[HN Gopher] Vitamin D and Omega-3 have a larger effect on depres...
       ___________________________________________________________________
        
       Vitamin D and Omega-3 have a larger effect on depression than
       antidepressants
        
       Author : mijailt
       Score  : 815 points
       Date   : 2026-01-29 10:35 UTC (12 hours ago)
        
 (HTM) web link (blog.ncase.me)
 (TXT) w3m dump (blog.ncase.me)
        
       | vegancap wrote:
       | I found this to be the case. Tried Sertraline for a while, gave
       | me headaches and made me feel sick. Then as part of a new gym
       | plan, started taking Omega 3+VitD daily, and I just felt a sense
       | of calm and peace after a few weeks. The massive uptick in
       | exercise probably also helped. I also felt quite an extreme
       | uptick because I was a vegan for 10 years, and found out I had
       | basically zero Omega 3 in my blood. I suspect one of the main
       | reasons my mental health declined was due to the lack of Omega 3.
       | 
       | Disclaimer, not saying vegans should stop being vegans, just make
       | sure you find a good supplement, and make sure you understand the
       | difference between EPA/DHA Omega 3.
        
         | dvh wrote:
         | > as part of a new gym plan
         | 
         | There's your answer
        
           | vegancap wrote:
           | Possibly, deffo would have been a big factor. Anecdotally
           | though, I forgot to take these supplements for a while
           | recently, just got out of the habit, and definitely felt
           | worse again for a bit. But, could have been a
           | coincidence/something else
        
         | serpix wrote:
         | Omega 3 comes from algae, which might be okay for some vegans.
        
           | hshdhdhj4444 wrote:
           | What vegans would not be ok with algae?
        
             | buddhistdude wrote:
             | algerians
        
               | Kichererbsen wrote:
               | @buddhistdude - thank you :) made my day!
        
           | tefkah wrote:
           | Unlikely any vegan would have any moral qualms about algae,
           | given that they're not animals. Maybe you were thinking of
           | oysters/clams/bivalves?
        
           | quietbritishjim wrote:
           | I think they meant their vegan diet didn't naturally have
           | Omega 3 in it if they didn't take supplements; not that they
           | couldn't take the supplements once they realised it.
        
           | augusto-moura wrote:
           | Or fish oil
        
           | vegancap wrote:
           | Yeah I took that for a while, and did slightly improve
           | things. Only problem I had at the time was those were super
           | expensive in the UK. Maybe that's changed now
        
         | hshdhdhj4444 wrote:
         | All my nutrient numbers improved when I became vegan because
         | nearly every one in the US/UK is deficient in VitD, Omegas and
         | B12.
         | 
         | Fortunately today's vegan communities are much more aware of
         | this so I started taking these supplements right up front and
         | all my blood markers improved dramatically since when I
         | consumed meat/dairy.
         | 
         | It's annoying to hear some push back against this when it's as
         | simple as taking relatively safe supplements (just make sure
         | you talk to a doctor, and not a social media influencer, about
         | how much you should take, and if you get a chance to regularly
         | check your bloodwork don't miss out).
        
           | johnisgood wrote:
           | Why did you become a vegan if apparently even non-vegans are
           | deficient in B12? Do you supplement B12? Since B12 is mainly
           | found in meat, and B12 deficiency is irreversible.
        
             | tefkah wrote:
             | why do you think the reason for them becoming vegan has
             | something to do with B12 levels? likely they became vegan
             | for different reasons, became much more aware of the
             | importance of B12 and started taking a supplement.
             | 
             | every vegan should supplement b12, so they probably do too
        
               | johnisgood wrote:
               | > All my nutrient numbers improved when I became vegan
               | because nearly every one in the US/UK is deficient in
               | VitD, Omegas and B12.
        
               | pseudalopex wrote:
               | > Fortunately today's vegan communities are much more
               | aware of this so I started taking these supplements right
               | up front and all my blood markers improved dramatically
               | since when I consumed meat/dairy.
        
               | johnisgood wrote:
               | Yeah but that sentence does not refer to why the person
               | switched to being vegan, the first one does. In any case,
               | let us not beat the dead horse there. :P Supplement B12
               | and it is fine.
        
           | vegancap wrote:
           | My cholesterol improved massively, but over time, a few, such
           | as Omega 3 suffered. But those were ultimately my own fault,
           | wasn't managing it properly. So, I'm absolutely not
           | suggesting there's an issue with veganism, this isn't really
           | why I fell out of it. So I do want to stress I wasn't
           | suggesting people should steer clear of Veganism, just
           | something to be mindful of. Oh, and my cholesterol
           | immediately shot back up again when I stopped being a vegan.
           | So, swings and roundabouts with every diet/lifestyle, I
           | guess!
        
         | brushfoot wrote:
         | > I was a vegan for 10 years, and found out I had basically
         | zero Omega 3 in my blood
         | 
         | I see your disclaimer, but just for more context, vegans can
         | get Omega 3 without taking pills per se. Flax seeds are an
         | excellent source. I often add a spoonful to a bowl of oatmeal
         | or as a pancake topping along with fruit sauce and granola.
        
           | pydry wrote:
           | Flaxseeds are probably the most flavorless things I've ever
           | tasted.
           | 
           | Chia seeds taste ok but you need to prep them by soaking
           | which is a pain (or experience bloating).
           | 
           | All other seeds have more omega 6 than omega 3.
        
             | grvdrm wrote:
             | Funny - I feel the opposite about chia. Soaked and plumped
             | is when I hate them. Dry on salads/etc. or just submerged
             | in an active bowl I'm eating is when I like them most - the
             | crunch adds texture to what I'm eating.
        
           | canucker2016 wrote:
           | Grind the flaxseed before eating them so your digestive
           | system can access more of the nutrients in flaxseeds.
           | 
           | from https://www.bhf.org.uk/informationsupport/heart-matters-
           | maga... :                 Eating ground flax seeds gives you
           | more benefits than whole seeds, as whole seeds remain
           | undigested and pass through the system.
           | 
           | from https://www.peoplespharmacy.com/articles/must-you-grind-
           | flax...                 Most people can't chew flaxseeds
           | effectively, so they grind them first or swallow them whole.
           | (They are tiny.) Nutrition experts do recommend grinding them
           | first to release the fiber and the beneficial fatty acids.
           | Flaxseeds are helpful for constipation and may lower
           | cholesterol as well.            Ground flaxseed goes rancid
           | easily, however, so it should be kept in the freezer until
           | you are ready to use it. If you buy it ground, you wouldn't
           | have to use the blender or coffee grinder to break those
           | seeds up before you have breakfast.
        
           | mistercow wrote:
           | Flax seeds are a very tedious and inefficient way to get
           | omega-3 as a vegan, particularly because they contain ALA, a
           | short chain omega-3, which our bodies are extremely
           | inefficient at turning into long chain fatty acids.
           | 
           | Just get an algae oil based DHA+EPA supplement.
        
           | the_pwner224 wrote:
           | Flax seeds & other seeds provide ALA but not EPA & DHA. You
           | need all 3.
           | 
           | The body has some ability to convert ALA to EPA & DHA, but at
           | extremely low rates (particularly for DHA) - it's not a
           | consideration in practice.
           | 
           | So no, eating seeds will not fulfill your body's
           | requirements.
        
         | Aurornis wrote:
         | > Then as part of a new gym plan, started taking Omega 3+VitD
         | daily, and I just felt a sense of calm and peace after a few
         | weeks. The massive uptick in exercise probably also helped
         | 
         | I would bet that 95% of that improvement or more was due to the
         | exercise.
         | 
         | Your anecdote is common: People start taking Vitamin D or fish
         | oil as part of a bigger plan to have a healthier lifestyle and
         | then they attribute success to the pills, not the lifestyle
         | changes.
        
           | vegancap wrote:
           | Possibly, but anecdotally, I went through a period of
           | forgetting to take them again recently, and definitely felt
           | worse again. Sleep started suffering, felt lower energy
           | again. But, could have been a coincidence/something else
           | entirely
        
           | seba_dos1 wrote:
           | I wouldn't bet so eagerly on these lifestyle changes being
           | achievable without these pills.
        
       | brushfoot wrote:
       | And better than taking pills for the former, add hemp hearts or
       | flax seeds to your cereal. One serving of hemp hearts has 10
       | grams of protein and 12 grams of Omegas 3 and 6. Flax seeds are
       | lower in protein but an even better source of Omega 3 in
       | particular.
        
         | cube2222 wrote:
         | I'm not an expert, but I've done a bunch of reading on this
         | previously, and also skimmed the article which also mentions
         | some parts of this.
         | 
         | First, when taking omega 3 supplements, you generally care
         | about increasing the ratio of omega 3 to omega 6. Hemp hearts
         | have much more omega 6 than omega 3, so they're not very
         | effective for improving the ratio.
         | 
         | Second, hemp hearts contain ALA, while what you generally want
         | to improve is EPA and DHA (this is also covered in TFA). The
         | body can convert ALA to EPA and DHA, but it's not efficient.
         | 
         | So all in all, if Omega 3 for the article's stated benefits is
         | what you want, this is not the way. I recommend looking into
         | eating more fish, or if you want a vegan route, algae-based
         | supplements. [0] is a decent source from the NIH about foods
         | and their Omega 3 content, split by ALA/EPA/DHA.
         | 
         | [0]: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-
         | HealthPro...
        
           | brushfoot wrote:
           | The ratio of Omega 6 to 3 needs to be below 4:1 to be a good
           | source of Omega 3, and hemp hearts are at 3:1, so they're
           | listed as a good source of Omega 3.
           | 
           | Flax seeds are even better just for Omega 3 at 1:3, but hemp
           | hearts have other benefits, like more protein, which is why I
           | called them out. That said, I eat a fair amount of flax seeds
           | as well.
        
             | cube2222 wrote:
             | Just to reiterate, both of those (hemp hearts and flaxseed)
             | only contain ALA, while what you're generally looking for
             | is EPA and DHA. TFA also explicitly mentions it's only
             | talking about EPA.
             | 
             | This is not to say that they're unhealthy of course.
             | 
             | EDIT: see the sibling comment by code_biologist, it's much
             | more comprehensive than what I've written.
        
               | brushfoot wrote:
               | Your body converts ALA into EPA and DHA, however, so
               | plants are fine sources of both.
        
