact. Seeing this happen made me lose a lot of
| trust in the medical profession. Is it like this for all
| illnesses or just mental ones?
| hirvi74 wrote:
| I was told by a psychiatrist that I respect that one day in
| the future we may look back on psychiatry of today like we
| look at blood-letting and lobotomies of the past.
| Workaccount2 wrote:
| Anytime I learn about bodily functions I become more and more
| aware of how shit it's engineering is. Works amazing, sure, but
| try and fix or debug anything? Good luck.
| onefuncman wrote:
| almost like life is an MVP that could pivot at any time
| hutzlibu wrote:
| Erm, are you aware of any other machine, that is able for
| self repairing and self replicating in a complex and changing
| environment?
|
| I really would not call my body bad engineering, just because
| I do not understand how it works in detail.
|
| Rather the opposite, the more I learn, the more amazed I am,
| how awesome it all is. The complex interactions of chemical,
| electrical and physical components. (And who knows, maybe
| even quantum field elements.)
|
| I could not design anything remotely complex at all.
|
| Also, I debug and fix my body all the time, or rather, my
| body does this mostly in auto mode.
| o_nate wrote:
| I guess we should be grateful our brains are complex enough
| to understand anything. Maybe it's too much to ask to ask
| them to be able to understand themselves. They would need to
| get more complex to understand themselves, but then that
| complexity would make them more difficult to understand. It's
| the snake trying to swallow its own tail.
| _jal wrote:
| Tractors don't know how to repair each other, either.
| Dudeman112 wrote:
| To be fair, tractors don't go on about how smart they are
| rustybelt wrote:
| Are you saying God likes to yeet buggy unmaintainable
| spaghetti code directly into production?
| rustybelt wrote:
| Or maybe this reality is actually a dev environment.
| N1H1L wrote:
| DNA is spaghetti code exemplified. We are carried around
| tons of dead viral DNA for example - what amounts to
| shipping code with older code commented out.
| rustybelt wrote:
| I'm using this argument in my next code review meeting.
| wizofaus wrote:
| As a reviewer I'd then insist that your code was thrown
| into a software-eats-software world and given a few
| million reproductive cycles to see how it fares. If it's
| still thriving you'll get your PR approval.
| ryandvm wrote:
| Hmm. We really ARE created in his image - at least I am.
| ZeroGravitas wrote:
| And now the opposite happens with headlines that imply "your
| medication is suddenly revealed to be useless" when in fact
| we've been aware that we don't know how it works for a while,
| but we're still reasonably sure it helps, which perhaps
| explains the increase in prescription more than the "serotonin
| is the only thing that matters" theory which the experts ruled
| out a while ago.
| virtuallynathan wrote:
| They barely work better than placebo, from what I saw in my
| reading of the literature.
| slibhb wrote:
| Well, placebos work fairly well for depression. And it's
| not like doctors can prescribe them...
| User23 wrote:
| They can however prescribe basically harmless pills that
| do more or less nothing. Low dose vitamin pills are
| sometimes used for this purpose.
|
| Whether or not it's ethical for a doctor to tell a
| depression patient that the depression is caused by a
| treatable vitamin deficiency is another matter. Then
| again, maybe it really is caused by a lack of
| micronutients. After all we really don't understand
| depression very well.
| jack_pp wrote:
| So the solution is prescribing something that has a lot
| of unpleasant side-effects for a lot of people?
| Medication that if you don't take will have SEVERE
| withdrawal symptoms?
| zasdffaa wrote:
| I wonder why you say 'SEVERE' so severely. It doesn't
| sound like you have any direct experience of this. I had
| to come off them and it wasn't a problem. My biggest
| fear, and it was huge, was that the depression would
| return. It didn't.
| MattRix wrote:
| I had horrible withdrawal effects coming off
| lexapro/escitalopram, it was literally the worst
| experience of my life. I spent a month with maxed-out
| anxiety, feeling like I was going to die any moment,
| waking up at night with electric shocks running through
| my body, etc. I wouldn't wish it on my worst enemy.
| zasdffaa wrote:
| OK, that's an SSRI which is what I had to come off
| (prozac), with no major issues.
|
| I'm not at all claiming it's a fun ride for everyone,
| just giving my one data point that it's not inevitably
| awful for absolutely everyone. Sorry you had to deal with
| it!
| hammyhavoc wrote:
| Anecdotal. n+1.
| zasdffaa wrote:
| I'm not sure what you're saying?
| guerrilla wrote:
| Because it's pretty damned severe with SNRIs. You
| probably only tried some SSRIs. Turns out not all
| medications are identical.
| zasdffaa wrote:
| Yep, never taken SNRIs - for me it was straight prozac.
| Side effects while on it weren't pretty though.
| slibhb wrote:
| SSRIs have mild side effects after the first few weeks.
| Withdrawal varies but is generally manageable if you
| taper slowly.
|
| I'm open to alternatives but I'm convinced that
| antidepressants help people.
| wins32767 wrote:
| I suddenly became allergic to SSRIs and had to go off of
| them cold turkey. I didn't have any withdrawal problems
| at all so it's not a universal issue.
| niemal_dev wrote:
| Wow, just wow. Quitting them cold turkey 0 problems,
| incredible.
| wins32767 wrote:
| I'm not trying to minimize the problems other people have
| had with withdrawal at all, just saying that it's
| possible to have a variety of different outcomes being on
| and off of them.
| CharlesW wrote:
| The AMA says they can if the patient is informed of and
| agrees to their use. But wouldn't that significantly
| impact their effectiveness?
| NickM wrote:
| There is also evidence that they might only work better
| than a typical placebo because the side effects make them
| an "active placebo", triggering a stronger placebo
| response. i.e. if you take a pill that doesn't make you
| feel any different, you may wonder if it's working, but if
| you feel weird and have unpleasant side effects then you
| know it's doing something.
|
| This is particularly underappreciated in the research done
| on these drugs, because a double-blind study isn't actually
| double-blind if many of the participants can easily tell
| whether they're in the placebo group due to very noticeable
| side effects.
|
| It's been mentioned in other comments, but I really
| recommend the work of Irving Kirsch on this; he's a
| brilliant scientist and his book The Emperor's New Drugs is
| a real eye-opener.
| swamp40 wrote:
| They work fantastically, from what I have seen firsthand
| many many times.
|
| There is a _very good reason_ for it 's use in up to 20% of
| the population in some groups in the US.
|
| Just because we haven't pinpointed _why_ doesn 't matter a
| bit.
| dimal wrote:
| "They work fantastically" is a statement that requires
| many qualifiers.
|
| They work fantastically for some subset of people. For
| other people, they do nothing. For other people, they
| have negative side effects that make them not worth
| whatever benefits they provide. For some people, they
| cause extreme negative effects when the medication is
| removed. For some other people, they increase the chance
| that they will commit suicide.
|
| It does matter that we haven't pinpointed why they work
| for some people, because if we did, we might be able to
| avoid those negative effects and wasted time for the
| people for which they don't work.
| marcosdumay wrote:
| If the effect is systematic, real, and measurable, it's
| just a matter of giving the medication to the people that
| benefit from it, and not giving it to the people that
| don't.
|
| The real question is by what level is the effect is
| systematic, real, and measurable?
| bowsamic wrote:
| Who should I trust? Peer reviewed literature, or one
| swampy boi?
| bratsche wrote:
| I've tried a number of antidepressant drugs and so far not
| been able to notice much difference with any of them.
| moth-fuzz wrote:
| I have a friend that's convinced that her ADHD 'causes
| depression' because her brain does not produce 'enough
| dopamine'. I'm noticing more and more among my peers a
| mythology around brain chemicals that's about as accurate as
| the four humors but with a scientific-sounding veneer. All
| brain function (and thus all bodily function, because the brain
| _is_ the whole person /s) can be traced back to the presence
| or absence of a nominal amount of certain chemicals.
|
| I wonder how the popular understanding of these processes will
| evolve as more and more is discovered and understood.
| oasisbob wrote:
| The low-dopamine hypothesis for ADHD is a legitimate idea
| still being actively studied.
| hirvi74 wrote:
| > legitimate idea still being actively studied.
|
| Yes, but it is not conclusive.
|
| I for one believe there are multiple types of ADHD. Be it
| lifestyle induced, lead-exposure induced, TBI induced,
| genetic, etc.. Us humans like to slap labels on things, but
| life is rarely so cut and dry.
| kemiller wrote:
| I think ADHD causes depression because you get constant
| negative feedback from (many) teachers & bosses.
| root_axis wrote:
| IMO, this hypothesis doesn't pass the smell test. One of
| the defining qualities of clinical depression is that
| personal success in life does not obviate the symptoms;
| there are many widely know examples of beloved and
| successful people being unable to overcome the burden of
| crushing depression.
| omniglottal wrote:
| Being beloved and successful does not negate negative
| feedback. In fact, rhetoric such as this is invalidating
| the experience of those who must thereby insist that,
| contrary to the signs you're seeing, they're actually
| feeling down, else they must further internalize the
| negative feedback which nevertheless exists in plethora.
| The notion that anyone could claim precisely what
| reasonably should bring another stranger happiness or
| resolve their depression is pure hubris. The defining
| qualities of this situation are all internal, and the
| externalities used in your measurement are correllative
| and either irrellevant or after-the-fact. A "smell test"
| one might consider is of empathy: if your mind ran
| quickly through various things which caught its
| attention, yet couldn't follow through with focus until
| resolution, negative feedback surely just recurs and
| piles up - it is neither sufficiently affected nor undone
| by positive feedback. OP's hypothesis smells true to me,
| but I choose to sniff the roots rather than the flower
| when we're looking for a cause more than an effect.
| hirvi74 wrote:
| It's true, and I alluded to this more in depth in a comment
| in this chain.
|
| Growing up in the semi-rural South East, USA, where kids
| didn't get diagnosed with ADHD. (Fun fact -- I had 5 boys
| who were my childhood friends that grew up with. We all
| lived within 3 miles of each other, and all of us have ADHD
| -- something in the water maybe?)
|
| I didn't know I had ADHD until I was in a dark dark place
| in my early 20s after 4 years of college (only took me 6
| years lol).
|
| I swear I have some kind of CPTSD from growing up with it.
| I developed all kinds of healthy and unhealthy coping
| mechanisms and a lot of anger and negative self-talk that I
| struggle with still to this day.
|
| I mean, I was chewed up and spit out by the public
| education system, little league sports, other children's
| parents, my peers, and even my own parents from time to
| time. Constantly, day in and day out, being punished,
| ridiculed, and humiliated for something I could not
| control. I didn't want to be that way, and I still don't
| want to be that way, but I am what I am.
|
| I would not consider myself to be anything but average
| intelligence, maybe even below average, but if it weren't
| for sheer luck and a determination to prove everyone wrong,
| then I do not think I would have survived.
| bitexploder wrote:
| There is a reason alcoholism (and drug addiction) and
| ADHD strongly correlate. Coping and self medication are a
| big deal when it feels there is no other tools available
| or the negative externalities just get to be too severe.
| Add in addictive personality traits common to ADHD folks
| and it is quite a thing to overcome for more significant
| ADHD sufferers.
| wongarsu wrote:
| I think a lot of this is about English (and probably most
| languages) being vary lacking in ways to describe both short-
| time and long-time mood effects. Talking about a dopamine
| rush from completing a difficult task or an endorphin rush
| from sport isn't very accurate, but despite everyone knowing
| the feeling we never made better words for them.
|
| Similarly "I've low dopamine" is just a modern version of "I
| have the blues" or "I'm depressed". That's all good, as long
| as everyone involved knows that it's a short hand, or maybe a
| double-meaning of the word, not an actual medical
| description. Just like somebody who is "a little OCD" has
| none of the symptoms of actual OCD.
| jugg1es wrote:
| This is like the right/left brain generalization that
| everyone seems to still believe in.
| hirvi74 wrote:
| > I have a friend that's convinced that her ADHD 'causes
| depression' because her brain does not produce 'enough
| dopamine'
|
| Interesting, and she is somewhat right, but is wrong about
| the 'enough dopamine' part, if I understand correctly. I have
| heard that dopamine plays a role in ADHD (seems likely our
| neurotransmitters don't absorb enough, but even that is an
| overly simplistic explanation of the unknown and true
| reality).
|
| But yea, I also have ADHD and yes, it can cause depression.
| Not due to dopamine, but because of the negative feedback-
| loop ADHD can create.
|
| For example, let's pretend I have some big assignment I need
| to complete, and I am without access treatment (professional
| or self-medication). If can't muster the "powers" to work
| on/finish said assignment, I start to get extremely anxious
| and/or I get depressed that I failed to finish said
| assignment. Said anxiety/depression only makes my ADHD
| symptoms worse which makes the anxiety/depression worse. Thus
| I will struggle more to complete future work, which only
| fuels said anxiety/depression even more, and the loop keeps
| on iterating.
|
| Though, sometimes the anxiety can be extremely helpful. I can
| muster some insane kind of hyperfocus due to the pressure of
| a looming deadline. I spent decades of my life relying on
| anxiety to complete tasks, that even with treatment, it's
| extremely hard to start and finish tasks without the anxiety.
|
| It's an annoying and rough way to live, but oh well, I am
| just grateful I do not have something worse.
| TurkishPoptart wrote:
| The Andrew Huberman podcast has a great episode on the
| dynamics of ADHD. The brain does not properly distribute
| dopamine to where it wants to send it, which challenges
| your planning/reward matrices.
| hirvi74 wrote:
| As much as I love the Huberman podcast, I do feel he
| spoke outside of his domain a bit too much on that
| episode in certain sections.
|
| Sure, he is far more credentialed than I am, but it's not
| like he conducted any of the research himself. He is
| merely spouting off what one could find on PubMed, APA,
| etc..
|
| While I think mindfulness can be beneficial, the research
| he cited about just 17 minutes (or whatever arbitrary
| number) can have permeant changes in the brains of
| individuals both with and without ADHD to be ridiculous.
|
| I also find any research relating to ADHD and fish oil
| supplementation to be extremely dubious. It appears
| research is starting to back-track on that one too.
|
| That being said, I do really enjoy his podcast, but just
| because he repeats something does not mean it's
| true/untrue. I would have preferred him to have an
| interview with an expert in the field of neuropsychiatry
| or of equal qualification.
| daniel-cussen wrote:
| Suicidalism and depression come from having a bad life,
| basically. All these quacks are trying to find what little
| chemical they can pepper on or what little product they can
| market. And society and especially psychiatrizing parents or
| bosses keep looking for the one magic trick that fixes this
| strange illness. Just make their life better! The actual
| circumstances, stop oppressing them! Admit your subterfuge and
| your child or employee will not suicide.
|
| But admitting the subterfuge would sometimes amount to suicide.
| king_magic wrote:
| I have (and have always had) an awesome life. I've still
| struggled with depression.
| daniel-cussen wrote:
| EDIT: Had and have always had an awesome life? The fuck?
| Sounds counterfactual. Yeah a perfect life with no problems.
| Wouldn't the depression make it not awesome?
|
| But to narrow down, shrinks dream of some like sweetener or
| artificial coloring they can add to all the shit the give
| someone to make it taste good. A spoonful of sugar makes the
| medicine go down! No it doesn't. It tastes bad because it's
| poison. That is the point of taste. And the best medicine
| tastes really good, Paltomiel, aspirin doesn't taste
| particularly bad, there's another one but it doesn't taste
| bad just really bitter, ah...alkaloids taste uh...well they
| reconfigure your notion of sweet=good bitter=bad, then
| there's dex, blood sugar, now sugar tastes like treacle. But
| the whole thing of medicine tasting bad is just like
| toothpaste tasting bad (sodium flouride), it tastes bad
| because it is bad for you, you should avoid it, get a
| toothpaste that doesn't have fluoride in it. Of course little
| children have no way of stopping their parents from forcing
| them to use this toothpaste, so they complain. And the
| parents say no complaints, backed by violence. Coercion.
|
| To the shrinks that said that to me, I say, you take all the
| shit since it tastes so good, give me your pay for doing your
| job for you, and yeah the seasoning...you'll need it.
| MrYellowP wrote:
| Depression isn't caused by chemical imbalances or whatever other
| causes outside of ones responsibility. It's caused by ones life.
| The people one shares his life with, the environment, ones
| approach towards life itself. When you suffer from depression,
| you suffer from your existence. Either because it is shit, or
| because you make it shit and don't know better.
|
| It's amazing how far we've come with ignoring that there are a
| lot of things well within our control when it comes to mental
| health, as long as we stop pretending they're not.
|
| I'm not saying that everyone has the chance to change his life.
| I'm saying that there's too much of a lack of self responsibility
| in favour of dependence on "luck" and "external factors" which
| "require" medication, because "there's nothing you can do."
|
| I'm not blaming anyone but myself for my state and I certainly
| don't try to pretend that it's outside of my control. It isn't. I
| know that, because I can manage it all by myself, without
| depending on anything. It doesn't change my life and I'm still
| working on that, but if i blamed some random ass excuse of a
| chemical imbalance for something that's actually my own fucking
| fault, then I'll just stay like this forever.
| chx wrote:
| There's a significant population of science denying cranks and so
| those who want to raise legit concerns about the quality and
| alas, often motivation of medical studies are easily grouped with
| those. But:
|
| 1. There's no such thing as good / bad cholesterol. This is
| complete baloney and Pfizer lost a staggering amount of money
| when a drug raising good cholesterol got as far as human trials
| -- and failed them. There is no significant evidence for
| concluding that dietary saturated fat is associated with an
| increased risk of coronary heart disease or cardiovascular
| disease. There's growing amount evidence though that cholesterol
| is a symptom and not a cause.
|
| 2. The diagnosis and treatment of ADHD in adults but most
| especially in children is extremely suspect. Last year there was
| a study pretty much confirming it is overdiagnosed in children.
| But even worse, whether ADHD is even a thing or multiple
| conditions wrongly bundled under a single name is basically an
| open question. We basically put labels on children with
| "problematic behaviors" like "autistic spectrum disorder" and
| "ADHD" and then eventually find that 30-80% of ASD children are
| meeting criteria for ADHD. First of all what sort of study is
| 30-80%? But if the higher end is true, the question strongly
| arises: are these even two things?
|
| 3. I would bet dollars to doughnuts in a few decades we will look
| at all current nutrition advice to something akin of medieval
| quackery. How is this not self evident: genes obviously affect
| how foodstuff interact with our bodies thus any sweeping
| generalization is inherently suspect or most likely complete
| baloney. Like, how can anyone seriously think _only_ lactose
| intolerance is an inherited genetic trait.
|
| I would need to dig into my notes if someone needs them but a
| group of statisticians at a university started to look into
| medical studies and then FOIA the raw data and found like 80% of
| them cherry picking the data.
|
| The incentives are not exactly at the right place.
| briefcomment wrote:
| Add polyunsaturated fats to that list
|
| If you really want to dive into the wealth of counter narrative
| research that's being conducted, here's a huge collection
| http://haidut.me
| drc500free wrote:
| > Last year there was a study pretty much confirming [ADHD] is
| overdiagnosed in children.
|
| That paper is very clear that they did not study misdiagnosis.
| They are a bit jargony with the use of "overdiagnosed."
|
| "Overdiagnosed" does not mean incorrectly diagnosed, it means
| that there are subgroups who get a net harm from being treated.
|
| A more understandable term for what they measure is
| "overtreated." The solution is likely better protocols for mild
| cases, not to state that ADHD is not a thing.
| klodolph wrote:
| > I would bet dollars to doughnuts in a few decades we will
| look at all current nutrition advice to something akin of
| medieval quackery.
|
| All current nutrition advice? Does this equally include the
| nutrition advice that your cousin gives on Facebook, as well as
| the advice given by doctors of nutritional science?
|
| I get where this skepticism comes from. Nutrition is
| complicated, and there's a lot of bad advice shared by random
| people you meet. There's also the diet supplement aisle at your
| local grocery store, which is full of poorly-regulated products
| with dubious claims. (At least, in the US, we have these. They
| are not regulated as drugs.)
|
| At the same time, nutrition-based interventions are some of the
| most effective public health policies we've ever implemented.
| In the US, we have programs like WIC. We have iodized salt. We
| cure blindness in children. We cure scurvy. These are all
| amazing things--things which we kind of take for granted,
| because we're not ever exposed to scurvy, childhood blindness,
| etc.
|
| This is not the first time I've heard such extreme skepticism
| of nutritional science and it just _boggles the mind_ because
| if you talk to someone who works in the field, they have
| amazing success stories to talk about.
| refurb wrote:
| _There 's no such thing as good / bad cholesterol._
|
| This is untrue. There is lots of data to suggest elevated LDL
| is a risk of cardiovascular disease and that high HDL lower
| risk.
|
| Pfizer's drug failed because of safety issues, not because
| "There's no such thing as good / bad cholesterol".
| chx wrote:
| > there is lots of data to suggest elevated LDL is a risk of
| cardiovascular disease
|
| Elevated LDL is a symptom of inflammation. It is not a cause
| and lowering it doesn't help. The research mixed up cause vs
| correlation.
| refurb wrote:
| I love reading medical advice on HN.
|
| Genetic errors which cause high LDL levels result in
| significant cardiovascular disease. It's a very strong
| cause and effect.
|
| I won't argue that inflammation doesn't play some role (it
| seems to play a role in many diseases), but I wouldn't
| dismiss current medical opinion on LDL.
|
| https://en.wikipedia.org/wiki/Familial_hypercholesterolemia
|
| _Familial hypercholesterolemia (FH) is a genetic disorder
| characterized by high cholesterol levels, specifically very
| high levels of low-density lipoprotein (LDL cholesterol),
| in the blood and early cardiovascular disease._
| imtringued wrote:
| Why aren't you adjusting for LDL subfractions? Seriously,
| yes having too much LDL can be a sign of having harmful
| subfractions but that doesn't mean high LDL actually is
| harmful or low LDL is healthy.
| refurb wrote:
| I'm not sure that changes my argument than "There's no
| such thing as good / bad cholesterol." is a false
| statement?
| toomuchtodo wrote:
| High sugar diet the cause ("Western Die" and whatnot)?
| imtringued wrote:
| > There is lots of data to suggest elevated LDL is a risk of
| cardiovascular disease and that high HDL lower risk.
|
| There is zero data to suggest that once you adjust for
| oxidized/damaged LDL.
|
| Smokers don't have elevated LDL but they still suffer the
| effects of inflammation/oxidization that ultimately lead to
| cardiovascular disease. If you want to guarantee
| cardiovascular disease just eat straight up oxidized
| cholesterol in the form of trans fats.
| refurb wrote:
| _" eat straight up oxidized cholesterol in the form of
| trans fats"_
|
| Trans fats aren't oxidized.
|
| Like I said, I _love_ reading HN health comments.
| emodendroket wrote:
| > 2. The diagnosis and treatment of ADHD in adults but most
| especially in children is extremely suspect. Last year there
| was a study pretty much confirming it is overdiagnosed in
| children. But even worse, whether ADHD is even a thing or
| multiple conditions wrongly bundled under a single name is
| basically an open question. We basically put labels on children
| with "problematic behaviors" like "autistic spectrum disorder"
| and "ADHD" and then eventually find that 30-80% of ASD children
| are meeting criteria for ADHD. First of all what sort of study
| is 30-80%? But if the higher end is true, the question strongly
| arises: are these even two things?
|
| You know, just the other day I read about some brain scan study
| which suggested high-functioning autism looked, in brain scans,
| more like ADHD than like profound autism. But I think to some
| extent this sort of problem is inevitable if you're trying to
| dream up a taxonomy for conditions entirely from how they
| present themselves with a limited understanding of their
| biological basis.
| eyelidlessness wrote:
| > The diagnosis and treatment of ADHD in adults but most
| especially in children is extremely suspect.
|
| Go on...
|
| (I'm adult diagnosed, for disclosure, but please do go on and
| tell me how suspect my diagnosis was, how I shouldn't have been
| diagnosed as a child, how my medication is harmful. Go on and
| tell me about my life which you know better than I do.)
| photochemsyn wrote:
| I think OP is just saying that 'ADHD' is not that valid of a
| diagnosis, in terms of any kind of underlying 'pathology'.
| The fact that many people appear to benefit from the use of
| 'medication' (i.e. amphetamines and derivatives, from
| Adderall to Desoxyn(methamphetamine) to Ritalin), is mostly
| unrelated to any 'diagnosis'.
|
| Personally I think all drugs should be legal and people
| should be able to take whatever they think helps them,
| although I always recommend the 'less is more' mentality and
| would urge people not to develop dependencies.
| eyelidlessness wrote:
| > I think OP is just saying that 'ADHD' is not that valid
| of a diagnosis
|
| I understand this in the comment's expression too, and it's
| emphatically wrong.
|
| > benefit from the use of 'medication' (i.e. amphetamines
| and derivatives, from Adderall to Desoxyn(methamphetamine)
| to Ritalin), is mostly unrelated to any 'diagnosis'.
|
| You're incorrect.
|
| > Personally I think all drugs should be legal and people
| should be able to take whatever they think helps them
|
| I agree, but this has nothing to do with the validity of
| actual diagnoses of actually treatable conditions.
| Elof wrote:
| I think the point is that actual diagonoses are often
| wrong and potentially harmful, which I agree with. I
| share a bit of your story, getting diagonised with ADHD
| benefited me greatly and led me down a path that likely
| saved my life. At the same time, while many people are
| helped by the medical system many others aren't and psych
| drugs are an area where there is a lot of finger waving
| in how drugs are perscribed.
| chx wrote:
| You got it. The shakiness of this entire thing also shows
| in how the medication for ADHD is chosen: by trial and
| error. For real.
| tptacek wrote:
| That's how medication for all sorts of things is chosen.
| kortex wrote:
| Ignoring the fact that basically all drug development
| outside of the computational stuff is large amounts of
| trial and error, there is ample evidence that ADHD
| results from dysfunction of specific neural pathways, and
| stimulant medication benefits ADHD individuals (more than
| just "speed helps everyone focus").
|
| > This literature is increasingly contributing to the
| notion that the pathophysiology of ADHD reflects abnormal
| interplay among large-scale brain circuits. Moreover,
| recent studies have begun to illuminate the mechanisms of
| action of pharmacological treatments.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876939/
| whimsicalism wrote:
| e: [deleted]
| eyelidlessness wrote:
| What's your point?
| mf2hd wrote:
| Focus.
| phs318u wrote:
| This is HN not Slashdot. Please don't turn it into
| Slashdot.
| pindab0ter wrote:
| Just because you might have gotten a diagnosis that helped
| you doesn't mean everyone has.
|
| I for one am actually interested if he can back up that
| claim. So when you as them to "Go on...", please leave it at
| that. There's no reason to be snarky.
| chx wrote:
| doi:10.1001/jamanetworkopen.2021.5335
|
| > Findings In this systematic scoping review of 334
| published studies in children and adolescents, convincing
| evidence was found that ADHD is overdiagnosed in children
| and adolescents. For individuals with milder symptoms in
| particular, the harms associated with an ADHD diagnosis may
| often outweigh the benefits.
| tptacek wrote:
| https://news.ycombinator.com/item?id=32161542
| harry8 wrote:
| Hey can you do that and provide something similar about
| cholesterol? I'd appreciate it. Thanks.
| eyelidlessness wrote:
| You have the benefit of being casually disconnected from
| the topic and presenting yourself as intellectually
| curious. I have the experience of being alive because I was
| diagnosed and treated. Your curiosity about whether I get
| to live or die is up to you, but my place to speak to that
| isn't up to you until I'm dead.
| handedness wrote:
| eyelidlessness wrote:
| What's your point?
| detaro wrote:
| That you are telling them about their life which you
| apparently know a lot about.
| tuxie_ wrote:
| Don't take it personal. Both things can be true, you can have
| adhd and adhd can be overdiagnosed, doesn't mean that none of
| those diagnostics are valid.
|
| I'm sure you must be tired of people telling you about how
| overdiagnosed adhd is, I'm sorry about that, but don't take
| it personal, it's just a person on the internet.
| peyton wrote:
| GP also claimed the treatment is extremely suspect yet
| provided nothing to back up the claim. Does GP think the
| treatment does not work? AFAIK it is among the most
| treatable psychiatric illnesses.
| chx wrote:
| doi:10.1001/jamanetworkopen.2021.5335
|
| > Findings
|
| > In this systematic scoping review of 334 published
| studies in children and adolescents, convincing evidence
| was found that ADHD is overdiagnosed in children and
| adolescents. For individuals with milder symptoms in
| particular, the harms associated with an ADHD diagnosis
| may often outweigh the benefits.
|
| What I mean is that we feed children Ritalin without a
| second thought. It's absolute nuts. There are many many
| ways to work with ADHD which doesn't require giving a
| children meds. We should be _way_ more cautious about
| doing that.
| tptacek wrote:
| This study comes nowhere close to supporting the claim
| you made upthread, that "The diagnosis and treatment of
| ADHD in adults but most especially in children is
| extremely suspect". The claims it makes are much narrower
| than your claim (in particular, it focuses on mild ADHD
| cases, and the "harms" it discusses from medication are
| subjective, like the diagnosis providing "an excuse for
| problems".
| eyelidlessness wrote:
| > Don't take it personal
|
| Oh I take it personally. I'm alive today because I sought
| diagnosis and treatment. I very nearly wasn't alive from
| the consequences of being undiagnosed and untreated. I very
| probably would be dead today if I had taken this "just
| person on the internet" more seriously than I already had.
| I'm more than tired of people offering their ignorant
| opinions about stuff they don't understand.
| willcipriano wrote:
| On the other hand, the state threw a ADD diagnosis on me
| because I was bored in school, pumped me full of a
| methamphetamine analog and put me into classes with
| profoundly disabled people ruining my social life from a
| early age. I'd stare at the wall in my bedroom for hours
| due to the drugs, eventually my parents stopped giving
| them to me when I was at home, but that lead my dad to
| try them, and eventually get addicted to meth proper
| himself.
|
| I dropped out at 15 and taught myself computer science,
| so it was all provably horseshit but it sure made my life
| harder as a child.
| eyelidlessness wrote:
| In all seriousness, I'm sorry you went through this. I
| also grew up with a parent and family with addiction. I'm
| in no place to assess anything about your life, but what
| you describe is consistent with the diagnosis. And
| unfortunately your dad taking your meds and becoming an
| addict is consistent too.
|
| ADHD is frequently hereditary, and substance abuse and
| addiction are common for people with undiagnosed ADHD.
|
| Your own story of dropping out and teaching yourself
| isn't just familiar to me, it's similar to both my
| brothers' stories as well.
|
| I'm sorry you experienced this the way you did. I wish
| you had better medical care, and better parental
| guidance. I hope the life that you've made for yourself
| is joyful and prosperous, and I hope if it's ever not
| you'll find your way to that however it makes sense.
| [deleted]
| wpietri wrote:
| As somebody who was diagnosed with ADHD in my youth and
| who has tried various medications, I've reached the point
| of suspecting that the disease model is just a poor fit
| here.
|
| Does my brain work differently than other people? Yes.
| Would this have been a problem for me in any pre-
| industrial society? (Which, to be clear, is most of human
| history?) I don't think so. Is it a problem for me when I
| have a fair bit of control over the work I do? Not
| really! I only experience it as a problem when I am
| expected to function in contexts with industrial-age
| labor models, where there's a hierarchy that expects me
| to labor like a robot in line with how my betters have
| decided how the work should be done.
|
| So I can entirely believe that authority figures over-use
| ADHD as a diagnosis so that their lives are easy. Reading
| through the DSM, it seems to me there are quite a number
| of diagnoses that could be used as Authority
| Inconvenience Syndrome. And I don't think I've ever seen
| one where people might need treatment for being too
| obedient.
| [deleted]
| imtringued wrote:
| I find the idea that we are born defective to be
| inherently suspect.
|
| It is quite illogical but very popular because well
| adapted people can just talk about superior genes and how
| everyone else has inferior genes and they can never
| change anything about that except with extensive medical
| treatment.
| wpietri wrote:
| For sure. I've read some really interesting stuff under
| the "medicalization of deviance" label. A classic example
| being how homosexuality was treated as a psychological
| illness because the dominant group saw it as a societal
| offense.
| emptysongglass wrote:
| I want to support you, also toward HN, that I do take it
| personally and am pretty exhausted by people all the way
| back to both of my parents denying I have a condition.
|
| People of the internet: there are better things you can
| be doing than playing armchair psychiatrist, especially
| by invoking notions that can ultimately be harmful to a
| class of people who have forever been told they just need
| to _put in more effort_. You don 't know what it's like
| to live with this so please stop with the conjectures.
| Thank you.
| dang wrote:
| We're glad you're alive. Please don't take HN threads
| into flamewar.
|
| People have different experiences/backgrounds. It's both
| inevitable and natural that there are different points of
| view on this or any other complex topic.
|
| https://news.ycombinator.com/newsguidelines.html
| biohacker85 wrote:
| wpietri wrote:
| I see people downvoting this and I think that's a
| mistake. There's a fair bit of stigma for all sorts of
| mental health treatment, and I think that's a reasonable
| thing to be angry about. It's possible that some people
| are over-treated and also that some people are under-
| treated. People who have suffered from either end of that
| are allowed to be angry about their suffering.
| jb1991 wrote:
| I would be curious to see discrepancies in ADHD diagnosis
| between countries. You hear about it all the time in the U.S.
| but rarely in many other places, including Europe.
| TulliusCicero wrote:
| > then eventually find that 30-80% of ASD children are meeting
| criteria for ADHD. First of all what sort of study is 30-80%?
| But if the higher end is true, the question strongly arises:
| are these even two things?
|
| 80% of ASD kids meeting criteria for ADHD doesn't mean that 80%
| of ADHD kids meet the criteria for ASD. ADHD seems a lot more
| common.
| pddpro wrote:
| Anecdote but I always noticed change in sleep patterns after
| starting antidepressants. Actually, terminal insomnia (you wake
| up and then are unable to fall asleep) are characteristic of
| chronic depression. Add to this that SSRI causes increase in
| sleep hours (maybe even quality?) and then you have a theory
| about how it might just have been due to lack of sleep after all?
| cpncrunch wrote:
| Given the placebo effect is 75% of the effect of
| antidepressants, and placebos have a large effect on sleep, I
| would say that the placebo effect is the first thing that
| should be considered.
| dotcoma wrote:
| I thought it was widely accepted by now that the serotonin thesis
| was a bullshit story spread, among others, by Al Gore's wife,
| maybe in good faith, maybe not.
|
| Edit: Tipper Gore; I did not remember her name (I'm not from the
| US).
|
| I read she was a big fan of the serotonin theory in a book (whose
| title I don't remember at the moment).
| dotcoma wrote:
| Edit #2: The book is: Lost Connections: Uncovering the Real
| Causes of Depression, by Johann Hari
|
| In chapter 2: The year after I swallowed my first
| antidepressant, Tipper Gore -- the wife of Vice President Al
| Gore -- explained to the newspaper USA Today why she had
| recently become depressed.
|
| Just so that it's clear: I have nothing against Al Gore --
| except that he lost the election.
| eyelidlessness wrote:
| There's no convincing evidence that discussing medical aspects of
| mental health is productive on HN. Currently my comment that I'm
| _alive_ has been downvoted at least half a dozen times because I
| had the temerity to still be alive, be glad to say so, be
| grateful for my psychiatric care, and reject that any of that is
| "suspect". This isn't the place to discuss psychiatry. Talk to
| your doctor.
| dang wrote:
| Please don't post offtopic flamewar comments, regardless of how
| wrong other people are or you feel they are. It just makes
| everything worse. Also, please don't go on about downvotes.
| That's in the site guidelines too:
| https://news.ycombinator.com/newsguidelines.html
|
| Edit: I assume you're talking about
| https://news.ycombinator.com/item?id=32161183, which was
| correctly downvoted for being a flamewar comment. Please don't
| post comments like that or
| https://news.ycombinator.com/item?id=32161488 or
| https://news.ycombinator.com/item?id=32161557 to HN.
| eyelidlessness wrote:
| > Please don't post comments like that or
| https://news.ycombinator.com/item?id=32161488
|
| This is the one I was referring to. I'll admit that the first
| one you linked was not productive, but I'm reasonably sure
| you're taking a less charitable interpretation of this one in
| light of that. As far as what makes "everything" worse, the
| prevalence of attitudes like those I was challenging are the
| reason I almost died without treatment. But if they're
| politely stated, no harm no foul?
| dang wrote:
| > But if they're politely stated, no harm no foul?
|
| That's not at all how we moderate HN. But IIRC (it's been a
| few hours since I've read the thread) your comments put an
| extreme personal skew on the comments you were taking
| offense at and then breaking the rules in reply to.
|
| It's natural and understandable that this happens sometimes
| on topics where you feel strongly (I don't mean you
| personally, but any of us). However, natural and
| understandable does not equal ok. On the contrary: we all
| need to catch ourselves when we're getting carried away
| like that, and either edit our posts to be within the site
| guidelines, or just walk away. I find it helpful, in such
| cases, to remember that the internet is to a first
| approximation wrong about everything, and there's nothing
| that any of us can do about it.