         | code_biologist wrote:
         | Never going to advocate against eating whole foods if they
         | taste good! But beware, the ALA omega 3 fat in flax and plant
         | sources is not the DHA and EPA omega 3 fats used by animal
         | cells, and so it's not as potent as what's in fish.
         | 
         |  _The main problem with ALA is that to have the good effects
         | attributed to omega-3s, it must be converted by a limited
         | supply of enzymes into EPA and DHA. As a result, only a small
         | fraction of it has omega-3 's effects -- 10%-15%, maybe less.
         | The remaining 85%-90% gets burned up as energy or metabolized
         | in other ways. So in terms of omega-3 "power," a tablespoon of
         | flaxseed oil is worth about 700 milligrams (mg) of EPA and DHA.
         | That's still more than the 300 mg of EPA and DHA in many 1-gram
         | fish oil capsules, but far less than what the 7 grams listed on
         | the label might imply._
         | 
         | https://www.health.harvard.edu/heart-health/why-not-flaxseed...
         | 
         | Also, beware of omega 6 fats. Seed oils (corn, soy, canola)
         | used in commercial food products are incredibly omega 6
         | dominant in terms of polyunsaturated fat content. Consequently,
         | the ratio of omega 3 to omega 6 fats we consume has plummeted
         | as food production has industrialized. Omega 3 fats are
         | precursors to generally anti-inflammatory signaling compounds,
         | whereas omega 6 fats are precursors to pro-inflammatory
         | signaling compounds. The bias in fat intake leads to more pro-
         | inflammatory signaling in the body, and a lot of alt health
         | types have alleged this is a major causative factor in the
         | obesity epidemic.
         | 
         | This is important for depression, because chronic brain
         | inflammation as a cause of depression was one of the going
         | hypotheses at least a decade ago when I last looked into all of
         | this. Upping omega 3 intake is an intervention that can address
         | chronic inflammation, which is potentially why it improves some
         | cases of depression.
         | 
         | Pretty much nobody in the west needs more omega 6s these days.
         | I hear even farmed salmon eat primarily corn and soy based
         | feeds these days, meaning their fat ratio is skewed much more
         | heavily toward omega 6 than wild salmon and fish.
        
       | r1ch wrote:
       | Please do not take 5000mg/day of Vitamin D. The author confuses
       | IU and mg which is very dangerous.
        
         | Aldipower wrote:
         | That would be 5g. At this point everyone should notice that
         | something is off. :-D 5000 mg of vitamin D3 = 200,000,000 IU
         | (200 million IU)
        
           | xi_studio wrote:
           | More often written as 200,000 IU as 5000mg of D3 is not
           | written as 5,000,000mcg
           | 
           | The author simply (and terrible mistaking) typed [mg] instead
           | of [UI] in the first paragraph: if readed entirely, the
           | author correct this typo in every other sentence
        
             | Xunjin wrote:
             | Still it needs proof reading and definitely a BIG WARNING
             | that anyone who reads the article should first talk with
             | their doctor before trying any "recommendations". Some of
             | these "recommendations" could literally kill someone.
        
               | hermannj314 wrote:
               | I bought the once weekly 50,000IU bottle on Amazon and am
               | currently taking 4 a day and I am ignoring all growing
               | signs of vitamin D toxicity because I read this guys blog
               | and never once ever decided to consult another source,
               | including later paragraphs in that same blog because
               | there was no warning. Without a warning, you should
               | blindly follow all medical advice you read online.
               | 
               | That is that pathway to death you are worried about?
        
               | deltoidmaximus wrote:
               | I was going to say, wouldn't following through on this
               | mistake require you to not just spend a ton of money on
               | pills but also take tons of them a day? I'd like to think
               | this would give even the dumbest of people pause just
               | because of the practicality aspect.
        
               | fc417fc802 wrote:
               | You might be surprised. Medical journals that specialize
               | in reporting one-off cases have some wild articles.
        
           | amai wrote:
           | Why didn't the author notice? AI slop?
        
             | dec0dedab0de wrote:
             | doctors prescribe vitamins in MG, but they're sold in IU.
             | It's an easy mistake to make.
        
           | AdamN wrote:
           | People don't always realize:
           | https://www.chemistryworld.com/news/university-fined-in-
           | caff...
        
             | ndarray wrote:
             | Wow that must be hell
        
         | cloudhead wrote:
         | So 5000 IU is the recommended amount?
        
           | Liquix wrote:
           | 5000 IU is very high, might be beneficial during the winter
           | for folks with very fair skin. but most probably shouldn't
           | take that much every day
        
             | HPsquared wrote:
             | That's equivalent to about 10 minutes of sun exposure. Not
             | very much when you look at it that way.
        
               | zelphirkalt wrote:
               | That comparison doesn't work. Only 10-20% of the vitamin
               | D we intake is delivered through food and the body cannot
               | process more sourcing from food. Even if you take more
               | you will not benefit in an unlimited way, processing
               | more. The skin is much better at generating/making/doing
               | it.
        
               | smallerfish wrote:
               | The skin is definitely much better, but a higher than
               | "recommended" dose is definitely (anecdata) effective at
               | bringing up and maintaining the measureable Vitamin D3
               | level in your blood if you are under the recommended
               | range. It's an important metric to track in your regular
               | blood tests.
        
             | graemep wrote:
             | I think you mean for those with very dark skin, not fair?
        
             | bloak wrote:
             | You mean very dark skin?
             | 
             | It's my understanding that northern Europeans evolved fair
             | skin in order to cope with the lack of vitamin D in their
             | diet.
        
               | Liquix wrote:
               | yes, i had it backwards - thanks for the correction.
        
             | Flatterer3544 wrote:
             | You got it backwards, it would be more beneficial in areas
             | with few hours of sun for darker skin folks, since they do
             | not absorb as much Vitamin D as fair skin folk do.
        
               | cies wrote:
               | absorb or create?
               | 
               | i understand it as: absorbing is in the intestine,
               | generating D happens in the skin when exposed to the sun
        
           | zelphirkalt wrote:
           | According to what I read in a newspaper article, the
           | recommended dose is much lower, at 800.
        
             | moritzwarhier wrote:
             | According to the internet, it is way higher, probably over
             | 9000.
             | 
             | Edit because the comment might be to shallow for HN: I
             | sympathize with the struggle against depression and, after
             | first-hand experience, share the skepticism against the
             | widespread prescription of antidepressants and the methods
             | of evidence presented for it.
             | 
             | Very serious and important topic.
             | 
             | Regarding Vitamin D, I am also supplementing in the Winter,
             | but I have not read the article, which says it has an
             | estimated reading time > 10min. I use one 1000IE (0.025mg
             | according to the package) tablet a day max.
             | 
             | I'll bookmark this discussion page to read TFA later maybe.
        
               | voisin wrote:
               | It's important to take Vitamin D, as a fat soluble
               | vitamin, with dietary fat during a meal. Something about
               | bile production and absorption.
               | 
               | Also important to take it with Vitamin K.
        
               | moritzwarhier wrote:
               | Yes, I remember that and have Vitamin D+K combo tablets
               | with calcium.
               | 
               | Seems like it would be best to increase time spent
               | outdoors though.
        
               | energy123 wrote:
               | There's likely significant individual variation in
               | bioavailability. I would start with 2-5K/day, then
               | measure and iterate.
        
           | lossolo wrote:
           | I was taking 2x2000 IU with almost no sun exposure and then
           | did bloodwork. My level was 77.8 ng/mL. The lab's reference
           | ranges listed 30-50 ng/mL as optimal, 50-100 as high, over
           | 100 as potentially toxic, and over 200 as toxic.
        
             | dns_snek wrote:
             | I don't know why this is downvoted, I had a very similar
             | experience a while back. I took 4000 IU/day for about 4
             | months, insignificant sun exposure and ended up at 60 ng/mL
             | (lab listed normal range as 30-40).
             | 
             | My starting levels were unknown but I assumed they were low
             | given my usual sun exposure and some low-energy symptoms
             | (which resolved a couple of weeks after I started taking
             | it). I discontinued VitD then and now I only take 1000
             | IU/day in the winter.
        
           | johnisgood wrote:
           | It depends. I have MS and I take 10k IU. My cousin who also
           | has MS takes 20k but gets regular blood tests for it.
        
           | neRok wrote:
           | This was linked on here a couple of months ago: [The Big
           | Vitamin D Mistake
           | [2017]](https://pmc.ncbi.nlm.nih.gov/articles/PMC5541280/)
           | 
           | > A statistical error in the estimation of the recommended
           | dietary allowance (RDA) for vitamin D was recently
           | discovered; in a correct analysis of the data used by the
           | Institute of Medicine, it was found that 8895 IU/d was needed
           | for 97.5% of individuals to achieve values >=50 nmol/L.
           | Another study confirmed that 6201 IU/d was needed to achieve
           | 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L.
           | 
           | > This could lead to a recommendation of 1000 IU for children
           | <1 year on enriched formula and 1500 IU for breastfed
           | children older than 6 months, 3000 IU for children >1 year of
           | age, and around 8000 IU for young adults and thereafter.
           | Actions are urgently needed to protect the global population
           | from vitamin D deficiency.
           | 
           | > ...
           | 
           | > Since 10 000 IU/d is needed to achieve 100 nmol/L [9],
           | except for individuals with vitamin D hypersensitivity, and
           | since there is no evidence of adverse effects associated with
           | serum 25(OH)D levels <140 nmol/L, leaving a considerable
           | margin of safety for efforts to raise the population-wide
           | concentration to around 100 nmol/L, the doses we propose
           | could be used to reach the level of 75 nmol/L or preferably
           | 100 nmol/L.
        
             | js2 wrote:
             | Multiple previous discussions:
             | 
             | https://hn.algolia.com/?q=vitamin+d+mistake
             | 
             | Vitamin D is a favorite topic around here:
             | 
             | https://hn.algolia.com/?q=vitamin+d
        
           | maximedupre wrote:
           | With K3! Otherwise you're fucking yourself up.
        
             | sowbug wrote:
             | Oh dear, here we go again.
             | 
             | IU, not mg.
             | 
             | K2, not K3.
        
         | consp wrote:
         | Isn't the oral intake pretty much negligible anyway? I remember
         | getting a vitamin d supplement in a syringe (to be put on
         | bread, from a physician) containing a very large dosis.
         | 
         | I'm not stating the dosage is wrong. Looks like it is anyway.
        
           | moritzwarhier wrote:
           | It is easily possible to overdose on oral Vitamin D tablets
           | and damage your body.
        
             | voisin wrote:
             | Source? There have been many articles on HN showing the RDA
             | to be ~10x too low (something like 5,000 IU) and that the
             | daily safety limit to be significantly higher than that
             | (something like 30,000 IU).
             | 
             | Edit: for clarity I am not saying it is impossible to
             | overdose on oral tablets, but rather that with most tablets
             | 400 IU to 1000 IU and the safe limit so much higher than
             | these, it seems like it would be extremely unlikely for
             | someone to be taking 30+ tablets daily. Not impossible, but
             | not easy either.
        
               | perching_aix wrote:
               | That's a bit of a non-sequitur, isn't it? The debated
               | point is how oral intake as a delivery method can pan out
               | specifically (and _its_ limits), not the dosage limits of
               | Vitamin D in general. Think consuming a drug vs injecting
               | it.
        