| adamwk wrote:
| Why is this an off topic flame war comment but "I'm too tired
| to write a paragraph but SSRIs kill" is fine? The moderation
| here rewards engineer's disease where we first principling
| our way to warning people to ignore Dr.'s suggestions as long
| as everyone's smiling at each other.
|
| It's like an anti-vax YouTube video where any dissenting
| opinion is flagged until mods give up and remove it from the
| front page. It's the same thing with abortion or anything
| else that isn't a Rust article.
| dang wrote:
| Yes, that was also a bad comment. It wasn't aggressive to
| other users, though, which is an important difference from
| a moderation point of view.
|
| HN is an internet watercooler. People come here to have
| casual, curious conversations. That requires being allowed
| to be wrong, to think out loud, to shoot the shit, to
| exchange. Imposing some sort of correctness requirement,
| besides being impossible (how on earth would we enforce
| such a thing without a truth meter?), would kill
| conversation and therefore kill the forum.
|
| You guys are overgeneralizing based on seeing comments you
| dislike. I understand (believe me I understand) how
| frustrating that is, but there are just as many people who
| agree with you, probably more. The fact that there's a
| range of views here is normal, inevitable, and fine.
|
| HN has always operated on the principle that readers are
| smart enough to make up their own minds, i.e. to find their
| way through internet bullshit however they choose to do so.
| I don't see any reason to change that operating principle.
| mlang79 wrote:
| Complaining about being downvoted on a related topic are not
| productive either.
| _moof wrote:
| Indeed. And I can't help but notice that every discussion is
| rife with people singing the praises of psychedelics, but TMS
| is never, ever mentioned. If people were genuinely interested
| in alternatives to SSRIs for the sake of efficacy, you'd think
| an FDA-approved, non-pharmaceutical, non-invasive treatment
| would come up at least once.
| Negitivefrags wrote:
| TMS gives me the creeps. I mean ultimately you are inducing
| current in the brain with magnetic fields.
|
| It boils down to the same mechanism of action as electro-
| shock therapy. Presumably with a lot less destruction of
| neurons of course.
|
| Now electro-shock is one of the most effective at treating
| depression, and I guess that might be why TMS might be
| effective too.
|
| But I think the reason I ultimately wouldn't do it is just
| that it feels like physically altering my brain and it's a
| hard pill to swallow. Just like I would be hard pressed to
| accept a treatment like someone surgically excising a chunk
| of my brain matter even if a doctor told me it was 100%
| effective as a cure.
|
| Perhaps this is irrational but I just can't shake it.
| pjc50 wrote:
| HN is only really great on technical issues. Everything else
| suffers from Engineer's Disease, where a person who has read
| half a dozen articles suddenly imagines they know a complete
| discipline. This thread is a prime example of "my googling
| trumps your life experience".
|
| That said, in countries where pharmaceutical manufacturers are
| allowed to _market_ prescription medicines, and one was
| recently convicted for pushing addictive substances on huge
| numbers of people, a certain amount of skepticism may be
| warranted.
|
| ("medicine X saved my life" and "a large number of people who
| don't get any real benefit for medicine X are being sold it"
| and "medicine X may have extremely bad side effects for some
| people" may co-exist, as well)
| ChildOfChaos wrote:
| I think this 'Engineer's disease' is just what society is
| now. Everyone thinks they know about everything, because they
| read something online/have access to google. Everyone is an
| expert.
|
| You have people arguing very strongly about things they know
| nothing about and sometimes if you actually know anything
| about it, it's painful to read just how bad some of the
| things people are saying, being a logical person, I try to
| point out what they are saying doesn't make sense, but it's
| wasted because that person just doubles down on whatever it
| is that they believe.
|
| The most powerful lesson from noticing this effect and the
| hardest thing to do, is not actually taking that step back
| and just not getting involved, it's also in realising that
| i'm likely doing that too, so it's better to try and step
| back and approach such comments with a more curious and open
| mind, rather than one of thinking i'm an expert.
| benevol wrote:
| It's not that anti-depressants shouldn't be an available
| choice.
|
| It's that natural remedies such as psilocybin and LSD which
| have proven their worth for a very, very long time are still
| being blocked by you-know-which industry.
| grapeskin wrote:
| As much as I think LSD helps, I don't think it's ever been
| found naturally. It's synthesized.
| bluecalm wrote:
| Doctors aren't some magical people who know everything. They
| read the same books and studies available to you. They have
| their own biases, not much time for an individual patient. They
| often stopped educating themselves once reality of long work
| hours set in.
|
| Just talk to you doctor might the worst popular advice on the
| Internet. My experience is the opposite: until you take matters
| in your own hands, experiment with various treatments and
| preferably find an open minded doctor who is willing to help
| you along the way (not only with advice but mainly with
| providing access to medication) it will not work. It might work
| if your problem is simple and typical but it won't otherwise.
|
| The reason is obvious: you are likely as smart as your doctor.
| They might have more experience and general knowledge but they
| have an hour (if you're very lucky) for you and you have all
| the time in the world to catch up and figure it out.
|
| Yeah, talk to doctors if you're the kind of person who drifts
| to homeopathy or other shamanism but please don't solely rely
| on them when it comes to your health of you have a bit of a
| brain.
| epups wrote:
| For every successful case as yours, there are many people
| suffering due to side effects that might include suicide.
| Therefore, your anecdotal evidence is of limited value, even
| though - gladly! - your treatment worked for you.
| Etheryte wrote:
| Have you considered that your comment may have been downvoted
| because you come across unnecessarily hostile, not because of
| some absurd attack on your person? Similarly, any space is a
| good space to discuss and spread awareness on mental health --
| even if only one person finds an idea to help them, whatever
| their situation may be, it's already a massive positive.
| irjustin wrote:
| > because you come across unnecessarily hostile
|
| And possibly justified.
|
| A lot of us are armchair psychiatrist from reading articles.
| OP that you're replying to lives this type of medication and
| attributes being alive right now to it while a lot of us who
| have only read articles sit and debate.
|
| A number of these comments can come across as "just eat
| healthier" to an overweight person or "don't be sad".
| im3w1l wrote:
| About 15% of American adults are _currently_ on
| antidepressants. I tried but failed to find how many people
| ever used it. But it goes without saying that it should be
| be even higher. In other words, antidepressant use is very
| common and many people will be drawing on personal
| experience. That might not feel comfortable divulging that
| about themselves.
| [deleted]
| PragmaticPulp wrote:
| SSRIs raise extra-synaptic serotonin levels within the first hour
| of taking them. However, their efficacy against depression takes
| weeks or even months to manifest. We've known this for decades,
| and as a result the "chemical imbalance" theory of depression
| hasn't been a real contender in depression research for a long,
| long time.
|
| The key thing to understand is that serotonin levels don't have
| to be low for SSRIs to induce positive changes. SSRIs don't just
| "raise serotonin levels" as many have come to believe, but rather
| change the dynamics of serotonin in the brain. This produces
| downstream changes that, over time, can contribute to lessening
| depressive symptoms in some patients.
|
| This makes more sense if you think about other conditions like
| chronic pain. Someone suffering from chronic pain doesn't have an
| "endogenous opioid deficiency". They're just in pain. Opioids are
| one medication we can use to modulate their pain.
|
| Unfortunately, the pop-culture misunderstandings about "low
| serotonin" can mislead a lot of people into thinking that
| research like this debunks SSRIs. It doesn't. As I said above,
| we've known for decades that something else is going on. This
| isn't actually a surprise to anyone in the field.
| petesergeant wrote:
| > the pop-culture misunderstandings about "low serotonin"
|
| Let's be clear though, I had an actual licensed psychiatrist
| say this to me last week. It's not like people are getting this
| "pop-culture" information via blog articles...
| dymk wrote:
| It's possible the psychiatrist is using "low serotonin" as a
| simple shorthand meant for the layperson
| readthenotes1 wrote:
| Sort of like saying "you'll do better in the new
| compensation plan," "masks don't work", "masks do work", or
| "I will mislead you because either I'm incompetent or
| because you can't handle the truth. Either way, trust my
| 'Science'"
|
| I e., Bullshit. Not the level of communication I would want
| with someone who is pretending to help me.
| techdragon wrote:
| Or like many practicing medical professionals in many
| specialties where the patient demand is high enough to fill
| their week ... they don't have time to keep abreast of
| current research in their field and since they aren't
| required to, they just don't. There is usually some
| required ongoing professional development but that is in no
| way designed to ensure they keep up with current research
| consensus, more that they don't continue doing things the
| old way when we know about newer better ways.
| JamesBarney wrote:
| This psychiatrist is either an lazy, an idiot or using
| shorthand.
|
| Anyone who spent even in a couple hours reading about
| depression (one of the most common ailments) in the last
| decade knows that low serotonin is not the cause of
| depression.
| techdragon wrote:
| I'd agree with your assessment. It was just an opportune
| time to mention that they may not be familiar with recent
| research results. But you're absolutely right, they
| should know this one.
| Veen wrote:
| I had a medical doctor describe the benefits of SSRIs with:
| "these pills will increase the happy chemicals in your
| brain".
| [deleted]
| Mo3 wrote:
| Funnily enough the one I used to take (Escitalopram) apparently
| has been found to begin permanently altering brain function
| after only a few hours of first ingestion. I was pretty happy
| with it. No pun intended
| PragmaticPulp wrote:
| Source? Im not aware of research that shows "permanent"
| alterations from a single dose, unless someone is really
| stretching the definition of "permanent"
|
| Pointing to alterations isn't really helpful without context.
| An anti-depressant should induce long-term helpful
| alterations in order to alleviate symptoms.
| Mo3 wrote:
| https://www.mpg.de/8426203/escitalopram-brain
| ratww wrote:
| Also a happy customer of that one. It worked great for me
| even with a low dosage and didn't otherwise negatively impact
| anything else.
| coffee_beqn wrote:
| How long were you on and what made you go off it? Four
| months in I'm feeling better now but I don't think I want
| to take it forever
| ratww wrote:
| For me it was around the same time Mo3 mentioned they
| took, maybe a bit more than one year and a half. It's
| been long, so I don't remember precisely.
|
| However I was in a quite sorry state before... I was
| having several panic attacks a week. My therapy alone was
| also not working well, I was doing twice a week. After
| starting it, everything started falling into place. I
| never had a panic attack again.
|
| I never had any downside whatsoever from taking them
| (didn't know they don't go well with summer!), including
| the regular complaints, it wasn't really a burden on me
| other than having to buy them monthly and take them every
| day.
| janeerie wrote:
| I would like to see more discussion of the role of SSRIs
| in treating anxiety, rather than depression (which always
| seems to be the default focus). I also suffered from
| panic that went away completely with SSRIs. I have never
| had issues with depression, but these medications gave me
| my life back.
| ratww wrote:
| Interestingly the reasoning from my doctor for me taking
| Escitalopram was that it was good for anxiety, so I guess
| there's at least some anecdotal evidence from doctors
| about its efficacy...
| Mo3 wrote:
| Not comment OP but I got off recently after about 1.5
| years - still very happy :) Although admittedly I did
| have some infrequent spouts of rebound symptoms for a few
| weeks, but those were pretty manageable.
|
| Also, kind of happy to be off it right now honestly, heat
| is something that doesn't go along well at all with
| SSRIs.
| spaceman_2020 wrote:
| Sertraline suplementation wiped out depression almost
| completely from my system within two months. I had been
| depressed earlier for half a decade. Its been nearly 8 years
| since I took sertraline (stopped within 3 months) and I haven't
| had a depressive episode since.
| agumonkey wrote:
| Was your ailment caused by events ? or something that creeped
| up invisibly ?
|
| I'm often worried about neurochemical solutions if some part
| of your brain is still associating events/memories/ideas with
| pain.
| jazzyjackson wrote:
| > the pop-culture misunderstandings
|
| You mean the TV commercials that played about 6 times per hour
| in the 00s explaining that depression is caused by a chemical
| imbalance ?
| pessimizer wrote:
| A pill with a smiley face.
| carlmr wrote:
| >SSRIs raise extra-synaptic serotonin levels within the first
| hour of taking them. However, their efficacy against depression
| takes weeks or even months to manifest. We've known this for
| decades, and as a result the "chemical imbalance" theory of
| depression hasn't been a real contender in depression research
| for a long, long time.
|
| This for me doesn't seem logical. It could be that a long term
| imbalance makes you depressed, and reverting that imbalance
| takes time to affect the thought processes towards the
| positive. Only because the reaction is delayed, it doesn't mean
| it's not causal.
| malfist wrote:
| There's a lot of evidence around hippocampus size in
| depressed patients. They tend to be smaller than average.
| After 6 months to a year of treatment with antidepressants
| the hippocampus grows to a larger size.
|
| It's speculated that hippocampus size might be one of the
| driving components of depression, but who knows. Mental
| illness is complex.
| tsimionescu wrote:
| > Unfortunately, the pop-culture misunderstandings about "low
| serotonin" can mislead a lot of people into thinking that
| research like this debunks SSRIs. It doesn't. As I said above,
| we've known for decades that something else is going on. This
| isn't actually a surprise to anyone in the field.
|
| The article itself quotes one of the authors of the study, who
| is attending medical school in psychiatry, as starting that his
| training explicitly made this claim, that his textbooks make
| this claim, and that he himself was later passing it down to
| other students.
|
| Other sources quoted by the news article are similar to your
| own claims. Overall, it sounds like there are camps in
| psychiatry that have indeed long abandoned this theory, but
| others who still hold onto it.
|
| Furthermore, the meta analysis being talked about in the
| article _does_ make the additional claim that SSRIs are perhaps
| not necessary for the treatment of depression. I don 't believe
| they are right, but it's also misleading to suggest that theur
| research is entirely in line with psychiatric orthodoxy.
| PragmaticPulp wrote:
| To be clear: The serotonin deficiency hypothesis has been
| floated for a long time as _one of_ the possible underlying
| changes involved in depression etiology. It's not even a
| stretch, given that we can find upregulations of the
| serotonin transporter in response to chronic unpredictable
| mild stress, the fact that 5-HTP (serotonin precursors)
| supplementation can boost mood, and the fact that many drugs
| of abuse operate through serotonin receptors to alter mood.
|
| However, like I said in my post above, we've know for decades
| that it's not _the_ explanation because SSRIs boost
| extrasynaptic serotonin levels within hours but their
| therapeutic efficacy is famously delayed by weeks.
|
| I suppose it's possible that the author had some weird
| textbook that misrepresented the state of research, or that
| he misunderstood the relative confidence and significant of
| each theory presented. However, the state of research didn't
| even believe that the serotonin hypothesis of depression was
| the full, accurate explanation when SSRIs were introduced for
| the reasons I stated above and more.
| hn8305823 wrote:
| I've tried lots of natural anti-depressant remedies.
| Background: I've suffered with major depression my entire
| life with frequent suicidal ideation and several near-
| suicides. It's fairly seasonal and wile it happens
| throughout the year the worst time is in the winter near
| the solstice. I've also struggled with difficulty falling
| asleep since very young childhood, though that has gotten
| somewhat better with age (over 50 now).
|
| ** warning ** If you are on any prescription anti-
| depressants, don't stop taking them or modify your routine
| without talking to your doctor first.
|
| 5-HTP: nasty side effects from unwanted metabolism in the
| gut and excess serotonin levels in the brain that border on
| serotonin syndrome sometimes. After the initial 8 hours or
| so of bad side effects the anti-depressant effects last for
| about two days followed by a very hard crash on day 3.
| During the 2 "good" days the quality of the effect is a bit
| "off" and gives me an unusually "comfortable feeling" that
| is while much better than depression is not the most
| productive or normal feeling (see melatonin below for
| contrast). Be extremely careful with 5-HTP, serious
| serotonin syndrome can easily develop, especially if you
| are on other anti-depressants and can be fatal. I don't
| take 5-HTP anymore because of these side effects and better
| options (below).
|
| THC: Very effective during use (edibles = 4-6 hours), but
| tolerance levels build requiring higher doses. mild anti-
| depressant effects trail off gradually after day or two and
| quality is generally good. Of course cannabis has some side
| effects: short term memory impairment, general slight
| cognitive reduction but I have found these side effects can
| be virtually eliminated with L-Dopa (see below)
|
| L-Dopa: Taken with vitamin B-6, this is one of the few
| things I have found that enhances the cannabis experience
| rather than taking away from it. This increases dopamine
| levels in the brain which enhances the high and for me also
| seems to miraculously eliminate the side effects of
| cannabis (maybe this is due to offsetting dopamine
| depletion by THC?). I have also found that L-Dopa even
| seems to increase general cognitive functioning beyond
| undoing the effects of THC (maybe reversing age related
| degredation? It makes my brain feel like it did when I was
| 18). L-Dopa does have serious side effects however: It
| dramatically and seriously increases anxiety/paranoia for
| several hours so I only take it with cannabis edibles and
| even then not every time, no more than once per week. It's
| very important to know how to manage paranoia since THC
| also frequently triggers paranoia and the L-Dopa seems to
| amplify that. My method is to consciously and affirmatively
| "acknowledge and disregard" any paranoid or anxiety related
| thoughts. I have found that once I consciously identify and
| acknowledge certain thoughts are _caused_ by the drugs
| /supplements and are not real (or as important as they
| seem), they disappear and everything is ok.
|
| Melatonin: This is by far the best anti-depressant I have
| ever used. Essentially no side effects other than putting
| you to sleep 30 mins after use, which when taken before bed
| is a huge plus (I have had difficulty falling asleep my
| entire life). Anti-depressant effects last for a few days,
| gradually trailing off without the hard crash of 5-HTP. The
| quality of the effect is also excellent (much better than
| 5-HTP). The best way I can describe it is "feeling healthy,
| energetic yet relaxed, and normal" most of the time. It's
| like a miracle drug, at least for me. I take 5mg every 3-4
| days as needed.
| Throwaway45htp wrote:
| Thanks for your post, and thanks for whoever vouched for
| this. I have a similar background to you, including age,
| living in a northern latitude with short winter days,
| long term sleep issues, and suicidal ideation.
|
| 5-HTP - There seems to be wide variation in the
| formulations available from manufacturers. Some have
| given me no issues at all, another brand, of the same
| strength, consistently leads to intense nausea and
| vomiting, followed by a significantly altered mental
| state. Almost tripping, and yes, I'm familiar with that.
|
| THC - agree with your comments, but by far the biggest
| advantage for me is that it enabled me to completely quit
| drinking. Alcohol is terrible in that it will temporarily
| shut those intrusive thoughts off, but then they seem
| supercharged them when they inevitably return after a few
| hours. Drinking definitely exacerbates my actual
| depression even if it masks some symptoms.
|
| I do use melatonin occasionally/as required but not super
| often. It's very effective as a sleep aid, but I have not
| noticed any antidepressive effects in myself. Valerian is
| also an extremely effective sleep aid for me. Will have
| to research L-Dopa.
|
| Consider trying Sceletium Tortuosum extract (Kanna). It
| has been commercialized as "Zembrin" and is available in
| OTC supplements. There are peer-reviewed studies
| indicating that it is safe and effective, and personally,
| I've found it to noticeably effective against anxiety,
| less so for depression. As supplements go, it's
| inexpensive.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124331/
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828542/
|
| Finally, psilocybin has been revolutionary for managing
| my mental health, and specifically depression. I found
| microdosing to be ineffective. A full trip sets me right
| for several weeks, to the point where it is startling
| when the intrusive thoughts start up again.
| cwkoss wrote:
| I've heard people say that the serotonin deficiency
| hypothesis was invented by drug companies rather than
| academics. Is that true?
| marincounty wrote:
| I'm pretty sure I'm hell banned, but forget about all the
| chemicals of the brain.
|
| Read anything by Irving Kirsch.
|
| He used The Freedom of Information Act to study All the
| antidepressants studies that were sent to the FDA by the pill
| pushers, Not just the cherry picked studies, but All.
|
| He found they basically don't work better than Placebo.
|
| Personally, I think the "Happy" drugs have been the biggest con
| job the American suffering have ever endured. At least we know
| opioids work--for awhile. Antidepesssnts just make Dr. Wealthy
| more wealthy.
|
| My hope is most of these wonder drugs are sued into history,
| along with those mandatory doctor office visits.
|
| Ask yourself this--why do Psychiatrists have the highest rate
| of suicide if these drugs work?
|
| I'm glad we have residents whom picked an easy speciality upon
| graduation, but these drugs have such low efficy rates they
| should be illegal, or over the counter, with the exception of a
| few. Trazadone can be nasty. A bad reaction is cured by a
| needle to the middle part of the brain.
|
| Most are easy on the body, but don't do anything besides make
| an Artist (Medicine is an art, and Psychiatrists are the
| milking to the bone.) wealthy.
|
| God help our suffering Americans.
| skjoldr wrote:
| You shouldn't talk about drugs you have zero experience with
| either as a doctor or as a patient. SSRIs do work.
| epups wrote:
| Only for severe depression, if you take into account all
| clinical trials - including the ones buried by pharma
| companies. This is the work by Irving Kirsch being
| referenced here, and it's excellent.
| butlerm wrote:
| Spraying water on your house usually doesn't accomplish
| very much unless your house is on fire. But if your house
| really is on fire, it is likely the only thing that
| works.
| bergenty wrote:
| I think you're throwing the baby out with the bath water here.
| Sure depression may not be linked to low serotonin levels but
| it almost certainly some chemical imbalance of some variety.
| niemal_dev wrote:
| Perhaps it's not a literal imbalance but more of a flow
| problem, neural pathways fail to deliver and a portion is
| lost along the way. There are so many ways this could be
| going wrong, we have absolutely no clue unless we devise
| proper tools and methodology for data-mining everything up to
| a satisfyingly objective level.
| bencollier49 wrote:
| Metabolism and stress hormones both seem to play a role. It's
| going to be a very complex thing - the best treatment for a
| lot of brain conditions is just exercise.
| belorn wrote:
| The key word when using exercise to treat stress is that it
| need to be voluntary (ie, something that the person want to
| do). Forcing oneself to exercise has the opposite result
| with increased corticosterone levels. Exercise is great if
| and only if the individual is doing something they enjoy.
| sneak wrote:
| That's vague enough to be a totally useless description.
| Dehydration is also a "chemical imbalance of some variety".
| bergenty wrote:
| I think that's part of the point. Whatever it is, it's a
| chemical imbalance. Just need to find which one. In the
| case of dehydration it's water.
| s1artibartfast wrote:
| I think the point is anything can be a chemical process
| because we are chemical beings.
|
| Drowning or having your leg cut off leads to a chemical
| imbalance, but chemistry isn't always the most productive
| lens to analyze the problem
| bergenty wrote:
| Drowning or having your leg cut off are not chronic
| conditions. I think it makes a lot of sense to analyze
| chronic problems in the brain through the chemical lens.
| s1artibartfast wrote:
| >I think it makes a lot of sense to analyze chronic
| problems in the brain through the chemical lens.
|
| Thats the basically the point I am taking issue with.
| Myopic focus on chemistry can be terribly misleading.
| There will always be a chemical component because we are
| beings made up of chemical components.
|
| a chemical imbalance is by definition always going to be
| part of the problem. That does not mean it is always the
| best point of intervention, and certainly not the
| exclusive focus when trying to understand the problem.
| bergenty wrote:
| There really isn't a lot more going on in there though
| based on our current understanding of the brain. It's
| neurons and synapses and all the neurotransmitters that
| regulate it all. What exactly are you suggesting could be
| the problem?
| s1artibartfast wrote:
| This is the perfect example of myopic thinking coming
| from the chemical Focus
|
| If your only tool is a hammer then every problem looks
| like a nail.
|
| The brain is a lot more than chemistry, and that's not
| even looking at the human being and their interactions
| with the environment.
|
| there are patterns encoded in the structure and biology
| of the brain. There are psychological feedback loops and
| complicated interactions between a human and their
| environment.
|
| Saying it must be a chemical imbalance is akin to
| debugging a malfunctioning computer and saying it must be
| a signal error from a loose wire. It ignores programming
| sending signals on those wires and it ignores the input
| to the machine from the environment
| kayodelycaon wrote:
| Or chemical imbalance is the symptom, not the cause.
| heavyset_go wrote:
| To add to this, SSRI onset efficacy corresponds with the
| downregulation of serotonin receptors in the brain. "Low
| serotonin" isn't what's being treated or changed, but the
| number of receptors and their activation rates. SSRIs can
| reduce emotional lability, which makes sense when you figure
| that downregulation and increased activation of serotonin
| receptors is a relatively stable system compared to an
| unmedicated brain with many receptors and widely fluxuating
| activation rates and lowered activation periods as serotonin
| gets recycled quickly without its transporter being inhibited.
| valec wrote:
| i think it corresponds most exactly with the desensitization
| of dendritic autoreceptors
| heavyset_go wrote:
| Yeah, downregulation is one of the last steps in
| desensitization.
| zeckalpha wrote:
| Hence the first S and the I in SSRI. A filter in certain areas
| increases other areas. Doesn't change overall values.
| PragmaticPulp wrote:
| I'm not sure what you're suggesting, but SSRIs definitely do
| change a number of measurable metrics of the serotonin system
| by prolonging the duration of serotonin in the extrasynaptic
| space. This is well studied.
|
| The first "S" is for selective, meaning they have minimal
| affinities beyond the serotonin transporter.
| zeckalpha wrote:
| I don't think we're disagreeing. Increasing duration spent
| in one place doesn't change the total count of the
| molecule. SSRIs don't make the body produce more. That's
| okay, they work by other means.
| eurasiantiger wrote:
| Where do you get that from? SSRIs act on SERT and SERT
| handles reuptake from the synaptic cleft, not from
| extracellular space which is "vacuumed" by MAOA/B and COMT.
| arsome wrote:
| The S for Selective actually means it _only_ works on
| serotonin, compared with say, an SNRI, which works on both
| serotonin and norepinephrine. Impacting the overall values is
| in fact pretty much the only thing it does.
| eurasiantiger wrote:
| This is true, but inaccurate, as it only accounts for the
| direct effects.
|
| However, increased serotonin receptor agonism also
| increases downstream dopamine and norepinephrine release.
| zeckalpha wrote:
| SRIs are a separate class of drugs: https://en.m.wikipedia.
| org/wiki/Serotonin_reuptake_inhibitor
| ComputerCat wrote:
| I can't access the full text but this is really interesting. I
| think with how fast paced all the advancements in the scientific
| community are it's crucial that things we thought we understood
| are continuously re-assessed and analyzed.
| am63517 wrote:
| fragcula wrote:
| > Other clinicians say, however, that the notion of depression
| being because of a simple chemical imbalance is outmoded anyway,
| and that antidepressants remain a useful option for patients
| alongside other approaches including talking therapies.
|
| This is the key line in the summary.
|
| The concept of attacking an idea no one really believes is really
| a straw man.
|
| More importantly the modern practice of medicine is "evidence
| based medicine", not "mechanism based medicine". That means
| treatments are tested as to _if_ they work, not _how_ they work.
| Ideally in multiple well run double blinded randomised controlled
| trials with at least some against treatment as usual. Unlike the
| past when we thought more about _how_ they might work, theorising
| something is off about someone 's humors and adjusting with
| leeches.
|
| Anyone looking for a truly mind bending result should look at
| Hjorth et al. 2021 [0], the study recruited people with social
| phobia and gave them all an SSRI (escitalopram). Half were told
| they were getting a sham active placebo and "should not expect to
| get better", half were told "you're getting the known effective
| treatment".
|
| Headline result being told you are being treated leads to 4x as
| much response _with brain changes_ in the dopamin networks.
|
| In the meanwhile, rather than worry about how antidepressants
| work, why not take a look at electroconvulsive therapy which has
| proven time and again to be the most effective treatment for
| depression. Yet we have no idea how it works, other than knowing
| a decent seizure in those without epilepsy makes you less sad?
| What on earth.
|
| [0] https://www.nature.com/articles/s41398-021-01682-3
| ZeroGravitas wrote:
| I don't think that's an accurate summary of the state of the
| art on ECT:
|
| https://www.nice.org.uk/guidance/ng222/chapter/Recommendatio...
|
| It sometimes works, it's contraindicated for certain people,
| comes near the end of the list of things to try (wait to see if
| you get better and get some excercise/sleep/sunlight being low
| risk interventions for mild depression) and even when it is
| used and does work, starting/continuing antidepressants and
| other treatments is recommended.
|
| It's just one more tool in an incomplete and inconsistent
| toolbox, not 1 weird trick your pharma company hates.
|
| I know of one person who recently had some success with it, but
| they tried other things first.
| fragcula wrote:
| I'm not sure what part of what I said you disagree with.
|
| Nothing in the NICE guidelines explains how ECT works -
| because like the rest of the world NICE does not know.
|
| Once odd aspect with ECT is that it seems to transiently
| improve parkinson's, again no one knows why.
| ZeroGravitas wrote:
| I was disagreeing specifically with this bit:
|
| > electroconvulsive therapy which has proven time and again
| to be the most effective treatment for depression
|
| Switch "the most" for "an" and we agree I think.
| openplatypus wrote:
| IMO key quote the study you referenced:
|
| > In conclusion, the anti-anxiety properties of SSRIs appear to
| be largely dependent on expectancy effects on dopamine
| signaling while SERT blockade is not sufficient for symptom
| remission.
|
| Drug works, if you believe it does :)
| kokey wrote:
| I wouldn't be surprised about this when it comes to panic
| disorder. Just knowing you have some emergency fast acting
| anti anxiety medication nearby, just in case you need it, can
| reduce the number of panic attacks. There's probably all
| kinds of psychological feedback loops when people have
| anxiety about anxiety and then it escalates because they're
| anxious about it escalating. I am guessing that medication
| can help mitigate some components of that feedback loop for
| some people.
| guggalugalug wrote:
| See also, David Foster Wallace's character David Cusk in
| 'The Pale King'. A wonderful portrayal of how attending to
| ANTs (Automatic Negative Thoughts) catalyzes this feedback
| loop.
| fragcula wrote:
| It's a shame that the imagining is so expensive, because I'd
| love to see a true control arm with placebos and follow up
| scans.
|
| i.e. if you are on a placebo and are told you will get better
| how many do?
| daniel_iversen wrote:
| Don't they do truckloads of tests and comparisons on anti
| depression medicine all the time including blind trials
| etc?
| fragcula wrote:
| The interesting bits, for me, are the imaging scans which
| are expensive and slow and you need more than one for
| comparison per subject.
|
| Secondly the 'covert treatment' aspect, and as far as I
| know only Hjorth et al. do in any reasonable numbers is
| the giving someone the treatment and usual and tell them
| it's a placebo and they "shouldn't expect to get better".
|
| It's ethically tricky to do that with an anxiety disorder
| but I imagine a doctor telling someone with depression
| that will be painfully close to "you're not getting
| better", "we're not going to help you" and other quite
| rejecting disheartening ideas.
|
| But plain placebo controlled SSRI trials I think show
| about a 0.2 absolute benefit in SSRIs in depression. i.e.
| if you compare SSRI with placebo you need to treat 5
| people with SSRI to see one more person respond. If you
| compare SSRI with no treatment, you only need to treat 3
| people with depression, to have 1 more respond. Those 3
| and 5 are called the 'number needed to treat' and can be
| compared to the 'number needed to harm'.
| davidy123 wrote:
| The drug does something. It at least creates a distraction.
| That distraction can create a helpful feedback loop. After
| all, depressive/anxious/etc thoughts are generally arbitrary
| (though relentness), out of the all the thoughts one could
| have. So a chemical causing an effect, or just the process of
| trying an intervention can be useful. Distraction is
| incredibly important in therapy, it is after all ultimately
| how we all deal with the fact our lives have an end.
| sinecure wrote:
| Belief dictates reality. This is the fundamental driver behind
| the common effectiveness of placebo. Which leads to the
| question, does depression exist as a flaw in the brain? A
| malfunction? Or is it like a mind virus, that it becomes an
| inescapable suffering because we are told we are broken and
| powerless to fight these feelings?
|
| If a person is feeling sad, often, and without reason, and you
| tell them "Sorry, your brain is broken, you have depression, we
| will give you these pills to fix your brain chemistry." You
| have taken that person's autonomy away. They are now the victim
| of a disease.
|
| I think the reality is that our society and civilization leads
| to a certain despair and sadness in many people, one that can
| be fixed by changing one's lifestyle, mindset, or overcoming
| challenges. This is not a disease, not a mental illness, not
| some health problem you cure with a pill. It's a spiritual
| dilemma that must be faced individually and overcome with
| effort and belief that one can change.
|
| Essentially, I believe that by diagnosing people with "clinical
| depression" we are creating a self fulfilling prophecy and
| condemning them to a victim status that perpetuates their
| suffering.
| s1artibartfast wrote:
| >That means treatments are tested as to if they work, not how
| they work. Ideally in multiple well run double blinded
| randomised controlled trials with at least some against
| treatment
|
| There are some concerning departures from this with medical
| approvals based not on treatment, but biomarkers.
|
| Without getting too political, two noteworthy recent examples
| come to mind. The first is abelacimab for alzheimer's, approved
| based on plaque, not disease progression.
|
| The other is juvenile covid vaccines, approved based on
| antibody presence.
| fragcula wrote:
| abelacimab in particular was quite worrying. The BMJ (the
| journal OP posted) contained a criticism of that.
|
| Similarly as you say is that because numbers are easy to
| think about antibody titres somehow took over the world when
| it came to covid vaccination. Despite good evidence t-cell
| activity is important for preventing severe disease.
| varispeed wrote:
| > are tested as to if they work, not how they work
|
| Should they be doing both? I can't imagine shipping code that I
| don't know how it works, but it passes tests...
|
| Otherwise, you'll get pseudoscience - just mix random chemicals
| and see how patient reacts, rinse and repeat until something
| works...
| workingon wrote:
| Welcome to modern medicine.
| kurikuri wrote:
| >Should they be doing both?
|
| Yes, but with different aims. The learning about 'how a
| treatment works' is useful for developing new potential
| treatments and new hypotheses, but the mechanism itself is
| not necessary nor sufficient in its potential treatment
| efficacy.
| boesboes wrote:
| > shipping code that I don't know how it works, but it passes
| tests
|
| We call that machine learning
| rmbyrro wrote:
| What isn't machine learning is sometimes called "tested
| code"
| fragcula wrote:
| The psychiatrists themselves don't need to do both, as
| doctors practicing EBM they are interested in proven results.
| The decision to recommend a treatment (and to accept it) is
| based on the pros and cons only.
|
| What people really care about is side effects. That's one of
| the reasons modern pharmas are so fixated in testing old
| drugs for new disorders (the other reason is they might be
| able to get a new patent case in point when Eli Lilly made
| pink fluoxetine for girls with a new indication for PMS [0]).
|
| Similarly, the best way to identify side effects is by
| looking at the molecule and guessing (static analysis),
| testing with cells, animals or other non-human biological
| systems (I guess this is alpha testing as we rarely think of
| the testers as human...), and then in human studies (early
| access).
|
| Even then we roll out incrementally (phase 2), before widely
| testing in phase 3 and collecting feedback.
|
| [0] https://money.cnn.com/2000/07/06/companies/lilly/
| vkou wrote:
| > Should they be doing both? I can't imagine shipping code
| that I don't know how it works, but it passes tests...
|
| If that were the criteria, then we would not have medicine at
| all, because biological systems are so incredibly
| complicated, nobody understands even a tiny fraction of _how_
| a particular chemical will affect them.
| harshreality wrote:
| I don't think that's quite accurate. We know first-order
| biochemical effects for a lot of drugs. There are always
| side effects, but they're _side-_ effects, and those are
| largely understood as well.
|
| Psych drugs have difficulties because they aren't used for
| their biochemical effects, they're used for their
| psychological effects, and psychological effects of
| biochemical processes are poorly understood.
| fragcula wrote:
| An extra foible is that many medications have psychiatric
| side effects.
|
| So even if you're prescribed a statin for the biochemical
| effect on cholesterol you might get some of the purported
| psychiatric effects.
| pineaux wrote:
| Most effective treatment for depression = psychedelics. They
| have been used by shamans for eons for this reason. A lot of
| modern research into this (including 1000s of research studies
| from the 50s and 60s) confirms it. It was only because Nixon
| didn't like the fact that kids were not going to war, that the
| war on drugs was started.
| tsol wrote:
| Not everyone wants to trip in order to feel alright, and not
| everyone can handle it. Children and the elderly come to mind
| multiplegeorges wrote:
| When used for treatment, you don't "trip" in the
| recreational sense.
|
| The medication is taken in a very controlled environment
| with a highly trained mental health professional.
|
| There are also pre- and post-sessions to help people
| prepare for the experience and come out from it with
| positive outcomes.
|
| Agreed that children probably shouldn't be given such
| strong drugs. I don't think you'd find a professional
| advocating for that.
|
| As for the elderly, the drugs have been used in near-death
| therapy with elderly terminal patients. It has helped
| people overcome their fear and anxiety around dying and
| come to terms with their situation in a peaceful way.
| olyjohn wrote:
| It's just too bad that most people can't get access to
| this treatment. It's extremely difficult to get into, and
| impossible for most people.
| MrDresden wrote:
| Psilocybin has done wonders for my anxiety and depression in
| the past.
| DFHippie wrote:
| > It was only because Nixon didn't like the fact that kids
| were not going to war, that the war on drugs was started.
|
| Was it this or that he saw asserting dominance over youth
| culture as a political winner? Judging from the present
| moment, bullying the less powerful seems to have a lot of
| political juice. People want to keep the uppities down.
| sneak wrote:
| Please do not assert pet theories as established scientific
| consensus or fact.
| pineconewarrior wrote:
| Lack of citation does not make it a "pet theory".