               | moritzwarhier wrote:
               | > Source? There have been many articles on HN showing the
               | RDA to be ~10x too low (something like 5,000 IU) and that
               | the daily safety limit to be significantly higher than
               | that (something like 30,000 IU).
               | 
               | First: the RDA and the safety limit are not the same, and
               | an RDA in a country being too low does not mean that the
               | maximum safe dose is wrong.
               | 
               | And it certainly does not mean that there is a higher
               | risk in under-dosing than overdosing when taking the RDA
               | (which already includes recommendations for supplementing
               | if you spend most of your time indoors).
               | 
               | I'm not a scientist, so I only know what physicians told
               | me and what's explained in news publications or by
               | consumer advocacy non-profits.
               | 
               | Here are a study (which I didn't read) and the NHS's
               | advise on Vitamin D toxicity:
               | 
               | https://www.ncbi.nlm.nih.gov/books/NBK557876/
               | 
               | https://www.nhs.uk/conditions/vitamins-and-
               | minerals/vitamin-...
               | 
               | The study says:
               | 
               | > Most cases of vitamin D toxicity resolve without
               | serious complications or sequelae. However, in some
               | instances, severe hypercalcemia can lead to acute renal
               | failure requiring hemodialysis. Cases of permanent renal
               | damage due to vitamin D toxicity are rare.
               | 
               | Which sounds good, but I don't think it supports that
               | there is no risk of oral Vitamin D overdose.
        
               | neRok wrote:
               | The first link makes the problem sound like it can happen
               | to anyone, but then when you tease out the details;
               | 
               | * Toxicity resulting from lack of monitoring is
               | frequently seen in patients requiring high doses to treat
               | ailments like osteoporosis, renal osteodystrophy,
               | psoriasis, gastric bypass surgery, celiac, or
               | inflammatory bowel disease.
               | 
               | * Patients who are on high doses of Vitamin D and taking
               | inadvertently increased amounts of highly fortified milk
               | are also at increased risk for vitamin D toxicity.
               | 
               | * According to the latest report from America's Poison
               | Centers (APC), there were 11,718 cases of vitamin D
               | exposure recorded in the National Poison Data System.
               | More than half of these cases were in children younger
               | than 5 years.
               | 
               | * The clinical signs and symptoms of vitamin D toxicity
               | manifest from hypercalcemia's effects.
               | 
               | * Clinical management of vitamin D toxicity is mainly
               | supportive and focuses on lowering calcium levels.
               | 
               | * Isotonic saline should be used to correct dehydration
               | and increase renal calcium clearance.
               | 
               | A lot of those point to people drinking too much milk!
               | (enriched milk)
               | 
               | * People with osteoporosis thinking "I better drink more
               | milk for strong bones" when they are already on
               | supplements/medicine.
               | 
               | * Kids drinking lots of milk and presumably not drinking
               | any water - hence the dehydration.
               | 
               | PS: There are a lot of people out there that don't drink
               | any water, and stick to juice or milk or soda, etc. They
               | are not always fat, but that doesn't mean they don't have
               | issues.
        
               | moritzwarhier wrote:
               | I've read the article by now and I like it. It's
               | balanced, more so than the comment section made me think.
               | 
               | And my takeaway is not that everyone should be taking 10k
               | IE, but it's a great reminder to be more consistent in
               | taking my Vitamin capsules in winter.
               | 
               | I'm still standing by my point that it's "easy" to
               | overdose on Vitamin D. Like the article already mentions,
               | one should remember possible kidney issues and not take
               | insane doses of it.
               | 
               | What the recommended daily intake should be, I don't
               | know.
               | 
               | The whole reason I'm commenting on this is I used to take
               | one of the "top" antidepressants on this list.
               | 
               | And I am a skeptic of antidepressants, that doesn't mean
               | I deny all positive effects in people who are prescribed
               | them, of course.
               | 
               | For what it's worth, it's also easy to overdose on
               | Venlafaxine. It's still considered safe.
               | 
               | Just an example to make clear that my comment was not a
               | critique of taking Vitamin D in general.
               | 
               | I don't find the article's main point surprising though.
               | That's the reason I'm taking Vitamin D, too. Doesn't mean
               | that it's impossible to overdose, and this point is also
               | important, because many people still think that it would
               | be impossible to take too much of an vitamin or mineral.
               | Thankfully, high-dose Vitamin A / retinol supplements are
               | not as widespread.
        
               | ifwinterco wrote:
               | Why would you not be able to overdose orally? It's not
               | like it stops absorbing past a certain dose, and there is
               | such a thing as too much (especially if vitamin k2 is
               | lacking)
        
               | bulbar wrote:
               | I do know somebody taking way more than 30k/day though.
               | 
               | Seems to be a thing in conspiracy theories "they try to
               | hide those simple tricks from you (drinking bleach,
               | ivamectin, 100k D3, ...)
        
               | seba_dos1 wrote:
               | It may not be that crazy in fact, unless it's prolonged.
               | Don't take 30k/day for several months without
               | supervision, but doing that for a single month is
               | unlikely to harm you if you start from deficiency. Some
               | people may need even more than that.
               | 
               | In any case, keep your blood levels in check. It's cheap
               | and easy. There are even services you can order to have
               | your blood sample taken at your home.
        
             | ndr wrote:
             | I would say it's almost impossible with typical packaging.
             | What makes it easy?
        
           | abelitoo wrote:
           | Oral has felt very effective for me. I take a daily
           | supplement that has roughly 100% of the recommended daily
           | dose of everything. I split it in half.
           | 
           | For D3, it is 25mcg / 1000 IU / 125%
           | 
           | After splitting in half it's 12.5 mcg / 500 IU / 62.5%.
           | 
           | I take with some fat-containing food to allow ir to absorb
           | which is usually breakfast (yogurt, some nuts, some kind of
           | fruit, oats), and it's a night and day difference in my mood
           | (how easily I can control my temper if already agitated, how
           | easily I brush off annoying stuff, takes the intensity off of
           | my reactions and mood during conversations).
           | 
           | I did a blood test before starting, and if normal is between
           | 30 - 70, I was at 10. Dr prescribed megadose of D2, followed
           | by daily D3, but I skipped on the megadose and went straight
           | to D3 -- makes me wonder if a megadose would build up my
           | stores since D is fat-soluble and make it so I could miss a
           | day and not notice.
           | 
           | All of the above is anecdotal from me, a self-professed cave
           | dweller, but it's been a couple of years now, and I still
           | notice the difference. Also, what I heard from people in
           | Boston is that 90% of them are on a vitamin D supplement. My
           | friend from there laughed at me when I was raving about it,
           | saying "yeah, literally everyone here is on it".
        
         | zelphirkalt wrote:
         | Only recently again I read in the newspaper, that most products
         | are overdosed. There is a typical number that the vitamin D
         | products usually show, and in the article it said, that only up
         | to 800 IU is safe, and everything above is an overdose. There
         | are many products out there with 2000 UI or maybe even more.
         | Beware.
         | 
         | EDIT: Wow, the HN-local doctors at it again. Imagine getting
         | downvoted for sharing information from newspaper article (and
         | honestly labeling that info as such), that probably was written
         | by someone consulting medical professionals. But hey HN will
         | know better!
        
           | weird-eye-issue wrote:
           | Misinformation. Do more research.
        
             | AndrewDucker wrote:
             | If you have useful information to share, please do so.
             | Telling people "Do more research" adds nothing to the
             | conversation.
        
               | viraptor wrote:
               | Neither does "I read in the newspaper, that most products
               | are overdosed" to the honest.
        
               | woadwarrior01 wrote:
               | Examine.com's page on Vitamin D has a table on tolerable
               | upper levels segmented by age ranges.
               | 
               | https://examine.com/supplements/vitamin-d/
        
             | spoiler wrote:
             | While (I think) I agree with you on the facts here, I don't
             | think this type of dismissive comments are that useful
             | either.
             | 
             | Can you give the replyee some pointers, for example? Link
             | to articles or studies that show a different view?
        
               | weird-eye-issue wrote:
               | Just Google it. There's tons of research on this so I
               | don't know why I need to provide a specific link when
               | this is common knowledge.
               | 
               | But also here is something to think about: your body will
               | produce more D3 than that by being in the sun for just
               | several minutes. So if you consider such a low dose of D3
               | an overdose then you better steer clear of the sun!
        
               | johnisgood wrote:
               | The problem with "Just Google it" that you can find a lot
               | of bullshit on this.
        
               | weird-eye-issue wrote:
               | You can find scientific papers on Google if you know how
               | to use it.
        
               | johnisgood wrote:
               | I do, but surprisingly a lot of people do not.
        
               | zelphirkalt wrote:
               | You can find scientific papers on a lot of search
               | engines, not only Google.
               | 
               | The problem with that is, that you still need to know how
               | to interpret any results and statements within the
               | supposedly scientific papers. If you are not a
               | statistician, you might overlook methodology mistakes. If
               | you are not an expert in the matter of the paper, you
               | might not realize some side condition, that makes some
               | statement or result of the paper irrelevant for your
               | individual situation.
        
               | weird-eye-issue wrote:
               | Another overly verbose worthless comment from you. Why do
               | you continue spewing text like this as if you're actually
               | helping anybody?
        
               | zelphirkalt wrote:
               | > But also here is something to think about: your body
               | will produce more D3 than that by being in the sun for
               | just several minutes. So if you consider such a low dose
               | of D3 an overdose then you better steer clear of the sun!
               | 
               | This is another superficial statement, that displays
               | shallow-at-best understanding. Staying in the sun and
               | producing via the skin, and intake via food are 2
               | separate pathways. You cannot just make wild assumptions
               | about one of those pathways from stuff you know about the
               | other pathway.
               | 
               | And actually: Yes, you shouldn't stay in the sun for too
               | long without proper protection. Having the sun shine on
               | your skin is not some inherently healthy thing. It too
               | comes with acceptable dosage and overdose. Symptoms of
               | overdose are commonly known as getting a sunburn.
        
               | weird-eye-issue wrote:
               | Thanks for clearing that up for me.
        
             | nilslindemann wrote:
             | Hi, Mr. wolf language.
        
           | krona wrote:
           | Being at the beach (in summer) for a half an hour will
           | produce 10,000 and 25,000 IU for the average european.
           | 
           | See: Vitamin D and health: evolution, biologic functions, and
           | recommended dietary intakes for vitamin D (293 citations)
        
             | zelphirkalt wrote:
             | So? What's your claim here? Are you claiming that our skin
             | works the same way as our digestive system? That would be a
             | ridiculous claim. And fyi, many people get a proper
             | sunburn, if they stayed in the sun for 30 min straight
             | without protection, at least in summer. So your 30 min
             | statistic doesn't really tell us anything about something
             | being healthy or not.
        