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767816/
|
| https://www.nature.com/articles/s41591-022-01744-z
|
| Go search it before being rude
| wkearney99 wrote:
| Or, include the links yourself when making such claims?
| Unsupported comments are perhaps just as rude?
| meijer wrote:
| Book recommendation: "How to Change Your Mind" (Michael
| Pollan)
| woevdbz wrote:
| I'm not sure we know about the side effects very well yet
| though?
| webmobdev wrote:
| > _why not take a look at electroconvulsive therapy_ ... _Yet
| we have no idea how it works_ ...
|
| Or you can stick with something that has been already been
| scientifically studied and proven to be as effective as anti-
| depressants in curing depression - Cognitive Therapy. In fact,
| it even prevents relapses more than anti-depressants:
|
| > Depression is one of the most prevalent and debilitating of
| the psychiatric disorders. Studies have shown that cognitive
| therapy is as efficacious as antidepressant medications at
| treating depression, and it seems to reduce the risk of relapse
| even after its discontinuation. -
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/
|
| For those considering going to a CT therapist you can search
| for certified CT therapist from here:
| https://cares.beckinstitute.org/get-treatment/clinician-dire...
| (the Beck Institute was started by the founder of CT and is now
| run by his daughter who is also a professional in this field.
| Nowadays most therapist learn about CT during the education but
| only have the base knowledge of it and thus don't apply CT
| techniques properly during therapy, and remain ignorant of the
| advances in this field. Those who actually train and specialise
| in it are more effective.)
| Pigalowda wrote:
| It's not an either/or scenario. CBT is recommended already
| for pretty much all comers. ECT is last line in treatment
| refractory MDD.
| fragcula wrote:
| We also don't know who CBT works for what it's worth.
|
| It's also fairly limited in suitability (good luck with
| someone with catatonic depression trying to get them do a hot
| cross bun), availability (thankfully online therapies are
| more common now, but it takes 2 mins a day to take a pill and
| about an hour per week for CBT), affordability (a year of
| sertraline will cost less than the initial session of session
| of CBT can).
| rozab wrote:
| See also "Serotonin and Depression" from David Healy (2015)
|
| https://www.bmj.com/content/350/bmj.h1771
|
| https://davidhealy.org/so-long-and-thanks-for-all-the-seroto...
| phkahler wrote:
| Nobody checks your serotonin levels prior to prescribing an SSRI.
| The drugs do help some people but the reality is that nobody
| really understands how it all works.
| walrus01 wrote:
| I have a completely unscientific, subjective theory that some
| significant portion of depression in the population as a whole is
| caused by the economic circumstances that some people live in.
|
| Things like being trapped in a dead end job to keep healthcare
| benefits in the USA, living in a never ending treadmill of debt.
| carabiner wrote:
| IOW: Are you ready for me to diagnose your totally normal
| reaction to our shitty society as mental illness so I can get
| you addicted to mind altering drugs for the rest of your life?
| https://imgur.com/Jb1mJyx
|
| Or as the Unabomber said, "Imagine a society that subjects
| people to conditions that make them terribly unhappy then gives
| them the drugs to take away their unhappiness. Science fiction?
| It is already happening to some extent in our own society.
| Instead of removing the conditions that make people depressed
| modern society gives them antidepressant drugs. In effect
| antidepressants are a means of modifying an individual's
| internal state in such a way as to enable him to tolerate
| social conditions that he would otherwise find intolerable."
|
| I think you're right. The problem is, this is the only life
| most of us have lived, and so we cannot imagine it otherwise,
| like a fish who cannot conceive of a world above water, or even
| that water is the medium surrounding it. If our entire society
| is causing this, then what can we do? Wage slavery, oligarchy,
| attention theft by tech companies, disintegration of community
| from various causes. Life for so many people is crawling
| through glass Monday through Friday, then getting shitfaced on
| the weekend. Is that happiness? How do we escape?
| seventytwo wrote:
| > Life for so many people is crawling through glass Monday
| through Friday, then getting shitfaced on the weekend. Is
| that happiness?
|
| Ooof
| grumple wrote:
| Brave New World and 1984 were near-future fiction, but were
| more near future than fiction. Drugs are soma.
| tptacek wrote:
| It's a strange mode of persuasion, making arguments about how
| we should frame psychological dysfunction that quote a man
| who pooped into a hole in the corner of a shack while in
| hiding after trying to down a passenger jet.
| eurasiantiger wrote:
| That is the definition of an "ad hominem" argument.
| tptacek wrote:
| I'm comfortable with "ad hominem" when the appeal in
| question is to the Unabomber.
| carabiner wrote:
| You wish to vilify him. That's fine. It's extremely
| uncomfortable to find that this mathematician was right
| about something. I respect your feelings. But that
| doesn't alter the substance of his social critiques.
| tptacek wrote:
| Sure it does. It's strange to argue that it wouldn't.
| Kaczynski is a madman, and perhaps the only person in the
| history of the United States whose quality of life was
| drastically improved by incarceration in a Supermax
| prison.
| inkblotuniverse wrote:
| He lived out in the fresh air and sunlight.
| tptacek wrote:
| So do rats.
| dathos wrote:
| I doubt he would agree with that, just like depression
| has many forms so does the concept of quality of life
| paulmilligrams wrote:
| Quoting the Unabomber was a strange choice considering the
| main idea isn't unique to him and stands on its own merit:
|
| "Instead of removing the conditions that make people
| depressed modern society gives them antidepressant drugs."
|
| Examining the social factors that contribute to pathology
| isn't controversial nor does it downplay the role of drugs
| in reducing harm.
| tsimionescu wrote:
| It's very funny to describe SSRIs or SNRIs essentially as
| "happy pills". They are very unpleasant drugs to take,
| especially in the first month or so when starting to use
| them, and no one would be using them if they didn't feel
| there is a serious problem in their lives.
|
| Not to mention, depression takes several forms, and not all
| of them are related to unhappiness. A common form is related
| to anxiety, with people experiencing a constant feeling that
| something awful is about to happen, sometimes getting
| terrible panic attacks. Given that many of these people live
| in objectively and subjectively extremely safe environments,
| much safer than at any other time in history, it's very hard
| to take seriously any environmental theory of this kind.
|
| Edit: corrected one bad auto-correct typo ("problem", not
| "purulente") .
| imtringued wrote:
| >no one would be using them if they didn't feel there is a
| serious purulente in their lives.
|
| You are playing into the argument, people often don't have
| a choice to avoid a depression inducing environment, they
| only have the choice of using drugs or not.
| bmitc wrote:
| Environment is only one component of certain types of
| depression. It is primarily a biological phenomenon.
| carabiner wrote:
| Would you rather be safe in prison for 100 years, or free
| in a world for 1 day where you could die?
| olyjohn wrote:
| Life isn't like that though. This question is kind of
| counter-productive.
| winocm wrote:
| I prefer death.
| tsimionescu wrote:
| I know for sure that I have much more anxiety when I'm in
| an unsafe environment than a safe one, regardless of how
| free I am in each. Lack of freedom does lots of bad
| things to your mind, but anxiety isn't one of them.
| bmitc wrote:
| This site has an unbelievable amount of armchair-science
| that gets rattled off. You are right, because depression
| and anxiety are primarily biological phenomena.
|
| People looking for an actual expert discuss these things
| should watch Robert Sapolsky's talk:
| https://www.youtube.com/watch?v=NOAgplgTxfc
|
| For example, in the talk, he points out one of the most
| telltale signs of depression is waking up early, which is
| completely backwards from the common perception that
| depression is someone staying in bed all day.
| imtringued wrote:
| Actually there is something worse than a deadend job. Having a
| job you are financially dependent on but where you aren't
| assigned any work so you must constantly come up with ways to
| look busy and productive.
| yomkippur wrote:
| There's rich people, famous people, powerful people, who fall
| into depression so not sure what your situation is but I hope
| you get through it.
| missedthecue wrote:
| All quintiles of the US population make more money (inflation
| adjusted) than they did 20, 40 or 60 years ago.
|
| Yet there are more depressives around than ever.
| asdff wrote:
| This inflation adjustment business needs adjusting I think if
| you think the average worker today has more buying power than
| they did in decades when they were actually buying homes.
| inkblotuniverse wrote:
| Yeah, nobody can afford a house.
| imtringued wrote:
| People constantly shout how property values would go down
| if people could afford homes.
| quickthrower2 wrote:
| Inflation measurement is a political tool.
| actually_a_dog wrote:
| Now look at what it gets spent on. Specifically, take a
| closer look at housing, healthcare and higher education. All
| three of those have risen far, far faster than inflation for
| many years.
| Taylor_OD wrote:
| I'm overall pretty happy and have a pretty great job, life, and
| family. I'm still often hit with waves of despair when I
| realize housing prices are insane, retirement feels like a
| joke, and the biggest issues the world is facing seem to be
| ignored.
|
| It's pretty depressing if you dwell on it for any period of
| time.
| asdff wrote:
| You don't even have to be broke to be trapped in the
| stranglehold of modern society and feel like shit about it.
| Just because you are paid well doesn't mean the work you are
| doing is remotely engaging or interesting or doesn't want to
| make you hate yourself. Being rich doesn't insulate you from
| toxic coworkers, in fact probably the higher you end up
| marching up the economic ladder the more of these narcissistic
| and toxic personalities you are liable to run into.
|
| At the end of the day we are probably happiest when we are
| foraging for berries or mushrooms. This whole abstract
| 'society' crap we put upon ourselves leads to a lot of self
| directed scorn, embarassment, disrespect, and no doubt
| depression. How many billions of calories have been burned to
| fuel thoughts of worry about an outfit choice around the world?
| How many grey hairs have sprung up as a result of fretting
| about appearance? The stress society tries to shovel on you is
| such a waste of energy and does nothing to help you.
| autoexec wrote:
| > How many billions of calories have been burned to fuel
| thoughts of worry about an outfit choice around the
| world?...The stress society tries to shovel on you is such a
| waste of energy and does nothing to help you.
|
| Sadly, not enough to offset our sedentary lifestyle and
| diets. I can't be too concerned about the energy expenditure
| involved in worrying about meaningless things. For now
| anyway, we've got energy to spare. The toll of all that
| stress on our bodies is much worse than the calories we lose.
| Still, I'd rather be worried about the trivial things that we
| occupy ourselves with than the life or death worries humans
| regularly faced when we were berry foragers. Going from
| worrying over "Will we eat today?" to "Which of several
| restaurants should we go to for lunch?" is a blessing.
| triyambakam wrote:
| I'm puzzled by those who disagree with this statement. How is
| it surprising that depressing circumstances would lead to
| depression?
| astrange wrote:
| Major depressive disorder isn't the same thing as feeling sad
| about your job.
| psyc wrote:
| If being down about your job causes symptoms of depression
| that last more than 2 weeks, then it's the same thing.
| Psychiatrists diagnose based on symptoms. Worse, its
| usually what you say your symptoms are, with words and
| talking. They don't scan your brain. I've been seeing
| psychiatrists for almost 30 years. The good ones take
| plenty of interest in your situation, lifestyle, and other
| non-chemical non-medical factors. Psychiatrists don't
| distinguish between so-called 'situational' and 'clinical'
| depressions. Laypeople do that. If you get diagnosed by a
| _clinician_ , _that_ is the part that makes it clinical -
| it isn 't a different kind of condition.
| an-honest-moose wrote:
| That is an incredibly dismissive and reductive argument to
| make. "Feeling sad about your job" isn't limited to burnt
| out software engineers with a safety net. It can also apply
| to, for example, someone stuck in a shitty, low paying job
| with few, if any, prospects for better employment. The lack
| of a path to a decent future can, in itself, be incredibly
| demoralizing, even if your present circumstances might be
| decent. After all, what's the point in continuing if I can
| see that it's all downhill from here?
| astrange wrote:
| That isn't major depressive disorder either. Even if
| those people think their life sucks, they're capable of,
| say, getting out of bed every day and don't regularly
| attempt suicide.
|
| Russian serfs might've revolted when they got the chance,
| but they were more or less psychologically normal until
| then. Their society adapts to not kill them all. (Or they
| all become alcoholics or something.)
| UK-Al05 wrote:
| Bad jobs can cause suicide
| WalterSear wrote:
| Suicide is usually due to distress than clinical
| depression. This is why suicide hotlines work at all.
| pcmoney wrote:
| I would recommend reading some history books before saying
| these are depressing circumstances.
| asdff wrote:
| Just because some people have suffered through worse
| doesn't mean that you can use that to invalidate someone
| else's suffering.
| ThrowawayR2 wrote:
| But when, for the vast majority of history, the
| population faced a much poorer, more monotonous, and less
| free existence than what the modern worker faces then you
| jolly well can.
| asdff wrote:
| That still doesn't invalidate people's mental conditions
| today.
| pastacacioepepe wrote:
| > the population faced a much poorer, more monotonous,
| and less free existence
|
| That's an over simplification.
|
| People could still have more free time than we do now[1],
| while their life could be more monotonous on some aspect,
| I believe an average office worker life today can be even
| more monotonous than what a serf life could be. You also
| have to consider labor alienation, which is a something
| that didn't exist so much before industrialization.
|
| Most importantly, life commonly revolved around tight
| communities, while today most people live in
| individualist societies.
|
| Individualism certainly has a larger impact on happiness
| than most modern convenience has.
|
| - [1]: https://groups.csail.mit.edu/mac/users/rauch/workt
| ime/hours_...
| ThrowawayR2 wrote:
| If there are people today who want to put their money
| where their mouth is and give up the conveniences of
| modernity to go back to communal subsistence farming
| under serf-like conditions (and there are places in the
| world that still live like that), more power to them. I
| haven't seen any takers.
| pastacacioepepe wrote:
| I don't understand this need to make everything white or
| black, unless we want to pretend we live in a word as
| simple as a kids' novel. You can't just throw away
| milleniums of history and people because in the past 60
| years we have become too lazy and addicted to modern
| convenience.
|
| No, preindustrial ages weren't the hell they're made to
| be nor a golden age by any means. The same can be said of
| today. Stop playing defensive and think openly instead,
| there's lot we can improve by learning from the past.
| sn0w_crash wrote:
| I know plenty of depressed rich people. I understand your
| theory but spend a week in the Hampton's and you'll see some
| real sad souls.
| [deleted]
| gillytech wrote:
| Yeah they are probably into some extremely toxic, unnatural
| things that cause them to secretly hate themselves. I wonder
| how much shady sexual shenanigans happens in the households
| of the top 1%? Plenty of drugs, gossip, gluttony, lust, etc.
|
| Happiness comes from the overcoming of not unknowable
| obstacles toward a known goal. It's the journey, not the
| destination. And the trick is to set another goal once you
| attained the one you're on.
| s-lambert wrote:
| >Happiness comes from the overcoming of not unknowable
| obstacles toward a known goal. It's the journey, not the
| destination. And the trick is to set another goal once you
| attained the one you're on.
|
| I find this kind of bizarre because you can look around and
| see how it's obviously not true. Dogs are happy as clams to
| just socialize with their owners / other dogs and just
| live. People hustling to always get to the next goal don't
| seem particularly happier than people who don't have a goal
| and just have a healthy social life.
| gillytech wrote:
| A. People aren't dogs. We are of a much higher level
| intelligence and self awareness. That's why psychological
| studies of rats, or even apes, as human analogs is
| ludicrous.
|
| B. The happiest people on the planet are extremely
| ethical, have a good moral compass and have a will to
| help others. They have goals and attain them. And they
| especially don't blame their environment for their
| shortcomings. They find ways to adjust their environment
| to themselves and not the other way around.
|
| Someone who is content with a simple life is still
| following that maxim. Their goal is to live each day in
| relative comfort according to their own standards.
| walrus01 wrote:
| > I wonder how much shady sexual shenanigans happens in the
| households of the top 1%
|
| _Fidelio_
| [deleted]
| emodendroket wrote:
| Plenty of people are very unhealthy despite ample access to
| fluids. Nevertheless, it is very difficult to be healthy if
| you don't have enough water.
| pcmoney wrote:
| We have it way better than almost any period in history and are
| profoundly unhappy.
|
| Also, we always like to think we will be happy "once I
| have...X" and then we get X and say well actually what I need
| is Y.
|
| Most unhappiness is driven by vanity and desire (a bargain you
| make with yourself where you chose to be unhappy until you get
| something) to be better than our peers.
|
| Until you can be content with nothing you wont be content even
| with everything.
|
| If people can be happy in concentration camps we can be happy
| in dead end office jobs. They cant stop us from being happy.
| kayamon wrote:
| > If people can be happy in concentration camps we can be
| happy in dead end office jobs.
|
| I don't think people in concentration camps are happy.
| carabiner wrote:
| He's probably referring to the book Man's Search for
| Meaning. The book's conclusion is a bit controversial for
| this.
| mercer wrote:
| and Frankl, the writer, is rather controversial himself.
| Personally, I can't take what that guy writes seriously.
| taylorius wrote:
| How are we measuring "better"? If suicide rates have risen
| significantly, then perhaps there are ways in which our
| modern paradise is worse than the past.
| scns wrote:
| This might help https://www.amazon.com/Happiness-Trap-
| Struggling-Start-Livin...
| WalterSear wrote:
| This is an article about clinical depression, not
| 'unhappiness'. While distress can result in clinical
| depression, they aren't at all the same thing. One gets
| better if the stressor is removed, the other does not.
| refurb wrote:
| I have a gardener. In fact, I have three gardeners. Three
| generations of men with no ambition, who are happier than I
| will ever be.
| ernestoperez wrote:
| Prof Montcrieff is Professor of Critical and Social Psychiatry. I
| wonder how her patients are doing, if she currently has a
| clinical practice.
| yomkippur wrote:
| Psilocybin has been quite promising and many people report
| positive changes.
| sammalloy wrote:
| Came here to say this. Although few people are aware of it, it
| is said behind closed doors that for some people, it is a cure
| for depression, although it's very controversial to make that
| claim in public, and obviously, it needs to be used carefully
| and with great respect.
| fredgrott wrote:
| The problem with these studies is....
|
| That they focus on one sub-system instead of how the sub-systems
| interact together.