               | krona wrote:
               | I've given you everything you need to find out for
               | yourself. Your incredulity on this is a self-confession.
        
               | zelphirkalt wrote:
               | What you have given is rather a comparison, that doesn't
               | stand up even the slightest scrutiny, and an improper
               | citation. I am not gonna read a whole paper on a whim.
               | Cite properly, with proper hyperlink, and at least a page
               | number, and I will consider looking at it.
        
             | SoKamil wrote:
             | Could you cite that claim from the paper?
        
               | poizan42 wrote:
               | Not OP, but the paper says on page 8
               | 
               | > An adult in a bathing suit exposed to 1 minimal
               | erythemal dose of ultraviolet radiation (a slight
               | pinkness to the skin 24 h after exposure) was found to be
               | equivalent to ingesting between 10,000 and 25,000 IU of
               | vitamin D (Fig. 6).
               | 
               | Doesn't say 30 minutes, but it may be 30 minutes
               | depending on your skin colour and the local strength of
               | the sun.
        
               | zelphirkalt wrote:
               | I think the OP's interpretation of this is wrong. Just
               | because someone was found to have an equivalent of
               | ingesting so and so much, after UV radiation, doesn't
               | automatically imply that it a good idea to ingest any
               | amount of vitamin D. Ingestion is different from exposing
               | skin to UV/sun. The paper probably doesn't state, that
               | ingesting that much will make a person absorb that much
               | from that ingestion, nor does it state, that ingesting
               | some equivalent amount will be safe and without side-
               | effects.
               | 
               | So the paper may be well researched or whatever, but the
               | interpretation of it is questionable.
        
               | poizan42 wrote:
               | I can't make any assesment on the quality of the paper as
               | that is far outside my expertise, but as far as I can
               | tell from a quick skim it does indeed make the claim that
               | recommendations for supplements should be significantly
               | increased.
               | 
               | From the abstract:
               | 
               | > The safe upper limit for children can easily be
               | increased to 2,000 IU of vitamin D/day, and for adults,
               | up to 10,000 IU of vitamin D/day has been shown to be
               | safe. The goal of this chapter is to give a broad
               | perspective about vitamin D and to introduce the reader
               | to the vitamin D deficiency pandemic and its insidious
               | consequences on health that will be reviewed in more
               | detail in the ensuing chapters
               | 
               | The full article is available on researchgate[1]. Direct
               | link to PDF [2].
               | 
               | [1] https://www.researchgate.net/publication/226676251_Vi
               | tamin_D...
               | 
               | [2] https://www.researchgate.net/profile/Michael-
               | Holick/publicat...
               | 
               | EDIT: I just looked up the author, Michael F. Holick.
               | Apparently he is one the people who identified calcitriol
               | in 1971. I know appeal to authority doesn't prove
               | anything, but it might be prudent to at least consider
               | his findings.
        
           | lynx97 wrote:
           | Before I take medical advice from a newspaper, I might as
           | well ask my local esoteric nut.
        
           | Ensorceled wrote:
           | Can you provide a link to the newspaper article at least
           | while whining about the downvotes?
        
             | zelphirkalt wrote:
             | I would like to, but I cannot, since it is a region-local
             | newspaper that comes as actual paper, that only has a paid
             | online offer, to which I have no access, nor could I post a
             | link to that. If I went through recent paper form
             | newspaper, I could get a photo of the text in German, but
             | then I would (A) need to spend that time, and (B) need a
             | place to upload pictures, without having to make an
             | account, and only then get back to you with a link. To be
             | honest, I am too lazy to do that, just to justify a comment
             | on HN.
        
               | freedomben wrote:
               | That's not unreasonable, but then you also didn't really
               | "cite" your source. Even without photographing the paper,
               | giving the name of it, article title, or author would go
               | a long way.
               | 
               | I think the downvotes are harsh btw and in general HNers
               | have gotten too reflexively downvoting IMHO.
        
               | Ensorceled wrote:
               | Understandable, but you wrote all of that and you still
               | haven't even named the newspaper.
        
           | turtlesdown11 wrote:
           | perhaps citing a source would be helpful
        
         | Xunjin wrote:
         | It's unbelievable crazy what the author suggests, even say
         | "10,000 IU if you're feeling daring / have darker skin / live
         | in less sunny climates.".
         | 
         | Just a simple look at the side effects of high dosages:
         | 
         | Safety and side effects
         | 
         | Taken in typical doses, vitamin D is thought to be mainly safe.
         | 
         | But taking too much vitamin D in the form of supplements can be
         | harmful and even deadly. Taking more than 4,000 IU a day of
         | vitamin D might cause:                   Upset stomach and
         | vomiting.         Weight loss and not wanting to eat.
         | Muscle weakness.         Not being able to think clearly or
         | quickly.         Heart rhythm issues.         Kidney stones and
         | kidney damage.
         | 
         | https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-2...
        
           | smallerfish wrote:
           | To my understanding Vitamin D is regularly underdosed.
           | Several points:
           | 
           | 1) There are lots of studies that correlate Vitamin D
           | production with sunlight exposure. For example,
           | https://pubmed.ncbi.nlm.nih.gov/20398766/ this one lands on
           | 1/4 of a MED = 1000 IU. Of course now we have a MED
           | definition problem, but we're roughly talking single digit
           | numbers for a white person in midday sun in NYC to reach 1/4
           | of a MED.
           | 
           | 2) If you also supplement with Magnesium, a lot of your side
           | effects go away. Vitamin D3 depletes Magnesium absorption.
        
           | Bender wrote:
           | FWIW just anecdotally I took 160,000 IU per day for a few
           | months along with 800mcg to 2mg of K2 MK-7 and about double
           | the suggested amount of magnesium _citrate_. I slowly
           | titrated up to that amount over a few months. I am not
           | suggesting anyone else do that as I had a specific purpose
           | _slow action TPA when combined with many protease so to
           | speak_ but just my own experience I did not have any of those
           | issues. I don 't know how they came up with them so I figure
           | they are just guessing like they did with the toxic level of
           | selenium _which has a funny back story_. I am back down to
           | 5000 IU a day. Years later still none of those issues. But
           | that is just me.
           | 
           | I did have one issue related to magnesium however. If I did a
           | very high dose of magnesium taurate _and a couple of other
           | chelated forms_ I would have trouble catching my breath after
           | physical exertion similar to chronic high doses of iodine.
           | Not the end of the world but it was unnerving.
           | 
           | Don't anyone else do what I do. I experiment on myself more
           | than scientists experiment on mice minus the whole dissection
           | bit. I am just continuing some experiments from the 1900's
           | but as I understand it AI will be learning all of those soon.
           | Fascinating stuff really.
        
             | leetrout wrote:
             | I respond well to magnesium oxide and magnesium citrate in
             | capsules but the chelated magnesium gives me heart
             | palpitations or makes them more frequent if I am already
             | having them. I hadn't noticed shortness of breath since the
             | palpitations would have outweighed that.
        
             | ncasenmare wrote:
             | Hi, I'm the author of the main blog post. Just wanted to
             | say that's a fascinating experience, 160,000 IU a day! I
             | mean, _I 'm_ not going to try that, but that's good to hear
             | that 5,000 IU/day for years has been working fine for you.
             | Thanks for sharing!
        
           | ncasenmare wrote:
           | Hi, author of the blog post here! Thanks for your concern. I
           | do still stand by my claim, since more recent peer-reviewed
           | studies have shown that up-to-10,000 IU is safe. As written
           | in the post:
           | 
           | > McCullough et al 2019 gave over thousands of patients 5,000
           | to 10,000 IU/day, for seven years, and there were zero cases
           | of serious side effects. This is in line with Billington et
           | al 2020, a 3-year-long double-blinded randomized controlled
           | trial, where they found "the safety profile of vitamin D
           | supplementation is similar for doses of 400, 4000, and 10,000
           | IU/day." (though "mild hypercalcemia" increased from 3% to
           | 9%. IMHO, that's a small cost for reducing the risk of major
           | depression & suicide.)
           | 
           | So why then does Mayoclinic, etc, all say 4000 IU is the
           | limit? I think because policy is decades behind science (this
           | happened with trans fats), and also policymakers are much
           | more risk-averse. (this is why in California, thanks to Prop
           | 65, up until ~2018, there used to be a warning in every
           | coffeehouse that coffee causes cancer.)
           | 
           | But thanks to your comment, I will edit the intro to note
           | what the official max safe dose is, and that more recent
           | peer-reviewed research shows it's too low!
        
           | gavinray wrote:
           | I've been taking 20,000iu of Vit D daily for years, split
           | into 10k AM/PM
           | 
           | Regularly have my Vit D levels checked and they are always
           | within the upper bounds of healthy reference range
        
           | mezzode wrote:
           | It depends on the person, as a sample size of one I was on
           | 5,000IU and my levels were still on the low end (almost still
           | deficient), and my calcium levels were still safely on the
           | low side as well. Ultimately people should be getting their
           | levels checked before and after to see exactly what the
           | effect on them is
        
         | josalhor wrote:
         | I also noticed that. Opened issue:
         | https://github.com/ncase/blog/issues/4
        
           | ncasenmare wrote:
           | Hi, author of the blog post here! Yes thank you for catching
           | this awful typo, it's fixed now! I _did_ write  "4000 or 5000
           | IU of Vitamin D" _everywhere else_ in the article -- main
           | text, conclusion -- just my luck that the one place I mess up
           | is right at the very start.
           | 
           | (Do not take 5000 _mg_ , that's 200,000,000 IU. You'd have to
           | chug dozens of bottles per day)
        
             | barbazoo wrote:
             | Let's hope the LLMs haven't picked it up yet and are
             | suggesting it to everyone already. :)
        
             | s-daveb wrote:
             | Hi, I'm curious about medicine in general and I'm
             | considering going back to school.
             | 
             | what formal education do you recommend so that I can better
             | understand this data?
             | 
             | It's clear you've dealt with anxiety before, but this
             | analysis is super thorough!
             | 
             | And thank you for quickly fixing that mistake - that could
             | have really harmed someone.
        
             | mixmastamyk wrote:
             | Colon Blow: _" It would take over 30,000 bowls. [ a giant
             | pyramid of cereal bowls shoots up from under the man, who
             | yells in terror as it rises ] To eat that much oat bran,
             | you'd have to eat ten bowls a day, every day for eight and
             | a half years."_
             | 
             | https://snltranscripts.jt.org/89/89ecolonblow.phtml
        
         | RandomTeaParty wrote:
         | Is "IU" another case of xkcd 927?
        
           | grumbelbart2 wrote:
           | No, it's to make it easier to dose different kind of
           | biologically active substances. They can have significantly
           | different "recommended weight to eat of this per day", IUs
           | make that sort-of comparable and easier to remember.
           | 
           | https://en.wikipedia.org/wiki/International_unit
        
             | sowbug wrote:
             | The usability issue with IUs is that people are used to
             | scales measuring weight and containers measuring volume,
             | but an IU is different for each substance.
             | 
             | Another issue is insulin syringes are labeled in "insulin
             | units," which hapless folks reasonably assume can be
             | abbreviated "IU."
             | 
             | If you are measuring out a certain number of IUs, and your
             | calculator or formula hasn't asked you which substance
             | you're working with, you're gonna have a bad time.
        
         | sschueller wrote:
         | If you don't have an underlying condition it is way better to
         | get the Vitamin D from the sun in 10-30min increments per day
         | after which you are saturated for the day. Overdose is not
         | possible via the sun (excluding sun burns of course).
         | 
         | > A single, optimal sun exposure session might produce the
         | equivalent of 10,000 to 25,000 IU from a supplement, but it
         | will not keep increasing with more time in the sun. That's your
         | max per session.
        
           | arethuza wrote:
           | From NHS Scotland:
           | 
           |  _" In Scotland, we only get enough of the right kind of
           | sunlight for our bodies to make vitamin D between April and
           | September, mostly between 11am and 3pm."_
           | 
           | https://www.nhsinform.scot/healthy-living/food-and-
           | nutrition...
           | 
           | Personally I found that taking Vitamin D supplements made
           | quite a bit of difference - and I spend a fair amount of time
           | outside (~3 hours each day).
        
             | matsemann wrote:
             | And in Norway we often don't see the sun during certain
             | months, due to it only being up for a few hours in the
             | middle of the day (when we're working). And even if I was
             | outside I would be covered in clothes.
             | 
             | We have a saying here to take cod liver oil all months
             | ending with R (in Norwegian that's September to Februar) to
             | get both omega 3 and the vitamin D.
        
           | pjc50 wrote:
           | .. how do you calibrate this against a cloudy sky? It's
           | pretty dark up here at 56 degrees north, and on top of that
           | it's been overcast for days.
           | 
           | It also sucks a lot when it's dark before starting work, dark
           | after leaving work, and during the day rather cold to be
           | exposing skin to the sun.
        
           | INTPenis wrote:
           | Agreed, but I live in Sweden so I take vitamin D supplements
           | every winter.
           | 
           | During the spring, summer, fall months I barely need it since
           | I'm outside so much with my dog.
        
           | Ensorceled wrote:
           | This is nonsense advice for pretty much anybody that is
           | shovelling snow right now.
        
             | bflesch wrote:
             | Why don't you just travel to the south during winter? /s
        
           | austinjp wrote:
           | Check local/national advice. In many places it is officially
           | advised to take vitamin D supplements, especially in winter
           | or if you have a darker skin tone.
        
           | bflesch wrote:
           | Your suggestion sounds a bit detached from reality of many
           | people.
           | 
           | In many countries it is physically impossible to get enough
           | vitamin D from the sun, even if you go out naked.
           | 
           | Also did you ever notice that the cheap apartments in many
           | places are facing north and do not have a balcony, and of
           | course do not have a private garden? Now you are reduced to
           | going to a park which in the "cheap" areas is also not a good
           | spot to chill for 30 minutes.
        
           | mixedbit wrote:
           | In winter, even on a sunny day, only tiny fraction of your
           | skin is exposed to sun. 10-30 min of sun when you are wearing
           | tshirt and shorts is much different from 10-30 min of sun
           | when you are wearing long sleeves, gloves, and a scarf.
        
             | pbhjpbhj wrote:
             | It's not really the exposed skin that's the issue. At
             | higher latitudes the ultraviolet (UVB) gets scattered by
             | the longer path through the atmosphere and so even if you
             | were naked you still wouldn't be getting enough.
        
           | RobotToaster wrote:
           | > it is way better to get the Vitamin D from the sun in
           | 10-30min increments per day
           | 
           | spoken like someone who has never lived in the UK
        
           | nimonian wrote:
           | Next time I get sunburn I'm calling it a vitamin D overdose
        
           | francisofascii wrote:
           | I would argue to do both in the winter, since sunlight has
           | other benefits than just Vitamin D synthesis, like
           | mitochondrial health and better circadian signaling for
           | better sleep quality.
        
           | theptip wrote:
           | Don't guess; just get your vitamin D levels tested. It's $20,
           | you can just buy it a la carte.
           | 
           | For some people even in sunny areas, 5000 IU might be needed
           | to get you in-range. This is highly individual.
        
         | koakuma-chan wrote:
         | I used an LLM to summarize and it told me 5000 IU.
        
           | phoronixrly wrote:
           | Wow, so what value is there in LLM slop exctracted from
           | already dubious self-medication advice?
        
             | perching_aix wrote:
             | They're saying that it successfully filtered out the bit
             | where the author told people to overdose by 40000x. I guess
             | that's the value.
        
               | phoronixrly wrote:
               | There would be value if it _pointed out the mistake_
               | instead of hallucinating a correction.
        
               | pulvinar wrote:
               | GPT5.2 does catch it and warns to not trust anything else
               | in the post, saying no competent person would confuse
               | these units.
               | 
               | I wonder if even the simplest LLM would make this
               | particular mistake.
        
               | naasking wrote:
               | IU was correctly used everywhere else in the article
               | except that one place with the mistak, so the LLM didn't
               | hallucinate a correction, it correctly summarized what
               | the bulk of the article actually said.
        
         | nialv7 wrote:
         | yes, once i saw that i stopped reading. if the author can't get
         | that right i am not going to trust anything else they say.
        
         | Aurornis wrote:
         | That's a large enough error that it calls the rest of the
         | writing into question, in my opinion.
         | 
         | Also, be careful taking 5000 IU/day of Vitamin D. I did this
         | for a few months and it was enough to send my blood levels over
         | the top of the range, even in winter.
         | 
         | Too much Vitamin D is not good for you. The supplement fans
         | have gone too far in recommending too high of dosages. My
         | doctor said she's seeing a lot of people with excessively high
         | Vitamin D levels now that it has become popular.
        
           | seba_dos1 wrote:
           | It's usually pretty hard to get to toxic levels though, most
           | people that don't live in a particularly sunny climate won't
           | get anywhere near there on 5000 IU/day.
           | 
           | Just test your blood levels before you start and then after 3
           | months or so. It's quick and cheap, and the only way to know
           | whether the dose is right.
        
             | Aurornis wrote:
             | > It's pretty hard to get to toxic levels though, most
             | people that don't live in a particularly sunny climate
             | won't get anywhere near there on 5000 IU/day.
             | 
             | No, that's literally what I was doing when I reached the
             | excessive range: 5000 IU/day in winter with an indoor job.
             | 
             | This commonly repeated idea that everyone is deficient and
             | you can't overdose on 5000 IU/day is wrong.
             | 
             | > Just test your blood levels before you start and then
             | after 3 months or so. It's quick and cheap, and the only
             | way to know whether the dose is right.
             | 
             | Literally what I did.
             | 
             | Every time I explain this online it seems like the
             | supplement people ignore what I wrote and just parrot the
             | same "5000 IU/day and everyone is so deficient you can't
             | overdose" myth.
        
               | seba_dos1 wrote:
               | > No, that's literally what I was doing when I reached
               | the excessive range:
               | 
               | That doesn't make it easy for most people. In my case it
               | was barely enough to move the needle, but that's not how
               | it will be for most people either.
               | 
               | > you can't overdose on 5000 IU/day is wrong
               | 
               | Of course you can (though it would usually have to be
               | really prolonged to actually cause you troubles, and even
               | then it's mostly due to calcium rather than vit D
               | itself). The vast majority of people won't, but you don't
               | know whether you're in that group or not until you test
               | yourself.
               | 
               | > Literally what I did.
               | 
               | That's good, but my post obviously used plural "you" as a
               | general advice.
               | 
               | (BTW. There's no evidence of toxicity below blood level
               | of 150 ng/ml, but there are many guidelines that consider
               | levels way below that, such as 50 ng/ml, as "too high"
               | already)
        
               | redhed wrote:
               | It can also be at non-toxic levels but still cause
               | arterial calcification.
        
         | globular-toast wrote:
         | Even 5000IU a day is huge and will likely result in calcium
         | buildup.
        
       | legulere wrote:
       | > A 2014 systematic review concluded that vitamin D
       | supplementation does not reduce depressive symptoms overall but
       | may have a moderate benefit for patients with clinically
       | significant depression, though more high-quality studies were
       | determined to be needed.
       | 
       | https://en.wikipedia.org/wiki/Vitamin_D#Depression
        
         | nayroclade wrote:
         | The meta-analysis cited in the article is from 2024 and
         | specifically mentions the Shaffer et al. 2014 review cited by
         | Wikipedia as being low quality:
         | 
         | > Some of the available reviews, owing to the limited number of
         | trials and methodological biases, were of low quality (Anglin
         | et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et
         | al., 2014).
         | 
         | https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/
        
           | afpx wrote:
           | Therefore what to do? I have seen these Hacker News vitamin D
           | ads appear every few months for the past 15 years, or so. I
           | always seem to have a vitamin D deficiency, so it reminds me
           | to take supplements. I take them for a few months, hoping to
           | see a change, but I don't feel any benefit. Then, I forget to
           | take the supplements until the next time I see an ad. How to
           | know if they're actually doing something useful?
        
             | phoronixrly wrote:
             | Until you see an article like this which calls for '5000
             | _mg_ ' of supplementation, decide that you didn't take
             | enough and overdose...
             | 
             | HN and dubious self-medication advice go hand-in-hand.
             | Please consult a medical professional instead of a bunch of
             | ad-tech devs.
        
               | mrguyorama wrote:
               | Remember when HN had an entire year of articles about how
               | we should all be on microdoses of various hallucinogenic
               | and psychoactive substances for "peak performance"?
               | 
               | Good times.
               | 
               | HN is as bad at medicine as it is at everything else.
        
               | phoronixrly wrote:
               | No, I was here just for the year in which they ended
               | COVID with vitamin D. With the weekly (n=5) articles
               | garnered with blog posts from randos swearing by it...
        
             | Palomides wrote:
             | you could make a decision informed by actual information,
             | i.e. your blood levels
        
           | legulere wrote:
           | If you're not in the respective fields it can be pretty
           | difficult to distinguish good from bad research. I am not
           | able to do so.
           | 
           | If you (or your close ones) don't suffer from depression,
           | then I guess it's best to ignore it until scientific
           | consensus has formed. That will for sure show up on
           | wikipedia. As far as I can see as a layperson there is a lot
           | of correlation with Vitamin D that breaks down in
           | interventions and Vitamin D is recommended mostly for babies
           | and elderly people. On the other hand I see Vitamin D pushed
           | as a miracle drug not unlike Vitamin C used to some decades
           | ago and regular reports of overdosing of supplements leading
           | to organ failure.
           | 
           | If you're suffering from depression, you should talk to your
           | doctor. They will be able to help you to weigh potential
           | benefits with risks
        
       | running101 wrote:
       | Chia seed and flaxseed high in omega3
        
         | grvdrm wrote:
         | + great for fiber. I load up chia as much as I can throughout
         | the day.
        