|
| My bias, I solved my ADHD control problems by researching how
| serotonin, dopamine, adenosine, ne, and cdb together regulate
| both the increases and decreases in dopamine and all the
| cofactors needed to increase dopamine production.
|
| The move from one system to full systems based understanding in
| the Biology and neurology space started in the 1970s as Chaos
| theory took hold. But it takes awhile to become fully entrenched
| in each science discipline.
|
| One cannot say that serotonin by itself controls depression as
| CBD is also involved! Runners know this as runners high is the
| result of high CDB neurotransmitter levels!
|
| Another fun fact, Cacao and Cocoa have anandamide which is the
| THC-less way to get that runner high!
|
| Sorry, was a Biology and Chemistry major once...I really cannot
| get it out my system.
| hestefisk wrote:
| So does this mean SSRIs don't work?
| [deleted]
| ggm wrote:
| My psychologist tells me that in his profession there is a
| significant gulf emerging between the ones who feel the
| prescribing is justified, and the ones (like him) with
| significant concerns:
|
| 1. they prescribe both boosters, and inhibitors, to treat the
| same symptoms. This suggests the aetiology of disease here, is
| not well defined by a single behaviour because the same symptom
| (depression, anxiety) is responsive in some people to suppressing
| of a chemical imbalance, and in others to boosting it.
|
| 2. the drugs were tested inadequately across race, age, weight,
| sex.
|
| 3. the drugs appear to be best applied for as brief time as
| possible but are routinely being prescribed for extended periods,
| and demand de-habituation and great care with withdrawal
|
| 4. almost all successful uses of the drugs are accompanied by CBT
| and like processes.
| PragmaticPulp wrote:
| > 1. they prescribe both boosters, and inhibitors, to treat the
| same symptoms. This suggests the aetiology of disease here, is
| not well defined by a single behaviour because the same symptom
| (depression, anxiety) is responsive in some people to
| suppressing of a chemical imbalance, and in others to boosting
| it.
|
| "Chemical imbalance" isn't actually taught as the root cause of
| depression. I suspect your psychologist might be overestimating
| their own knowledge of a different field (psychiatrist formally
| study these systems and medications, psychologists do not) and
| underestimating the amount of research being performed in this
| field.
|
| Regardless, these drugs don't really work as "boosters" like
| commonly thought. It's better to think of them as modulators.
| In fact, in conditions like anxiety SSRIs are well-known to
| actually reduce serotonin transmission in certain areas of the
| brain. The research has diverged quite a bit from the simple
| marketing-material models that a lot of people have about these
| drugs.
|
| The purpose of the drugs is to _induce changes_ that result in
| positive downstream effects. It 's not actually a contradiction
| that enhancing and inhibiting certain receptors could result in
| similar downstream effects. For example, a number of receptors
| in your brain will downregulate in response to both agonists
| and antagonists, even though they have opposite direct effects.
| Your psychologist's understanding of this topic is deeply
| flawed.
|
| > 2. the drugs were tested inadequately across race, age,
| weight, sex.
|
| SSRIs have been in widespread use since the 80s and tricyclics
| since the 50s. At this point, the idea that we haven't tested
| enough or that we haven't collected enough data is just a
| strawman argument proposed by people with impossibly high
| standards. I suspect no amount of testing would actually
| satisfy someone proposing this argument for drugs that have
| been studied for this long.
|
| > 3. the drugs appear to be best applied for as brief time as
| possible but are routinely being prescribed for extended
| periods, and demand de-habituation and great care with
| withdrawal
|
| It doesn't make sense to make blanket statements about "the
| drugs" when psychiatric drugs differ widely in this regard.
| Benzodiazepines should absolutely be prescribed for brief
| periods and this is reflected in their status as controlled
| substances and all of the prescribing literature. There are
| some doctors who ignore this advice and overprescribe, of
| course, but they are going counter to standard practice.
|
| On the other hand, medications like SSRIs can actually take
| weeks or months to reach full effect and many patients
| unnecessarily relapse by quitting them early.
|
| I'd be cautious of taking advice from anyone who makes blanket
| statements about "the drugs". This is bordering on uninformed
| anti-psychiatry.
|
| > 4. almost all successful uses of the drugs are accompanied by
| CBT and like processes
|
| The _most successful_ uses of SSRIs are accompanied by therapy.
| However, we have plenty of studies where SSRIs are prescribed
| without any accompanying therapy and a positive result is still
| seen. If you 're suggesting that the therapy is actually doing
| 100% of the work, that's easily disproven by the studies that
| test all combination (placebo, therapy alone, SSRI alone,
| therapy + SSRI).
|
| I'd recommend getting your psychiatry advice from actual
| psychiatrists. The number of misunderstandings and mistruths in
| what you've relayed here is quite high.
| ggm wrote:
| I'm not a psychiatrist or psychologist. He is, and has
| professional standing. You're judging him, on my paraphrases
| of what is said to me. Perhaps what you really should be
| saying is "don't try to represent the views of professionals
| in a field you are not an expert in" which btw, I would take
| as good advice.
|
| None the less, I think the substantive point stands: the
| field is not in unity about the applicability of these drugs,
| and their use.
|
| Do you disagree?
| PragmaticPulp wrote:
| > None the less, I think the substantive point stands: the
| field is not in unity about the applicability of these
| drugs, and their use.
|
| Which field? You said he was a psychologist. Your post was
| about psychiatry and neuroscience topics.
|
| I don't disagree that psychologists have a lot of opinions,
| but it's not really their domain. I think it's a mistake to
| think that a psychologist is better educated on psychiatry
| topics than actual psychiatrists or neuroscientists who
| actually study these things and understand the research.
| ggm wrote:
| I think the gap between GPs, Psychologists and
| Psychiatrists lies at the heart of this. GPs can (and do)
| prescribe psychoactive drugs. What they do subsequently
| is subject to the constraints of the health economics
| which apply: In the UK (I am told) the delay to be seen
| by anyone other than your GP can be measured in YEARS
| because of the backlog in patents presenting. Many of
| these patients are young people. The GP has the
| determinant of the path. They can recommend something
| like CBT and a clinical psychologist, or they can
| recommend drugs and a psychiatrist. They can do either,
| for what is the same presentation of problem.
|
| They get seen by a GP, with limited time and tools. They
| are prescribed SSRIs, and booked in to see "some other
| health professional" and what emerges is a delay of some
| significant time, before they get that next stage of
| engagement.
|
| I was also triaged by my GP, in Australia, and was put
| into the non-drug path, and I am content. If my health
| practitioner prefers not to use drugs, and that is a
| bias, so be it.
|
| I can say that my mother in law was treated in other
| ways, became addicted to Xanax, and narrowly missed being
| placed in "deep sleep" therapy which wreaked havoc on
| many people, although it was "peak treatment" at the
| time. She was a deeply unhappy woman. I cannot say she
| would have been better off without drugs, but I do know
| the process of managing her drug regime was intense.
|
| Deep sleep therapy lasted a long time. It was credible
| for decades. Psychiatry is as capable as any other
| science of being led a long way down paths it
| subsequently walks back on.
|
| ECT, which is much more "confronting" in some ways,
| remains a useful tool. If you ask most people in the
| streets, They react with horror.
|
| I place great hopes in ketamine, and in psylocybin.
| Again, both require a context of use, and are still
| experimental. What I like about both, is that they appear
| to being considered as rapid-intervention therapies, not
| as sustained, long lived treatments. I like that because
| of the short duration. I guess I don't like the SSRI
| story precisely because of the long duration, and the
| consequences on young kids, especially on things like
| sexual dysfunction. (I'm not a young kid and that isn't
| an immediate concern for me)
| tptacek wrote:
| This is for the most part a thread about SSRIs. Xanax is
| a benzodiazapine. There are no controversies on this
| thread, or really any ordinary place, about the dangers
| of benzodiazapines; they're scary drugs.
| ggm wrote:
| To stick to SSRI's I know one person who reacted badly to
| a change of meds, predicated on her personal dislike of
| the effects of the prior, but finding the replacement had
| extremely strong negative effect. I think had she been
| absent any support, this could have ended tragically, the
| effect was so strong and so sudden.
|
| This, coupled with the emerging reports of longterm
| sexual dysfunction in young women, I think represent
| pretty severe concerns. Obviously anecdata is not
| science, but this is what informs my own sense of place
| here. I am not anti drug in the wider sense. I think
| drugs of all kinds have been and are and will be
| beneficial. I am concerned with how SSRIs are being used
| in practice, with what longterm consequences, and short-
| term risks.
|
| There's a strong vibe of "butt out, stick to your
| knowledge" in responses to my posting here. I will take
| that advice. I'm off-piste, this isn't my area of work.
| klodolph wrote:
| Agree that the system is a bit fucked, in pretty much
| every country (as far as I can tell).
|
| Unless you are involuntarily committed, you won't be put
| on the drug path if you don't want to. Psychiatric
| medications like SSRIs are generally awful. What I mean
| when I say "awful" is that the experience of taking them
| is awful. You may end up with symptoms that are under
| control, but you may still experience symptoms, or the
| symptoms can sometimes get worse, and the side effects
| are often just kind of shitty to deal with. These are
| generally not habit-forming drugs. These are nasty pills
| that you'll look at in the morning and dread taking.
|
| Non-compliance rates are already high, when you have
| patients who _want_ to take the medication. There is no
| way you 're going to prescribe antidepressants to
| somebody who says they don't want to take them. It's just
| a waste of time.
|
| Xanax is different. It's a benzodiazepine. The entire
| category of benzodiazepines is known to have a high rate
| of misuse, and Xanax in particular has a high rate of
| misuse. It's prescribed because it's an extremely
| effective and fast-acting. Very different from SSRIs.
| mercer wrote:
| I would add the caveat that low doses of SSRI do seem to
| be quite effective for issues like compulsiveness and
| anxiety without much in the way of negative side-effects.
|
| I'm not sure what the scientific support for this is, but
| at least anecdotally I know 5+ people who take an low-
| dose SSRIs and claim it works.
| _moof wrote:
| Psychiatrists are medical doctors. Psychologists are not
| (and can't prescribe medicine). There is a huge difference.
| aahortwwy wrote:
| > "Chemical imbalance" isn't actually taught as the root
| cause of depression.
|
| The article contradicts this.
| asveikau wrote:
| > It doesn't make sense to make blanket statements about "the
| drugs" when psychiatric drugs differ widely in this regard.
|
| > I'd be cautious of taking advice from anyone who makes
| blanket statements about "the drugs". This is bordering on
| uninformed anti-psychiatry.
|
| Yeah, as someone who has been close to people who need
| antipsychotics, I sometimes feel the anti-antidepressant
| crowd extrapolates to _all_ psychiatric drugs and this is
| very scary. Especially since people with conditions like
| schizophrenia or bipolar frequently think they don 't need
| medication.
| fragcula wrote:
| It's interesting that anyone other than the R&D arm of the
| pharma industry even cares how it works.
|
| From the medical side what's important is what risk/benefit
| which is independent.
|
| Antidepressant as a term is really only for convenience
| which the medications themselves being quite broad in
| action.
|
| Antipsychotics too are having a bit of a revolution, the
| first generation seemed to all be about D2 blockade, the
| second generation acting on 5HT-2a much more than D2.
| Finally, pimavaserin acting only on seratonin (5HT-2a) and
| not on dopamine at all [0] now there's SEP-363856 [1] which
| has action not at D2 or 5HT-2A but TAAR1 and 5HT-1A.
|
| The point is that psychiatrists are not particularly
| married to any mode of action or mechanism. Only the
| results.
|
| [0] https://nbn2r.com/search#drug/90
|
| [1] https://en.wikipedia.org/wiki/Ulotaront
| ggm wrote:
| I am not anti-antidepressant, or drugs in general. Bipolar
| people get huge benefit from their medications. And their
| families!
|
| The ones I know also say there are times they miss the
| emotional highs. It's probably why they (and
| schizophrenics) go non-compliant.
| asveikau wrote:
| I think it's different for a lot of people. But one
| common thing is to get grandiose and think that all
| problems are with other people. Why would such a person
| need meds? Clearly there is something wrong with the
| person who might suggest that.
|
| Then potentially add paranoia on top of that...
|
| Edit: and as the sibling comment said, people can feel
| pretty shitty on them. I know I've heard and been
| sympathetic to that for many years, so don't want to
| sound insensitive by only focusing on anosognosia.
| kayodelycaon wrote:
| Antipsychotics are nasty medications. Here are the list
| of problems I've had:
|
| - Sedation (too tired to function)
|
| - Emotional numbness if I need to increase the dose to
| stop an episode.
|
| - Headache
|
| - Loss of balance.
|
| - Impaired fine motor control.
|
| - My arms and legs don't move properly. I'll command my
| arm to move, and it only moves halfway. I used to fall a
| lot before I learned to be very careful walking.
|
| - Inability to orgasm.
|
| These get pretty bad in the first four hours after taking
| them. During the day, if I get dehydrated or have low
| blood sugar, I can easily get incapacitated and be unable
| to drive.
|
| And no, my dosage isn't too high. This is the lowest
| effective dose I can be on. The alternative is lithium,
| which can be worse.
| SamoyedFurFluff wrote:
| I think you might want to do some research as to why
| schizophrenics might end up non-compliant. Antipsychotics
| are serious drugs that, historically, have had severe
| side effects. Additionally, they're rarely a complete
| solution (people can still have delusions and
| hallucinations while taking medication). Additionally,
| like other psychiatric medication, not all antipsychotics
| will work for people, sometimes they'll stop working,
| etc.
| makeitdouble wrote:
| I had the same feedback talking to a few professionals. There
| is doubt about the exact effect of the prescription and the
| science behind it, and they regularly have patients that get no
| clear effect from commonly prescribed treatments.
|
| But they also see other patients showing measurable
| improvement, and trying different prescriptions until finding
| one that seem to have an effect is a common practice.
|
| All in all, this is very murky situation, but drug prescription
| can still be effective and might be the only option for some
| patient for who other approaches didn't work.
| marincounty wrote:
| Traubenfuchs wrote:
| 5. the drugs can cause permanent sexual side effects (PSSD)
| jmcgough wrote:
| > they prescribe both boosters, and inhibitors, to treat the
| same symptoms
|
| So here's the interesting thing - there's evidence that 5-HT2a
| receptors are way too dense in people with depression.
| Antagonists obviously have a blocking effect, but increasing
| serotonin at the synapse counterintuitively has a similar
| effect - your body responds to it by paradoxically
| downregulating 5-HT2a receptors. Two totally opposite
| approaches with a similar outcome.
| wisty wrote:
| Maybe just giving the system a kick can be a bit effective
| (especially in conjunction with a patient trying to change).
| aahortwwy wrote:
| If you have a broken arm a cast can be helpful during the
| healing process, but a cast does not heal a broken arm.
| raducu wrote:
| > but a cast does not heal a broken arm
|
| I don't know why people take such reductionistic stances.
|
| There are dozens of anti-depressants, I think most people
| get significant improvement after trying a few.
| pessimizer wrote:
| I don't think the number of different anti-depressants
| make it inevitable that some work significantly better
| than others. You can get casts in many different colors.
| kzrdude wrote:
| It's common to a lot of treatments that we can't heal the
| body, we can only help it heal itself. Quite amazing in
| that sense.
| gloosx wrote:
| So maybe low serotonin levels are caused by depression? My naive
| understanding is that these amines play a critical role in our
| emotional response, social interactions and other complex psyche,
| so as a consequence, depressed person suffers decline in these
| functions, as well as a whole higher nervous system suffers
| regression. I always had a feeling that SSRIs are treating
| consequence, not the cause. Maybe I'm too naive and my
| understanding is very poor, I just architect systems in the end,
| so I'm looking at this problem like at a bug in the very root of
| an unimaginably complex system, while treating it by boosting one
| or another amine is looking like the most ugly hotfix.
| neuroma wrote:
| As we're dealing in analogies...
|
| Better think the serotonin/ monoamine hypothesis of depression
| is akin to saying a server load balancing failure is because of
| "electricity imbalance". Whilst electrons are undeniably
| involved, the explanation is not useful, and distracts from
| better truths.
|
| We have such a scarcity of safe and effective tools to probe
| and influence the human brain. Herein lies the hope that the
| diseases we invent might be treated neatly by the tools we
| posses. Yet, given the origin of disease and the tools are
| sparsely interlinked, it is too often just a fantasy.
|
| Yet to "do nothing" is usually not acceptable and so we
| persist, and iteration or invention become the next hope.
| malf wrote:
| "electricity imbalance" may be a myth, but a short
| electricity "fast" (HYTTIOAOA) is still a useful fix for many
| problems.
| taurath wrote:
| That's my understanding and feeling as well. Psychiatric
| medication imo should be used to help stabilize for
| psychological work, not create a new chemical baseline.
| [deleted]
| current_thing wrote:
| https://m.youtube.com/watch?v=tFgF1JPNR5E&t=9m35s
|
| Tom Cruise was right then.
| sigg3 wrote:
| Tom Cruise is a leading member in the fascist cult Church of
| Scientology, who is on record saying they can bring back people
| from the dead and levitate.
| bowsamic wrote:
| And? People also listen to Buddhists about depression, and
| Buddhists believe that enlightened people can fly!
|
| EDIT: I'm rate limited so I can't reply to the child
| comments:
|
| I think a majority of Buddhists believe that Buddhas and
| bodhisattvas have special powers. It is in a majority of the
| traditional scriptures, from both Mahayana and before. I
| don't think the authoritarian nature of scientology changes
| the situation. Scientologists were being mocked for believing
| in such things, but that is not far from the beliefs of most
| Buddhists which people will happily listen to.
|
| I mean, you will likely even listen to His Holiness the Dalai
| Lama, who is literally a prophesied reincarnation of the
| bodhisattva Avalokiteshvara (Guanyin in Chinese, Kannon in
| Japanese)
|
| My point isn't that people can be right about some things and
| wrong about others, it's that people mock their disliked
| religious figures on one basis, but their mocking also
| applies just as much to their favourite religious figures,
| however they don't realise it because they are usually
| ignorant to many aspects of it. Everyone loves Buddhism, but
| go and criticise other religions for reasons that apply just
| as much to Buddhism, they are just ignorant that it also
| applies to Buddhism.
|
| I am a devout Buddhist, and believe in these traditional
| things, such as Buddhas flying or having their own Buddha
| lands or faith in my rebirth in a western Pure Land. I
| emphasise it because you probably don't know of these things
| telchior wrote:
| "Buddhists" represents many sects, and many more
| individuals who aren't beholden to anyone. The majority of
| these assuredly don't believe anyone can fly, enlightened
| or not.
|
| Scientology is a rigidly hierarchical, authoritarian cult
| that speaks with a single voice: that of a handful of
| leaders.