           | code_biologist wrote:
           | Chia is awesome for making pudding out of random liquids. I
           | have to restrain myself from eating a batch of coconut milk
           | cinnamon chia pudding in a single sitting.
        
         | freehorse wrote:
         | ALA, not EPA, though, and it is unclear how much of it is
         | converted then to EPA in the body. Afaik only EPA has shown
         | antidepressant effects.
        
       | b800h wrote:
       | Can I just add: In addition to this, if you struggle with anxiety
       | or have some sort of ADHD, then try cutting out caffeine
       | _entirely_. Not just switching to  "decaf" (which isn't), but
       | cutting out tea and coffee, and switching to an alternative like
       | Barleycup.
       | 
       | Doing this has had a massive positive effect for me, and combined
       | with decent nutrition and daily exercise, has been wonderful.
        
         | grvdrm wrote:
         | Fascinating.
         | 
         | Can you describe what else you tried? Other supplements? Any
         | other non-food/supplement techniques like journaling,
         | breathing, etc.? Any therapy and other similar human
         | interventions?
         | 
         | After all those - is it / was it still the case that cutting
         | caffeine drove the best outcome?
        
           | parag0ne wrote:
           | Not OP but I'll share my experience. For me, I have to quit
           | caffeine for those to even become an option. Otherwise I get
           | my short burst of productivity then everything shuts down
           | after and I don't want to do a thing, everything feels
           | "impossible" or like it doesn't matter at all.
           | 
           | Things like journaling / breathing / etc calm the nervous
           | system while caffeine stimulates it. I would say caffeine is
           | counterproductive to those practices.
        
             | grvdrm wrote:
             | Thanks for sharing.
             | 
             | I briefly quit caffeine once but it as well before any
             | realization of anxiety. So, hard to extrapolate forward
             | from that experience.
             | 
             | What feels different to me (compared to you) is this:
             | sometimes I'll drink 2 cups of coffee in the morning and be
             | awake but useless. Sometimes totally productive. Caffeine
             | in some form is there - recently sometimes substituting
             | coffee for a Celsius.
        
             | b800h wrote:
             | I am OP, and I can confirm exactly this line of thought.
             | Once I had given up caffeine, I was able to start using
             | methods like Pomodoro and Eisenhower grids, and they
             | actually worked.
        
         | bamboozled wrote:
         | I love coffee so much, I'd prefer to deal with the anxiety, and
         | I do suffer from it.
        
           | ramon156 wrote:
           | You can also get decaf beans, or try to see if you can get
           | used to tea. I do both right now and I feel a lot better
        
           | buddhistdude wrote:
           | Or the addiction just makes you think that this is good for
           | you when actually you'd feel better without it?
        
             | bamboozled wrote:
             | It's the smell, texture and taste of coffee I love, not
             | really the caffeine. I tried decaf, doesn't taste the same.
        
               | majkinetor wrote:
               | Find better decaf. Caffeine has no taste.
        
         | tripledry wrote:
         | How long would you say it takes to feel the effects after
         | switching? I did this a couple of years ago and as far as I
         | remember the only real effect was my energy levels were more
         | stable.
         | 
         | I gave it maybe 2-3 months and decided it's not worth it.
         | 
         | Tempted to give it another shot!
        
           | b800h wrote:
           | I think some of the positive effects are very quick (better
           | sleep) whereas others take longer to materialise. My wife
           | commented after maybe 2-3 years that I had become much more
           | organised. I think that happened because I came off caffeine
           | and then adapted over time to having a different brain
           | chemistry, so I learned techniques to organise myself that I
           | wouldn't have stuck to had I carried on consuming caffeine.
        
         | binsquare wrote:
         | I did the same thing and experienced the same effect.
         | 
         | I'd add that my ability to sleep naturally was negatively
         | affected as side effect of medication. I tried a various combos
         | to induce sleep and found the best solution to just be...
         | exercise.
         | 
         | No caffeine, exercise, sleep lead to a significantly reduced
         | anxiety and more.
        
         | parag0ne wrote:
         | Agreed, anyone that already struggles with something like this
         | should quit caffeine. My life is so much better off of it, but
         | I struggle to stay off of it because I'm addicted to the 2hr
         | productivity boost vs the all-day steadiness when you're not on
         | caffeine. Things that improve for me were: No sense of urgency
         | for every single thing. Significantly improved confidence. Word
         | things better and speak better in general. No hard crash later
         | in the day. All my scattered thoughts become cohesive. No more
         | random heart palpitations.
         | 
         | All of these likely got better due to the overall effect of
         | decreased anxiety and not making ADHD worse. I'm not myself
         | when on caffeine. Nikola Tesla quit all caffeine/other
         | stimulants for a reason.
        
           | b800h wrote:
           | The silly thing is that when I drank caffeine, the hit from
           | it would make me overcreative. Yes, I might do more, but it
           | probably wasn't what I was supposed to be doing - I'd pursue
           | some new and exciting thing with tremendous fervour, before
           | realising later that it was a load of nonsense.
        
         | xenospn wrote:
         | As someone from the Middle East, just thinking about not
         | drinking coffee makes me lose my will to live. It's like asking
         | me to wear sunglasses on a cloudy night.
        
         | voidUpdate wrote:
         | I wish I could cut down on my caffeine intake to help my ADHD.
         | Unfortunately, I already have basically zero caffeine intake
         | (apart from diet coke sometimes)
        
           | b800h wrote:
           | Exercise is another good thing to do on a daily basis. It
           | prevents me from self-medicating with alcohol.
        
         | jofzar wrote:
         | > Not just switching to "decaf" (which isn't)
         | 
         | Going to argue here, this is wildly bad advice. Decaf
         | practically has no caffeine, it has 2-7 mg from what I can tell
         | which is less then chocolate. 2-7mg is like impossible to
         | notice and might aswell be water with how little there is.
        
           | dddw wrote:
           | Agree, althouh quiting it altogether might simply help with
           | establishing the new habit.
        
             | charles_f wrote:
             | But replacing it with decaf is also easier to get into.
        
               | dddw wrote:
               | Yeah, some people need to go cold turkey. Or... Help them
               | out by replacing their coffee with decaf without them
               | knowing. ;D
        
         | haght wrote:
         | Very true! I recently found out that i am extremely sensitive
         | to caffeine, and one cup at 6 pm makes me unable to fall asleep
         | at night until 4 am. Trying to cut off the caffeine entirely
         | now.
        
           | b800h wrote:
           | Yes, I'm sensitive to it, and a slow metaboliser. A lot of
           | people will be in the same boat and not realise it.
        
         | marginalia_nu wrote:
         | Downside with going completely off caffeine is you get _so_
         | tired and unfocused and it lasts for ages.
         | 
         | I tried doing this for almost a full year, and while the
         | improved sleep and generally improved mood was fantastic, and
         | even toward the end it was so much harder to get any focused
         | work done.
        
           | b800h wrote:
           | I have to say that I don't find this at all. I've been off
           | caffeine for years, and I'm perfectly able to focus without
           | it.
        
             | marginalia_nu wrote:
             | Stimulants (of caffeine is one) are the de-facto treatment
             | for ADHD, not entirely unlikely caffeine is keeping me
             | subclinical.
        
               | b800h wrote:
               | Some stimulants are a treatment for ADHD. Caffeine is not
               | one of them, and whilst there are suggestions it can act
               | as a short-term treatment for some people, it's not
               | recommended.
        
               | marginalia_nu wrote:
               | Actual ADHD meds aren't available to me, so it'll just
               | have to work.
        
           | cameronh90 wrote:
           | I think my average level of _useful_ focus is just simply
           | higher with caffeine. I was off it for three years, which is
           | well beyond the time it would take to lose any tolerance, but
           | never really reverted back to the same level of focus that I
           | get with caffeine.
           | 
           | I'm not sure my overall focus over time is higher with
           | caffeine, but it does allow me to nudge more of it into the
           | useful part of my day. However I'm a fast metaboliser of
           | caffeine, and it doesn't impact my sleep at all, so could be
           | that there's a genetic component to one's experience here.
        
         | driverdan wrote:
         | > if you struggle with anxiety or have some sort of ADHD
         | 
         | Those are two different things. Cutting out caffeine can help
         | with anxiety but not ADHD. It's the opposite for ADHD,
         | stimulates help significantly.
        
           | Aurornis wrote:
           | This is not true. Caffeine is not necessarily helpful for
           | ADHD. It has a different mechanism of action from ADHD
           | stimulants. They are not interchangeable. Not all stimulants
           | help ADHD.
           | 
           | Also there's a growing trend of diagnosing every focus
           | problem as ADHD when many patients might have focus problems
           | secondary to another condition like anxiety. It's sadly all
           | too common to find someone who believes they have ADHD due to
           | TikTok self diagnosis or even a lazy doctor's diagnosis but
           | their core problem is actually anxiety. For these people,
           | stimulants of any kind can actually worsen focus even if then
           | provide a short term perception of helping due to the energy
           | boost.
        
         | ivm wrote:
         | Tea, especially green tea, doesn't have the same caffeine
         | bioavailability as coffee - otherwise people would abuse it
         | just as much as coffee.
         | 
         | I'm quite sensitive to caffeine, yet I can drink green tea all
         | day without noticing much effect, while even a light coffee or
         | a caffeine pill is clearly noticeable. I can also drink tea
         | before going to sleep without any problems.
        
           | Aurornis wrote:
           | > Tea, especially green tea, doesn't have the same caffeine
           | bioavailability as coffee - otherwise people would abuse it
           | just as much as coffee
           | 
           | You can absolutely get high doses of caffeine from tea if you
           | really want to. It comes down to the type of tea, how much is
           | used, and how strong it's brewed.
           | 
           | There is nothing special about tea that breaks the rules of
           | caffeine. It comes down to the content of the leaves,
           | quantity, and extraction into water.
           | 
           | > while even a light coffee or a caffeine pill is clearly
           | noticeable
           | 
           | Caffeine pills generally have really high dosages, FYI. Even
           | light coffee drinkers can be caught off guard by how much
           | caffeine is in a typical off the shelf caffeine pill.
        
             | ivm wrote:
             | _> There is nothing special about tea that breaks the rules
             | of caffeine._
             | 
             | There's definitely something special, just poorly studied:
             | typical "how much caffeine is in X?" tables show tea having
             | caffeine levels similar to coffee, but I never feel the
             | same effects.
             | 
             |  _> Caffeine pills generally have really high dosages,
             | FYI._
             | 
             | I use 200 mg tablets split into quarters for doses of
             | 50-100 mg. Yet, they produce a much milder curve than
             | coffee (which I no longer drink) and, as a side effect,
             | cause no gastrointestinal side effects!
        
               | Aurornis wrote:
               | > typical "how much caffeine is in X?" tables show tea
               | having caffeine levels similar to coffee,
               | 
               | I have never seen a caffeine comparison table that shows
               | tea and coffee at the same level.
               | 
               | It's common knowledge that typical coffee brews are in
               | the range of 2-5X higher in caffeine content than typical
               | tea brews.
               | 
               | Tea is widely used as a lower caffeine alternative to
               | coffee.
        
               | ivm wrote:
               | Quick search shows various infographics: green tea at
               | 20-35 mg, black tea at 45-50 mg, espresso at 45-75 mg,
               | and instant at 60-80 mg on average. The day I feel
               | anything close from a cup of black tea to what I get from
               | an instant coffee or a quarter of a pure caffeine pill, I
               | might start trusting those numbers, but for now I see
               | them as nonsense that tries to present as science.
        
               | seba_dos1 wrote:
               | There are also other ingredients in coffee and tea that
               | may affect caffeine's effect (L-theanine in tea for
               | example). Same with energy drinks, these will have a
               | different effect even with the same caffeine intake due
               | to presence of taurine.
        
             | volkk wrote:
             | i thought that the mechanism in green tea is that it has
             | l-theanine that helps with caffeine jitters/spikes. a bunch
             | of people drink coffee + theanine which gives a much calmer
             | high.
        
         | dec0dedab0de wrote:
         | Counterpoint, purposely adding caffeine in the form of
         | different mushroom coffees has greatly improved my ADHD
         | symptoms.
        
         | __turbobrew__ wrote:
         | I am in the middle of trying this out. When I first stopped
         | caffeine I had better sleep and very vivid dreams every night.
         | I also feel better as I think coffee was making my stomach too
         | acidic which was causing me other indigestion problems, not to
         | mention that coffee was nuking my teeth as well with acid.
         | 
         | Im on week 3 of no coffee now, I will maybe give it a month or
         | two more to make a judgement call if I want to continue with
         | coffee or not.
         | 
         | It is unfortunate as I really enjoy coffee, but it causes some
         | issues for me with anxiety and stomach problems.
        
         | charles_f wrote:
         | I cut coffee for over 6 months, and one of the most significant
         | thing it did for me is that, when I resumed, I noticed that
         | caffeine actually helped me feel more awake and alert (while I
         | didn't notice any effect when taking a lot of it before
         | stopping cold-turkey)
        
       | daoboy wrote:
       | My physician prescribed Vitamins D and B12, so a quality Omega 3
       | is the only supplement I currently purchase.
       | 
       | After an absurd amount of trial and error with every over-the-
       | counter, trendy supplement over the last couple of decades (and
       | lord only knows how much money), these are the only ones that
       | seem to make a subjective difference on my quality of life and an
       | objective difference in my bloodwork.
        
       | Iolaum wrote:
       | Your body makes Vitamin D when in sunlight. Could it be that
       | sunlight - and the whole being outdoors situation - is the thing
       | that helps rather than vitamin d levels?
        
         | rini17 wrote:
         | There's a research that winter sunlight in northern latitudes
         | just does not convert precursors to vitamin D. Even when it's
         | shining, no matter how long you are outside.
        
           | 7952 wrote:
           | And I guess you need uncovered skin which can be tricky in a
           | cold winter.
        
         | NoPicklez wrote:
         | It could be, but the same effect can be observed in people who
         | dont change their outdoor habits but take vit D and omega 3
         | supplements
        
         | xi_studio wrote:
         | Sunlight alone don't help, it helps just because our body makes
         | Vitamin D during the sunbathing process.
         | 
         | So sunbathing is one of many way of integrating Vitamin D in
         | our body not THE way.
        
         | account42 wrote:
         | Well if you'd be so kind to move the earth so that we get
         | enough sun during winter then that'll solve the problem.
        
         | notTooFarGone wrote:
         | What drove you to write this comment? There are enough
         | countries where sun is an exception in winter and this is a
         | valid problem.
         | 
         | Comment is neither helpful nor is it funny.
        
         | Ensorceled wrote:
         | It's going to be sunny this morning, but also -14 and also I'm
         | too far north for adequate Vitamin D synthesis in winter. But
         | thanks for the advice.
        
         | zipy124 wrote:
         | In most northern countries like the UK, there is simply not
         | enough UVB in the winter to make any Vitamin D through
         | sunlight.
        
         | dennis_jeeves2 wrote:
         | Interesting point, there is at least one theory out there which
         | says that neither sunlight nor Vitamin D is necessary if an
         | individual is really healthy. The ones that feel better on the
         | Sun and/or Vitamin D are people who are at least mildly
         | unhealthy and it's of form of addiction where the individual
         | ought to keep taking something to just not feel miserable.
        
       | Liquix wrote:
       | can vouch for a diet high in fatty fish along with
       | supplementation of D3 + cofactors (K2, A, magnesium, zinc,
       | copper, boron). sample size of one but noticeably improves mood
       | and energy levels.
       | 
       | recent evidence [0] suggests there's not much of a link between
       | serotonin and depression, and therefore the effects of SSRIs are
       | either placebo or an as of yet unexplained mechanism of action.
       | IMHO it seems much more likely that modern lifestyles (excessive
       | screen time, poor diet, lack of socialization, no connection to
       | nature, no spirituality, etc) have more of an effect than
       | serotonin levels.
       | 
       | [0] https://pubmed.ncbi.nlm.nih.gov/35854107/
        
       | shimonabi wrote:
       | Over the last few months, I've increasingly come to believe that
       | depression is not caused by a chemical imbalance. After trying
       | ten different antidepressants with no success, I found far
       | greater improvement by changing my patterns of thinking.
        
       | meindnoch wrote:
       | Yeah, I call bullshit. Tried both, and SSRIs are a godsend.
        
       | lynx97 wrote:
       | Can confirm. Since I take 20000 IU vitamin D every sunday, my
       | winter depression is gone.
        
       | rustyhancock wrote:
       | These are always tricky, vitamin D deficiency and low fat diets
       | clearly cause depressive symptoms.
       | 
       | Does that mean vitamin D treats depression in general?
       | 
       | When most people talk of depression they aren't even using
       | talking about major depression.
       | 
       | We live in a world that in many ways is comfortable but crushing.
       | Is that depression? Or just harmful levels of understandable
       | unhappiness? Are they different?
        
       | nxobject wrote:
       | Be careful - many studies in the Vitamin D meta-analysis
       | *enrolled patients already taking antidepressants.* [1] Reporting
       | effect sizes without specifying "on which population?" is
       | misleading.
       | 
       | (As an aside, Cohen would be the person _not_ to tell you to
       | assign qualitative values to effect sizes. They are as arbitrary
       | as any other threshold used by working statisticians.)
       | 
       | [1] https://www.cambridge.org/core/journals/psychological-
       | medici...
       | 
       | EDIT - that is, _please_ don 't draw the conclusion that you can
       | substitute supplements for antidepressants. The meta-analyses
       | don't seem designed to examine that hypothesis, and I doubt
       | anyone would ever participate in a such a trial. In general (and
       | as a working biostatistician), I would be very, very, very
       | cautious applying estimates of average effect to myself, you, or
       | any other individual person in a field as murky as psychiatry.
       | That's why even the stingiest American health insurance plans
       | still have an incredibly large range of antidepressants in their
       | formularies.
        
         | GenBiot wrote:
         | Based on your own citation, this is untrue. The citation you
         | have linked is a meta analysis of 31 trials, many of which
         | specify no medication use at recruitment.
         | 
         | You are however correct about population being important (which
         | is a big reason meta analyses can be very useful).
        
           | nxobject wrote:
           | I said "many", not "all". (Many don't indicate, either.)
        
         | ncasenmare wrote:
         | Hi, author of the blog post here! Thanks for bringing this up
         | -- it wasn't my intention to say one should _replace_
         | antidepressants with vitamins (the conclusion even says
         | "(Don't quit your existing antidepressants if they're net-
         | positive for you!)", but you're right that the intro may give
         | that impression. I'll edit the intro to say you can stack, not
         | substitute, regular antidepressants.
         | 
         | > many studies in the Vitamin D meta-analysis _enrolled
         | patients already taking antidepressants._
         | 
         | Yes, and that's even more encouraging, that there's still
         | effects of Vitamin D on major depression even if already on
         | antidepressants! This suggests we can "stack" the
         | interventions.
         | 
         | Table 1 of the meta-analysis (
         | https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ) shows the
         | raw sub-group analysis. There were 9 studies on patients using
         | antidepressants, 13 on patients who weren't, the rest were
         | Mixed or Not Reported (...how do 6 studies just _not report_
         | that?) Anyway,
         | 
         | Effect size of Vit D for people on antidepressants: -0.54
         | (-0.85, -0.23)
         | 
         | Effect size of Vit D for people NOT on antidepressants: -0.28
         | (-0.40, -0.16)
         | 
         | Both negative. Weirdly, the effect of Vit D seems to be a bit
         | stronger for people _on_ antidepressants, but the difference
         | isn 't statistically significant at the p<0.05 level (P
         | subgroup difference is 0.23)
         | 
         | (As for why those effect sizes, -0.54 & -0.28, are lower than
         | what I (and that meta-analysis itself) report, -1.82, that's
         | because the majority of RCTs for any group used far less than
         | 5000 IU. Table 2 in that paper shows the effect (with 95% CI)
         | for various dosages.)
         | 
         | I'll lightly edit my blog post to emphasize _stack them, don 't
         | substitute_. Thanks again for your comment!
        
           | zahlman wrote:
           | > Yes, and that's even more encouraging, that there's still
           | effects of Vitamin D on major depression even if already on
           | antidepressants! This suggests we can "stack" the
           | interventions.
           | 
           | I think the point here is that such a study selects for
           | people where their antidepressants are already known not to
           | work very well for them, or they wouldn't be interested in
           | participating.
        
       | trhway wrote:
       | then it would suggest why depression gets worse in colder and
       | less sunny part of the year. That even has its own name -
       | Seasonal Affective Disorder (SAD).
        