|
| There is a slight difference between these two things.
| ok_dad wrote:
| What do Buddhists have to do with Tom Cruise? Is he a
| leading member of a Buddhist organization?
| neonate wrote:
| I assume bowsamic's point is that people can be wrong
| about some things and right about others.
| ok_dad wrote:
| It was whataboutism, and it successfully derailed the
| conversation, so I guess it worked.
| bowsamic wrote:
| It isn't whataboutism. I'm simply pointing out that the
| same argument people use to disparage Tom Cruise also
| applies to religious figures that they respect far more.
| I'm pointing out ignorance about other religions, it
| isn't whataboutism at all.
| ok_dad wrote:
| In Scientology's case, there is a bit more to it than
| just believing some monks can fly.
| dang wrote:
| We detached this subthread from
| https://news.ycombinator.com/item?id=32160909.
| imadierich wrote:
| cbxyp wrote:
| SSRI's are without a doubt the leading cause of divorce and mass
| shootings in America. The quacks in the medical profession
| handing them out like candy to people whom it is clearly
| contraindicated in, without any followup study and usually
| without any competent analysis of what the drugs are doing to
| these peoples behavior and brains. Getting my girlfriend off of
| SSRI's completely changed her life, as she was indicated bi-
| polar, and yet over 10 mental crisis hospitalizations with
| specialist psychiatry teams failed to notice the direct
| contraindication and continued recommending use of SSRIs. The
| kind of mental breakdowns she was having as a direct result of
| SSRI use is the type of behavior that in a male could lead to a
| mass shooting or other particularly crazy behavior.
| Uncontrollable flights of emotions and repeating panicked
| behavior.
|
| After seeing her be "treated" by numerous psychiatrists who
| failed to take note or recommend cessation despite SSRI usage
| being _clearly_ contraindicated on her pre-existing diagnosis,
| the last crisis we simply took her to another hospital, they
| concurred on cessation of SSRIs and all of these problems ceased.
| Of course, it 's not possible to sue the previous doctors or
| hospital due to the laws that protect the industry.
| chalst wrote:
| > without a doubt
|
| Not a mark of wisdom to use these words about such topics.
|
| I agree that SSRIs and bipolar are a tricky mix, but they work
| for some patients.
| cbxyp wrote:
| Divorce: https://pubmed.ncbi.nlm.nih.gov/23931947/ Mass
| shootings / violence:
| https://www.psychreg.org/antidepressants-ssri-mass-
| shootings...
|
| While they may provide benefit to some patients, the sheer
| volume of prescriptions and the quite clearly linked effect
| leads me to stand by my original statement - without a doubt,
| they are a leading cause of both.
| chalst wrote:
| The existence of studies attesting to a link does not
| demonstrate causation beyond reasonable doubt.
| jinder wrote:
| SSRIs appear to work through the vagus nerve in a similar way to
| psychobiotics. Their direct effects on neurotransmitters are
| probably an unwanted side-effect:
|
| Oral selective serotonin reuptake inhibitors activate vagus nerve
| dependent gut-brain signalling (2019):
| https://www.nature.com/articles/s41598-019-50807-8
|
| Identification of SSRI-evoked antidepressant sensory signals by
| decoding vagus nerve activity (2021):
| https://www.nature.com/articles/s41598-021-00615-w
| jinder wrote:
| To add to my comment, this explains why SSRIs take some time to
| work - it's the signalling through the vagus nerve that takes
| time to impact the brain. Other compounds such as curcumin and
| famotidine (H2 antihsitamine) have also been found to work via
| this mechanism. For many many years scientists had dismissed
| curcumin as having no effect because it's not bioavailable -
| recent research has shown that it doesn't need to be if it
| directly activates your nervous system! There's a lot more
| research that needs to be done here, and I think promising
| therapeutics for impacting brain function are coming our way as
| researchers learn more.
|
| If you consider the brain a state machine, inputs from the
| nerves - through gut-brain axis, through your eyes and ears
| (socialising, environmental cues, sounds of safety vs sounds of
| threat), through your skin (touch) etc all impact the state.
| This state can range from safety to fight-or-flight (anxiety)
| to shutdown (depression). This is hugely simplified (for
| example neuroinflammation, endotoxins/LPS etc can impact this
| also) but I've found it very useful for regulating my own state
| and understanding why I feel happy, agitated, low etc.
| konfusinomicon wrote:
| recently procured an acupressure spiky foot ball that was
| originally designed to combat depression by stimulating the
| vagus through the foot. I don't consider myself depressed by
| any means, but after a few minutes of rolling my feet
| aggressively over the ball and targeting a few key areas, I
| generally feel much better and can actually sense that my body
| is less stressed. everyone should have one or 2 of them
| 72deluxe wrote:
| This is very interesting - is that just a general acupressure
| spikey ball? I am looking for one on Amazon, if you had the
| link?
|
| Also, reading up on the vagus how is the vagus stimulated via
| the foot? Reading on wikipedia on the vagus nerve I cannot
| see how it is connected to the foot in any way?
|
| Thanks in advance
| konfusinomicon wrote:
| apologies, it wasn't vagus, it was the solar plexus, a few
| inches back from the 2nd biggest toe. got mine from
| gokanjo.
| WalterSear wrote:
| It's connected to the vagus nerve via the leader of the
| 1950's Chinese communist party:
|
| https://slate.com/technology/2013/10/traditional-chinese-
| med...
| tested23 wrote:
| There are probably a million different causes for depression and
| im convinced for all but the most extreme cases that usage of
| anti depressants is a mistake.
|
| I think viewing depression as a disease instead of a symptom is a
| mistake. So many people eat food completely devoid of nutrition,
| stay indoors all day, have erratic sleep schedules, drink absurd
| amounts of alcohol and smoke weed all day. Why are we giving
| these people antidepressants when what they need is to go outside
| and walk and to take a multivitamin?
| quacked wrote:
| Completely agree with you, although I think that "going outside
| and taking a multivitamin" is an inadequate substitute for
| "live inside a prosperous, functional human-shaped society".
| gillytech wrote:
| It's not society. It actually starts with the individual. In
| order to have nay kind of decent society, each individual
| needs to recognize that they are responsible for themselves
| and their own society. Going outside, exercising and
| consuming nourishing foods are the literal starting place.
| Then seek to find things you like doing and become competent
| in them. Find a good wife or husband. Don't cheat on them.
| Don't take alcohol to excess, etc. etc.
|
| The point is, you cant start from the outside and work your
| way down the the individual. It starts with the person.
| DontchaKnowit wrote:
| While this is true in terms of finding a solution to
| depression, I do think that the societal norms of our
| society are extremely conducive to these sort of depressive
| behaviors. E.g. many societies are setup to make these
| kinds of behaviors (self isolation, dopamine seeking
| hedonic treadmill type behavior, etc) very difficult to
| engage in without being chastised
| gillytech wrote:
| I see your point, and my argument supports it. Who
| creates "societal norms" other than the individuals that
| make up society? It starts with individual action to
| reverse the dwindling spiral.
| DontchaKnowit wrote:
| Sure. It is certainly a "collective action" type problem.
| quacked wrote:
| I completely disagree with that. If you are a westerner
| with a 50th percentile mind and follow every rule set up
| for you, you end up on a console for 8-10 hours per day,
| struggling with bills and health insurance and watching the
| land and culture around you be slowly eroded into a
| formless mass of concrete and advertisements.
|
| "Depression" is a natural response to living an alienating
| modern lifestyle. The people who can appropriately "deal"
| with it (like myself) all have something extra going for
| then, like deep family structures or unusual minds.
| ChildOfChaos wrote:
| The book lost connections is a really good read on this.
|
| It points out the problems in modern society and our lives that
| lead to depression rather than it just being something that can
| be solved with a pill.
|
| Things like our lack of connection to meaningful work, our lack
| of connection to each other and our lack of connection to nature
| all play a big part.
| falafelite wrote:
| I found the author to have cherry-picked and poorly-cited
| information earlier on in the book when talking about
| antidepressants, and then a complete lack of rigor when
| discussing the various lost connections. I think he has a
| point, but I just didn't find it very well done, and as another
| comment here has quoted: > Other clinicians say, however, that
| the notion of depression being because of a simple chemical
| imbalance is outmoded anyway, and that antidepressants remain a
| useful option for patients alongside other approaches including
| talking therapies.
|
| It is also notable that the author has had plagiarism issues
| and other questionable behaviors in the past:
| https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism_and_fab...
| 127 wrote:
| There's also the driving our novelty seeking brains into
| overdrive with all kinds of artificial stimulants, including
| this very forum.
| n0tth3dro1ds wrote:
| Sounds like Kaczynski's "power process" in Industrial Society
| richardatlarge wrote:
| I recommend "The Cult of Pharmacology," which long ago
| characterized this serotonin theory as bio-babble reductionism
| smolder wrote:
| I'm going to go out on a limb and guess the prominence of
| depression is _largely_ caused by a broken interface with the
| world at large. The traps created by modern society wherein you
| struggle for other people 's benefit are better designed than
| ever before. What our social machine procedurally treats as
| progress is advances in subjugation. Depression may often be an
| artifact of "efficiency" with respect to extracting value from
| the population at large. We might need to dial back the
| exploitation of the currently-exploitable class to have a
| sustainable society, assuming pills don't work. In different
| terms, maybe we have too many rich people (exploiters) in a
| situation where it's clearly very foolish to keep growing in
| number (and productivity) to support them. Maybe we just need to
| rebalance our economy to make it work better for those currently
| exploited and endemically depressed people.
| bawolff wrote:
| > In different terms, maybe we have too many rich people
| (exploiters) in a situation where it's clearly very foolish to
| keep growing in number (and productivity) to support them.
| Maybe we just need to rebalance our economy to make it work
| better for those currently exploited and endemically depressed
| people.
|
| Don't all those rich people also get depression? I think that
| rules out a marxist reading here.
|
| If you're going to go this general direction, i'd say a better
| way would be, we now live in a system where work is never done,
| stress is pretty constant, and labour is less physical but more
| mental in the modern world. Perhaps our mind is just not made
| for continous mental labour. Being a farmer in pre modern times
| sucked, but at least you could turn your brain off more often.
| imtringued wrote:
| People lament their functional redundancy in society. Markus
| Persson Notch got depression after he became a billionaire.
| The workers lament their redundancy because they can be
| replaced and abandoned all the time.
|
| People want to be needed, instead we have become isolated
| individuals that need no one in particular.
| hikingsimulator wrote:
| Marx clearly stated that alienation was a phenomenon that
| affected all classes. Marxism explains alienation just
| intervenes in a different manner.
|
| Depression then also happens among rich people. But the
| source, and expression of it might differ. An anecdotal
| saying explains that wealth is often a barrier to create true
| friendships because it insulates you from society and creates
| antisocial thought processes: the "thinking people just want
| to be your friend because you're rich" rhetoric.
| smolder wrote:
| Rich people aren't automatically immune to exploitation. It's
| more a finely tuned web of pressures than a strict hierarchy.
| I'm also aware of differences in genetics and diet and other
| behavior that predispose people to depression.
|
| I'm not rooting for Marxism exactly. I think it is an extreme
| overcorrection, but that some correction has been and is
| still warranted at times, given regulatory capture and other
| abuses that come from concentration of power. Anti-trust
| action and semi-effective democracy/representation are
| needed.
|
| I think we are in a society with solutions to almost every
| problem except for those that require cooperation on the
| scale we exist at, which is unprecedented.
|
| I sympathise with the idea of mindless hard labor being more
| fulfilling. Working food service in the backroom as a
| teenager worked my body but left me less stressed mentally
| than anything I've done post-graduation.
| tptacek wrote:
| You're right: you've gone way out on a limb.
| emodendroket wrote:
| I've heard plenty of people involved in mental health care
| themselves lament the fact that they're often just trying to
| happy-talk people who genuinely have harrowing lives. I don't
| think the notion is absurd.
| tptacek wrote:
| All sorts of non-absurd-seeming notions turn out to be
| wrong, which is why people train for many years to conduct
| medical research.
| emodendroket wrote:
| How would you "medically disprove" the notion that some
| people are unhappy because the circumstances of their
| lives are bad rather than biological defects?
| nl wrote:
| Unhappy is dramatically, completely different to
| depression. I've been both and they don't even feel that
| similar.
| dr_dshiv wrote:
| Sadness or distress vs not feeling anything and not
| having motivation?
| nl wrote:
| Yes, this is roughly in the right area.
| dr_dshiv wrote:
| I wonder how a week of low dose amphetamine usage, like
| adderall, might help disrupt no-motivation mood loops. A
| friend of mine (cycling through many antidepressants)
| seems like he would respond well to this. As in, he would
| feel better and be able to "shift gears." Not to get more
| work done, but say, enjoy going to an art museum. And
| feel what it is like to be enthusiastic again.
| emodendroket wrote:
| If we change the word "unhappy" to "despairing" does it
| make sense?
| nl wrote:
| I don't know - it's your argument.
|
| If it helps, unhappiness/despair seem like different
| degrees of the same feeling. Depression is a different
| feeling.
|
| The closest analogy I can think of is that "amused" and
| "satisfied" are both positive feelings, but they are
| different and you can't treat the cause the same even if
| some of the symptoms are similar.
| emodendroket wrote:
| "Exogenous depression" is supposed to be experienced by
| about a fifth of people at one point or another. What if
| many persistent cases of depression were actually
| exogenous? That might be more interesting than parsing
| the difference between despair, hopelessness, anhedonia,
| and depression.
| NavinF wrote:
| No
| emodendroket wrote:
| Thanks for your contribution to the discussion.
| tptacek wrote:
| Nobody needs to disprove the notion that some people are
| happy for reasons having nothing to do with clinical
| depression.
| emodendroket wrote:
| OK. And the notion that psychiatry has been used to
| simply stamp anyone agitating for political change as
| insane is also attested (see
| https://en.wikipedia.org/wiki/The_Protest_Psychosis for
| instance). So what's your objection to this line of
| inquiry?
| tptacek wrote:
| I don't know what you're trying to argue here, but it
| doesn't seem to have anything to do with the claim at the
| root of the thread, and I apologize but I'm not
| interested in the tangent.
| JamesBarney wrote:
| The idea that a terrible life can cause depression is not
| the limb he's going out on. It's the idea that somehow
| depression is caused by being way more exploited than our
| ancestors in the 1700's who were working on someone else's
| farms and factories as children is the limb he's going out
| on.
| smolder wrote:
| Fair criticism as usual and maybe I should have been more
| specific, but I didn't say anything about the 1700s or
| prior specifically. If we talk about trends in the
| lifespan of people alive today (which represents a huge
| number of people) the picture is much different.
| Thorrez wrote:
| My grandma (alive today) grew up with no indoor plumbing
| in the United States. They had to use an outhouse.
|
| > In 1940 nearly half of houses lacked hot piped water, a
| bathtub or shower, or a flush toilet. Over a third of
| houses didn't have a flush toilet.
|
| https://www.aceee.org/files/proceedings/2004/data/papers/
| SS0...
| emodendroket wrote:
| OK, well, that's an easy rhetorical maneuver but one that
| can be met with equally facile ripostes, such as "how do
| you determine that people weren't just as if not more
| depressed in the 18th Century when the concept was less
| familiar?" or "perhaps having the gulf between themselves
| and the wealthy rubbed in their faces every day is what
| causes the distress, since there can be little sense of
| exploitation if one is surrounded only by those in
| similar straits."
| Thorrez wrote:
| Didn't people in the olden days also see the castles and
| mansions of the rich on a daily basis?
| emodendroket wrote:
| Daily I very much doubt because it's not like most people
| were commuting to work. Would you sometimes see them,
| sure, but people also had a belief system that would have
| done more to justify the social order, and it would
| probably be limited to provincial elites for most.
| missedthecue wrote:
| You don't need to go back to the 1700s to find
| comparatively low levels of depression. The 1980s will
| do.
| UK-Al05 wrote:
| Is it exploitation that's the problem?
|
| Or social isolation? People are very isolated these days.
| People can have good jobs, have lots of shallow
| acquittances but no true friends.
| dogcomplex wrote:
| Gonna attempt to short circuit the "you think WE have it bad?
| Whatabout 1700s?" argument by adding that the "broken
| interface" theory may be much more about the patient's
| _perception_ and _confidence_ of the trap we 're in than the
| actual truth of relative conditions. There also might now be a
| greater philosophical understanding of the global picture than
| the average person back in the day. Back then we didn't have an
| internet to give us rigorous detail on both the widespread
| extent the human race is trapped in a broken system and the
| futility of the common man's attempts to change it. Even if
| this wasn't true (I'm hard pressed to find a more optimistic
| take, though I'm always searching and fighting for it -
| technology is the best hope imo), it is an easy perception to
| fall into, especially for anyone already a few steps into
| depression. It's a reasonable bet that even if people in the
| past were just as likely to get beaten down and depressed about
| their own lives, they still might have been able to look at the
| world around them and the future of humanity and see optimism
| and hope that the next day might be better/luckier. The world
| was also much more malleable at the local level - both
| politically and individually (i.e. go outside and chop a tree
| down) and less of a complex leviathan of laws and exploitations
| which immediately instills a feeling of being trapped in the
| jaws of something that you can't even explain or understand.
|
| Alternatively - or just, adjacently - with the internet (and
| big business, and widespread university education) we are
| culture-shocking vastly more people into a medium that can
| barely be understood from a detached intellectual and
| philosophical perspective, and is almost impossible to fathom
| from historical, traditional, ancestral or biological ways of
| understanding (the way humans operated for vast majority of our
| existence). We have little history to compare this new way of
| life to, and it's unsurprising if it's doomed to breed mental
| disease by its very nature. We have awakened far more people to
| an absurd reality, and "what is meaning?" is no longer just a
| question for a tiny group of overintellectual philosophers.
| Some of those philosophers say that one must walk through the
| valley of the shadow of death before we can find that answer
| for ourselves - but even they're gonna admit that a whole lot
| of people are gonna get stuck in that valley for a while if you
| just throw the masses in like we have. Hopefully that's just a
| temporary growing pain of our society as we gather our strength
| and do better but - time will tell!
|
| (P.S. rich people are just as trapped in this malaise of
| meaninglessness. They have more agency, sure, but they're also
| still part of the systemic trap and unlikely to have much
| better answer on how to change anything than the common man.
| Only so long even a rich person can hide in hedonism before the
| depression catches up - or they just embrace the cold reality
| and adopt the "I got mine" attitude which said system is
| naturally inclined to. Depression may very well be due to our
| moralistic social being nature chafing with a cruel capitalist
| system which has won by almost every measure possible)
| smolder wrote:
| Yes, honestly I regret making the jab at "rich people". It's
| oversimplifying things.
|
| I appreciate your take on this.
| zackmorris wrote:
| Don't feel too bad about it, you hit the nail on the head.
|
| It might be helpful though to define the term "rich".
|
| A rich person usually isn't your manager, or their boss, or
| even the owner of the business, because the people
| supervising you may have never had a raise in life either,
| and the owner might be in debt.
|
| A rich person is someone who dismisses their dependence on
| others. They will act impeccably in all situations and
| often appear to have an untarnished reputation. A rich
| person will deny help to someone in need, and then justify
| their lack of empathy with something along the lines of
| tough love. A rich person will demand that others work and
| portray an image that they themselves work, while secretly
| delegating all work to others. A rich person will wear a
| suit, a lapel pin, all manner of regalia, to preserve their
| image at all cost. A rich person has an untethered ego that
| will go to any length to maintain control. A rich person
| will decide for others. A rich person will never question
| their own beliefs. A rich person achieves affluence by
| denying it to others.
|
| Unfortunately the rich are in charge of all facets of our
| lives in the US and pretty much everywhere else. Their
| undying devotion to wealth inequality and the status quo is
| specifically the primary cause of suffering for the rest of
| us.
| raptorraver wrote:
| I tend to think that our disconnection from the nature causes
| depression to humans. We have come so far from our natural
| living conditions that we fall ill to depression and other
| diseases. Another aspect is the lack of physical work that is
| very unnatural for us. We sit in cubicles (or at home office
| nowadays), use our brains and fingers to do work and at best
| hit the gym few times a week. After which we eat our stomach
| full and entertain us with things that were invented during
| last generation. Life certainly is safer and better for us, but
| it's making us unhappy. We live like medieval royals and like
| them we suffer mental illnesses
| (https://en.wikipedia.org/wiki/List_of_mentally_ill_monarchs).
| [deleted]
| oq_computer wrote:
| 'The Weariness of the Self' from Alain Ehrenberg gives a really
| good account about the history of the depression more or less
| along these lines.
| taurath wrote:
| Imagine a kid growing up in the US today, they are functionally
| under house arrest as neighborhoods are built for cars and not
| people. Everyone is isolated to their family unit almost
| entirely and all activity gated on parents time and willigness
| (or control).
| JamesBarney wrote:
| You must be reading very different history books than the ones
| I've read.
|
| The idea that we're somehow way more exploited than the people
| who came before us does not seem compatible with any history
| book I've ever read.
| smolder wrote:
| It depends on the timespan and comparative frame you are
| thinking about. If we limit ourselves to post-WW2 MAD world,
| there are much different overall trends in quality of life
| than starting in the middle ages or from colonial times,
| where many people did not enjoy the rights or luxuries modern
| people would, not in small part because they couldn't,
| technologically speaking. It's easy to compare modern poverty
| to peasantry and say we have it good now, but it doesn't
| address modern problems in a meaningful way.
| tomnipotent wrote:
| > It depends on the timespan and comparative frame you are
| thinking about
|
| There are few dimensions where pre-industrial life is
| better before than after. The quality of life for the
| average human is many standard deviations above what it was
| just a few centuries prior. It wasn't that long ago cholera
| was a death sentence.
| scsilver wrote:
| Have you ever wondered why the user is the product in so many
| internet companies?
| hoseja wrote:
| Turns out it's more efficient to keep the cattle somewhat
| happy. Doesn't change a thing when it comes time to get
| steak.
| eurasiantiger wrote:
| Before, the body was in chains, but the mind was free.
|
| Now, the mind is in chains.
| becquerel wrote:
| What evidence do you have for this? Do you think chattel
| slaves of the USA weren't broken in mind - indoctrinated
| into Christianity, stripped of their original languages,
| culture and names? That was not some novel evil created by
| Southerners - it's the tried-and-true method for enslaving
| populations throughout history.
|
| But I'm sure the existence of TikTok is an existential
| threat.
| eurasiantiger wrote:
| How successfully?
| white_dragon88 wrote:
| Lol so dramatic.
| randomopining wrote:
| Equal and opposite reaction. Right now may literally be the
| best time to be alive in the world history for those who have
| direction, purpose, inner strength. Endless possibilities and
| safety nets.
| jwmoz wrote:
| Right, so who's correct?
| lettergram wrote:
| 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/
| klodolph wrote:
| Bolts of lightning can be factually wrong, it sounds.
| lettergram wrote:
| 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 wrote:
| > 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 wrote:
| > 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.
| lettergram wrote:
| > 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.
|
| I don't think we disagree in almost any of this.
|
| I'm simply pointing out depression may be caused by
| environmental factors, one which can be treated. It could
| be why they found "nothing convincing" in the study.
|
| I have yet to meet a depressed person or almost any
| person who couldn't use more community. I suspect most
| peoples depression is a rational / emotional response to
| lack of basic needs of some kind. Whether that's
| community, sleep, job, food, etc
|
| That's not to say all people have environmental factors
| or that drugs can't help people cope. I'm merely sharing
| what struck me and for some reason hadn't clicked with me
| prior, even seeing people get out of depression.
|
| The people I know who overcame depression all did the
| following: worked out, improved sleep patterns, joined
| some activities. One could argue correlation (ie as
| depression reduced, they became more active). But it
| didn't seem that way looking in. Anyway, just an
| observation and contemplation really.
| klodolph wrote:
| > I have yet to meet a depressed person or almost any
| person who couldn't use more community.
|
| Depression is known to _cause_ this. Yes, it's not that
| simple. But this reasoning is extremely dubious.
|
| > The people I know who overcame depression all did the
| following: worked out, improved sleep patterns, joined
| some activities.
|
| All the people I know who graduated high school got
| married and had children. Maybe we should encourage
| people to get married and have children to increase the
| graduation rate!
|
| Sarcasm aside, this reasoning is just beyond dubious. Do
| you know what the symptoms of depression are? Are you
| familiar with the very basics of what depression is? All
| of the things that you described that people overcame are
| actual symptoms of depression.
|
| Or maybe to abuse another analogy--everyone I know who
| got over chicken pox stopped getting those pustules. That
| doesn't make "stop getting pustules" actionable advice!
| bwood wrote:
| 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 wrote:
| 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.
| standardly wrote:
| " _I_ think depression is _really_ caused by X, and anti-
| depressants are really just a placebo "
|
| It's tough to quantify the efficacy of AD's, especially given the
| differences in individual neurochemistry, but claiming they don't
| work at all, or that depression isn't even real, is plain
| ignorant.
|
| Everyone should be forced to watch Dr. Sapolsky's lecture before
| commenting on depression:
| https://www.youtube.com/watch?v=NOAgplgTxfc
| VLM wrote:
| There's two separate medical systems, one focused on making money
| and boosting financials where science does not matter, and the
| other focused on medical science where at least theoretically the
| financials do no not matter.
|
| Its up to the end user to figure out which system they're
| interfacing with and act accordingly. Hint, antidepressants make
| a lot of money for the correct people... People who make
| treatment decisions based on financials and kickbacks are not
| going to care about all this "science" and "logic" and
| "statistics" stuff where their wallet is concerned.
| jugg1es wrote:
| I understand where your cynicism comes from but I think it
| might be overblown in this case. These drugs do help people and
| psychiatrists want to help. The fact is that we just don't know
| that much about how higher cognition works. I have a
| neurobiology degree and was very surprised how little we
| actually know.
|
| We don't know how to really measure things like depression, so
| we rely on animal models and medieval tests such as "Lets throw
| this mouse into a bucket and see how long it takes for it to
| give up treading water".
|
| When we are able to take 'in situ' measures in a live person
| without risking their life, we may start to make progress on
| better treatments.
| SkyPuncher wrote:
| > People who make treatment decisions based on financials and
| kickbacks are not going to care about all this "science" and
| "logic" and "statistics" stuff where their wallet is concerned.
|
| Can you elaborate on who these people are? You're casting a
| wide net here.
|
| My partner works in mental health. The reality I've observed is
| mental health is incredibly challenging. Much of it is highly
| situational and requires hours and hours of extremely time
| consuming, labor intensive therapy to even begin creating a
| meaningful treatment plan. If mental health had unlimited time,
| many providers would love to be able to provide this level of
| care.
|
| In practice, medications are a highly cost-effective means of
| improving people's mental health. They can increase people's
| baseline significantly with therapy (time and cost) focusing on
| rounding out the rough parts. Many patients are not interested
| in the therapy component if they can get "80%" better with some
| medication.
|
| IMO, this is why we're seeing such a boom in "pill mill" mental
| health startups. A large portion of the affected population is
| content being "mostly better, quickly" rather than "fully
| better, slower".
| d0mine wrote:
| > medications are highly cost/effective..
|
| You are commenting on the article that says that it is BS.
| The most upvoted comment on the article at the moment says
| "it [the ineffectiveness] is old news hardly worth
| mentioning"
| SkyPuncher wrote:
| No, the article does not say this is BS. The article is
| about a specific theory on anti-depressants. Not about
| their ineffectiveness as a whole.
|
| > Antidepressants are an effective, NICE recommended
| treatment for depression
|
| This fact remains. It's pretty well known in medicine that
| we don't really know why anti-depressants work, but they
| do. Different people react differently to different
| versions.
|
| This article is simply stating that the original "simple"
| theory of "low serotonin" is not sufficient to explain
| depression.
| d0mine wrote:
| Last time I've looked into it in any detail, there were
| tendency for any effectiveness to vanish in repeated
| studies (indistinguishable from placebo).
| roody15 wrote:
| Think we have known this for a while. For example Wellbutrin
| (Bupropion) works well for many people and it doesn't work on
| serotonin levels at all. In fact it causes an increase of
| dopamine uptake in the brain.
|
| Think increasing the dopamine levels causes a variety of changes
| to complex systems in the brain that are not really fully
| understood.
|
| SSRi's also cause changes to underlying systems in the brain that
| are not as simple as you are "low" on serotonin.
|
| My two cents
| y-c-o-m-b wrote:
| I'm on Wellbutrin (lowest dose) and it works great. I have no
| side effects whatsoever. Been on it since 2019. It's kept my
| depression in check and even helps with my ADHD a little. They
| say you can't drink alcohol with it, but I binge drink every
| weekend (I _really_ love alcohol) with no problems.
|
| SSRIs were an absolute train-wreck to be on; they made me angry
| and violent. I was on them for 10 years and I honestly don't
| believe it ever helped against depression. If I missed 1 day,
| I'd get the infamous "brain zaps". It took me about 3 months to
| taper off the damn things and it was a brutal 3 months. The
| last one was in October 2012 and I will never take them again.
| I did not experience any increase in depression either, so that
| makes a stronger case for them basically be worthless for me.
| pizzathyme wrote:
| Based on this, can anyone explain what treatment should be
| pursued if they are suffering with debilitating depression? I
| have a family member on SSRIs and therapy.
| gillytech wrote:
| I'm seeing a lot of measured and thoughtful comments in this
| thread. Unfortunately I don't think we can "science" our way out
| of depression. Especially since these drugs have an inexorable
| link to violence and suicide. Here's plenty of documented proof:
|
| https://www.cchrint.org/pdfs/violence-report.pdf
| jahewson wrote:
| The document you've linked to is whacky propaganda from the
| Church of Scientology.
| gillytech wrote:
| There's nothing but claims backed by facts in that document.
| Your _ad hominem_ attack is not a valid argument.
| InfiniteRand wrote:
| In a lot of ways the study of mental illness is like the war
| against cancer, you can expect perpetual expectations of miracle
| cures being made while slow progress happens in the background
| and major reverses of assumptions sporadically occur, and
| therapeutically specific variants make big progress while the
| majority of the disease is treated by blunt tools which do offer
| some help but at a considerable cost
| hirvi74 wrote:
| Same with Alzheimers. We finally have medications to remove the
| plaques of tau proteins, and... it didn't do shit.
| [deleted]
| [deleted]
| fithisux wrote:
| Like Vitamin D? Just take your pills and make us rich? If you
| don't get better is because you need more pills.
|
| Legal substitutions
|
| Pills <-> Credit Cards <-> Vaccines <-> Supplements <->
| Technocrats <-> Religion
| Uptrenda wrote:
| There are many people who are anti-psychiatry who would probably
| still benefit immensely from treatment. My worry is that such
| people will look at this and say: "see look, the psychiatrists
| got it wrong. I was right to question treatment all along; Anti-
| depressants don't work." But the message here isn't that SSRIs
| don't work for depression. It's that depression is a complex
| illness and can't be reduced to a single chemical deficiency.
|
| Anti-depressants mechanism of action is more complex than
| 'corrects a chemical deficiency.' I hope such people considering
| treatment know that while theories may change as we learn more:
| medications still have to be evaluated against real-world
| results. So the effectiveness of a drug remains the same.
| KennyBlanken wrote:
| It's less a specific study and more that almost none of their
| research is reproducible and there have been a number of
| serious breaches of trust, like Prozac being widely prescribed
| to kids and turning out to be horrifically bad for them.
| tyronehed wrote:
| jonnycomputer wrote:
| Some expert reactions to paper:
|
| https://www.sciencemediacentre.org/expert-reaction-to-a-revi...
| Arubis wrote:
| So...why do SSRI users self-report efficacy?
| BrianOnHN wrote:
| Correlation isn't causation. The serotonin effect may be a
| symptom of the depression. Treating symptoms is sufficient
| intervention for many.
| carabiner wrote:
| https://en.wikipedia.org/wiki/Placebo
| kennywinker wrote:
| When they test drugs, they test them against a placebo.
| [deleted]
| hackerlight wrote:
| Yes, but according to Irving Kirsch, the benefit of anti-
| depressants above placebo is very small for anyone who
| isn't severely depressed, and the observed small effects
| can plausibly be explained by patients unblinding
| themselves (due to the presence of other side effects in
| the treatment group), or by things like publication bias.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
| rando14775 wrote:
| I'll add that side effects alone can influence depression
| scores. Any medication that de- or increases sleepyness
| will change the score of any questionaire when taken at
| the appropriate time of day.
| [deleted]
| copperx wrote:
| In my case, at this very moment, I'm going through
| antidepressant withdrawal and have random crying spells.
| Sure, depression might not be mediated by serotonin, but
| these drugs have an effect on mood. It might be that there's
| a different mechanism of action.
| nvrspyx wrote:
| My guess, without digging into the study itself since I'm on
| mobile, is that there is no singular cause for depression.
| Rather, depression is simply a symptom of a wide range of
| causes, with one possible cause being low serotonin (or a
| reduced sensitivity to it). Or even, low serotonin is a symptom
| of the depression.
|
| Not all patients with depression find relief from SSRIs, or
| medications in general, but some certainly do.
| patmorgan23 wrote:
| It could even be that increasing serotonin is helps improve
| the patients mood and break thought patterns/cycles than kept
| them in their depression.
| lumost wrote:
| It could be that _any_ forced cognitive pattern change
| would have the same effect.
|
| Double blind trials are hard, double blind comparative
| trials are more or less impossible.
| klodolph wrote:
| The mechanism of SSRIs is not well-described as "increase
| serotonin".
| simonsarris wrote:
| If we don't understand the mechanism of action it can still
| cause an effect. After all SSRIs certainly cause plenty of
| other side effects.
| raphlinus wrote:
| It might be a different mechanism, like brain-derived
| neurotrophic factor[1].
|
| [1]: https://www.science.org/content/blog-post/how-
| antidepressant...
| [deleted]
| JaceLightning wrote:
| It's mostly a placebo
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/
| PragmaticPulp wrote:
| Because psychiatric drugs don't necessarily work by
| counteracting specific deficits in the brain. That's a myth
| driven by unfortunate marketing campaigns and surface-level
| misunderstandings of the science.
|
| This makes intuitive sense to people when discussing other
| topics. For example, when someone is in pain they don't need to
| have an "endogenous opioid deficiency" for opioid painkillers
| to alleviate their pain. They're just in pain, and modulating
| the opioid system with drugs is one way we can reduce that
| pain. Or COX-2 inhibitors. Or a number of other substances.
|
| Likewise, modulating the serotonin system with SSRIs is one way
| we can modulate depression symptoms. People don't need to have
| a "serotonin deficiency" to see benefits from modulating their
| serotonin system.
| biophysboy wrote:
| Depression has no common cause or common set of symptoms. I
| read a paper that likened it to a watershed, with tributaries
| feeding into a general pool of malaise. The watershed varies
| from person to person, and affects their internal "ecosystem"
| differently.
|
| Maybe it's a bit cute, but with this understanding, I think the
| headline is not shocking. We will never find the one cause of
| depression because there isn't one.
|
| In my opinion, our best bet is more personalized medicine:
| helping people identify which rivers are filling up their lake
| of depression. For most people it will be a weighted
| combination of many things, but I think there will usually be
| some principal components.
| frazbin wrote:
| The test to see how depressed a lab mouse is, is to put it in
| a bucket of water and see how long it struggles. True story.
| kortex wrote:
| One of them is, yes. There are several, and basically all
| of them are some variant of "how resistant to giving into
| despair are you? (as a rat)". Forced swim, tail suspension,
| light/dark exploration activity. Kinda dark, but this
| research saves lives, and depression is notoriously hard to
| study objectively.
| WalterSear wrote:
| > ...two recent meta-analyses question this picture. The first
| meta-analysis used data that were submitted to FDA for the
| approval of 12 antidepressant drugs. While only half of these
| trials had formally significant effectiveness, published
| reports almost ubiquitously claimed significant results.
| "Negative" trials were either left unpublished or were
| distorted to present "positive" results. The average benefit of
| these drugs based on the FDA data was of small magnitude, while
| the published literature suggested larger benefits.
|
| > ...A second meta-analysis using also FDA-submitted data
| examined the relationship between treatment effect and baseline
| severity of depression. Drug-placebo differences increased with
| increasing baseline severity and the difference became large
| enough to be clinically important only in the very small
| minority of patient populations with severe major depression.
| In severe major depression, antidepressants did not become more
| effective, simply placebo lost effectiveness.
|
| > These data suggest that antidepressants may be less effective
| than their wide marketing suggests. Short-term benefits are
| small and long-term balance of benefits and harms is
| understudied.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/
| sidcool wrote:
| I am torn between two schools of thought on depression and
| anxiety. Some say it is a purely biochemical issue. Others say
| it's more of a psychological one and can be addressed with
| therapy and exercise alone.
| padolsey wrote:
| Why not both? We always seem to try to dichotomize and
| categorize incredibly complex systems for some reason. Surely
| there are many components to the symptom clusters of depression
| and anxiety. Life circumstances can matter, exercise can
| matter, neurological dispositions can matter. All at once.
| tus666 wrote:
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