       | cardanome wrote:
       | With depression it is important to find the cause of it.
       | 
       | You might be depressed because you life objectively sucks. Then
       | you symptoms are good and healthy and a signal to make changes in
       | your circumstances.
       | 
       | You might actually have a good life but still feel depressed
       | because there is a chemical imbalance in your brain. (Very
       | simplified). That is when drugs come in.
       | 
       | It might be just a seasonal thing and you need to go outside more
       | and take some supplements.
       | 
       | You might have some other undiagnosed issue. You might have ADHD,
       | autism and other things that cause you to struggle and develop
       | depression as a side effect.
       | 
       | So find out what works and what doesn't work for you.
        
         | ajkjk wrote:
         | That's the sorta standard socially accepted way of thinking
         | about this. but uh... to a lot of people it doesn't ring quite
         | true.
         | 
         | For example: if your life objectively sucks, why aren't you
         | doing anything about it? Some people whose lives suck fix their
         | lives, and other people get depressed and do nothing; what's
         | the difference? And: all of us know somebody who appears to
         | have a good life and therefore their depression is presumably a
         | chemical imbalance thing _but_ if you 're being honest the
         | vibes in their life are a bit off, actually, like you can tell
         | they're not _really_ getting everything they need out of it,
         | that they 're clearly good at masking (for example people who
         | are clearly not thriving in their relationships) .... in which
         | case sure medication could help but you can't shake the feeling
         | that facing the reality of their life would help a lot more.
         | 
         | However! Questioning this stuff becomes a bit of a moral
         | minefield. "Believing" in the chemical imbalance theory is part
         | of why it's medically helpful. If your life has sucked for
         | years and you could find no way of fixing it and then SSRIs
         | helped, then you basically need to believe that it really was a
         | chemical imbalance, because believing that it might not be
         | threatens to take away the thing that's making your life work.
         | So much so that I would bet at this point there are already
         | readers of this comment who are ready to angrily reply to my
         | preceding paragraphs, because the model I just described
         | threatens their existence. (If so, wait a sec and read the
         | rest...)
         | 
         | On the flip side, for some people _not_ believing in the
         | chemical imbalance model for some particular case might be
         | important. Maybe they _want_ to feel responsible for their life
         | being bad, so they will be motivated to do something about it,
         | and being happy due to drugs would make them feel complacent
         | and okay with years passing by at a shitty job or something. Or
         | picture someone whose parent has gone their whole life unable
         | to take them seriously as an adult, which as a result means the
         | child and parent have a bad relationship, and then picture the
         | parent complaining about depression and taking medication for
         | it. This can be really infuriating: the child thinks about the
         | parent,  "your life sucks because of the tension created by not
         | treating people around you with respect, and you're so
         | incapable of recognizing this even when it's told to your face
         | regularly that you're taking drugs to feel better despite not
         | fixing the problem". Now ascribing depression to medical
         | problems seems like avoidance, and having people write off your
         | frustrations and say that you're just depressed and need to
         | take a drug for it is frustrating.
         | 
         | Just saying: the two narratives really get tangled up. I don't
         | really know what to do about it, but I do think that some harm
         | is done by harping on the concept of a "chemical imbalance". A
         | lot of the issue is avoided if you just think of the drugs as
         | _helpful_ but don 't choose any model (with its moral
         | implications) for what exactly it is they're helping with. Just
         | treat them as a tool for making you feel better.
         | 
         | Also, I suspect that people who have an intuitive aversion to
         | mental health drugs are probably way overindexing on that
         | intuition. I definitely did this for a long time, as did some
         | friends I knew growing up. Turns out whatever your issues you
         | can sometimes just deal with them sooner than later if you
         | accept that doctors might be onto something. (Actually I think
         | the reason people get stuck avoiding medication for so long is
         | precisely that they feel like they're not _allowed_ to be
         | skeptical of them... which makes them kinda plant their feet in
         | the ground and refuse to be open to it. That 's kinda why I'm
         | typing this long comment, to tell anyone reading that it is a
         | reasonable thing to feel. And now that you know that maybe try
         | them anyway..?)
        
         | xnzakg wrote:
         | The problem with the "your life objectively sucks" option is
         | when you end up too depressed to actually bother doing anything
         | and just give up. That's another case where drugs can help.
        
         | citrin_ru wrote:
         | > You might be depressed because you life objectively sucks
         | 
         | The problem with this that to a bad situation different people
         | react differently - some trying to do what they can to improve
         | the situation or at least don't make it worse and some give up
         | and let situation to slip and become worse and worse (becoming
         | a self fulfilling prophesy). It's not a choose one makes I
         | think (it's likely a biological predisposition) but the
         | difference is still exists.
         | 
         | People prone to depression genuinely believe the main (only)
         | reason for a depression that the life sucks and as a result
         | they avoid medical help and don't do anything which could help
         | them.
        
         | tock wrote:
         | You mean relatively sucks. Else every single human ancestor
         | would have to be super depressed too given the standard of life
         | in the past.
        
           | cardanome wrote:
           | Objectively in the sense that there are actual causes in you
           | life that distress you and cause your symptoms instead of
           | thinking your life is shitty because you are depressed. Of
           | course being able to determine if it is your depression
           | talking or if things are objectively bad isn't easy and
           | people often need outside help from a therapist for that.
           | Plus it isn't really clear cut in practice.
           | 
           | On a sidenote, I know that knowing that it is "just your
           | depression talking" is also a pretty hard pill to swallow and
           | not always helpful. Personally I have a lot of fears that I
           | know are irrational but that doesn't make them any less real.
           | 
           | And even if your problems are external, sometimes you need to
           | focus and your inner self first, find some strength and help
           | so you can tackle the external problems later. But for other
           | people "working on yourself" can be avoiding the actual
           | problems they need to work on.
           | 
           | And yes happiness is always relative.
        
           | sambuccid wrote:
           | I guess there are different types of "life sucks" that can or
           | cannot contribute to depression, my current understanding is
           | that a lot of it depends on whether you feel you have some
           | control over the situation or if you think you have
           | absolutely no power over it
        
             | citrin_ru wrote:
             | Isn't people in the past had less control? There were dying
             | from infections and not only had no vaccines and drugs they
             | didn't understand how infections are spread. They also
             | suffered from various natural disasters not having a
             | protection a modern civilization gives us.
        
               | sambuccid wrote:
               | I don't know enough about how people lived in the past
               | but I would tend to agree with you that they might have
               | had less control than us on many things. But what I meant
               | was that it depends on how much control you *think* you
               | have rather than the control you actually have. So I
               | think a lot of it is about perception, in 100 years time
               | people might wonder why we weren't all depressed because
               | we had a life expectancy of "just" 80/90 years, but for
               | us it's just normal and expected
        
             | the_pwner224 wrote:
             | According to Victor Frankl (psychiatrist concentration camp
             | survivor, author of Man's Search for Meaning) being in a
             | shitty situation without any control over it isn't
             | necessarily bad. Humans can still be mentally okay in the
             | face of extreme unavoidable suffering like in the camps.
             | The key thing is that you need to have some purpose /
             | meaning in life (often a loved one or dependent).
        
           | zug_zug wrote:
           | I don't think that's true. I think that just shows how
           | disconnected we are.
           | 
           | We tell ourselves that we must have "better lives" than say a
           | native american in the year 1000AD, but there's no reason to
           | think that.
           | 
           | I think odds are that maybe the native american was happier
           | -- having a small group that you spend time with outdoors
           | every day, getting extensive exercise, having a clear sense
           | of purpose, eating healthy fresh food every day, never once
           | thinking about politics or bills or global warming. I bet
           | they liked their life more than a depressed divorced
           | accountant in our modern society, even if we have more
           | material wealth or health access.
        
         | BeetleB wrote:
         | Most people's lives objectively suck. Most of them are not
         | depressed.
         | 
         | Pinpointing problems in your life as the cause of your
         | depression is a trap.
        
         | jillesvangurp wrote:
         | This stuff is complex. There are no magic potions or hacks that
         | work for everyone. No amount of positive thinking can fix
         | physiological issues that you have because of some underlying
         | condition. But it's quite possible to create new issues as a
         | side effect of being depressed, stressed, chronically
         | exhausted, etc. So, working on those issues is probably smart.
         | 
         | And each of those things can be caused by physiological issues
         | as well. You might feel stressed because you don't sleep well.
         | You might sleep poorly because you suffer from e.g. sleep
         | Apnea. Which in turn might be because of a mix of physiological
         | and other reasons (diet, weight, alcohol abuse, etc.).
         | 
         | Or you might be working too hard, which makes you stressed and
         | causes you to lose a lot of sleep. Different causes that have
         | similar results. Including long term physiological results.
         | Your brain can actually get damaged if you chronically abuse it
         | or neglect it. Many "between the ears" type problems are
         | actually physiological.
         | 
         | Root causing your issues enables you to deal with them properly
         | instead of fighting the symptoms.
         | 
         | Anyway, I take vitamin D and a few other things. Getting
         | yourself checked out regularly once you hit middle age is a
         | good idea. There's a lot of stuff that is long term lethal that
         | a checkup can detect early. And some of it is fixable. I have
         | the usual cardio vascular challenges that many people struggle
         | with because of a combination of genetics, age, and life style.
         | And indeed a vitamin D deficit.
         | 
         | I was also recommended to consume more omega-3 as well. Eat
         | salmon. Work some flax/chia seeds in your breakfast. I put flax
         | seeds in my yogurt and use it as a thickener in sauces as well.
         | You have to grind it to dust for it to get absorbed properly.
         | Dirt cheap and it doesn't mess with flavor/texture too much. I
         | keep a jar of ground flax seeds in my fridge. Takes 2 minutes
         | to top it up every 1-2 weeks or so with some freshly ground
         | seeds.
         | 
         | But I'm also aware that me being a stressed startup founder has
         | health consequences that a few pills and suplements won't fix
         | for me. I need to actively make sure I get my rest and sleep. I
         | deal a lot better with stressful situations when I'm well
         | rested. And I seem to be better at avoiding getting in to those
         | as well. And I feel happier. Sometimes the best thing I can do
         | for my company is having a proper weekend or going to bed early
         | enough that I can get my 8 hours of sleep. You can survive on 4
         | hours (been there done that), for a while. But most people are
         | not at their peak performance if they do that. And it's not
         | good for you to work yourself to exhaustion all the time.
        
       | isoprophlex wrote:
       | Because it's common to hate on antidepressants, I've always
       | personally had a bias against them.
       | 
       | For the past 15-20 years, november thru february are basically a
       | writeoff due for me due to seasonal affective disorder. Cold
       | showers, exercise, no alcohol, strict sleeping rituals. Vitamin
       | d. I can still sleep 11 hours and feel like reheated cat shit.
       | 
       | Enter citalopram. "It will take up to six weeks to dial in" they
       | said. Within four days I felt like the inside of my head was
       | designed by Apple in their glory days. My mind became an orderly,
       | well lit, tastefully designed space... instead of a dimly lit
       | crack den. I'm more emotionally available, no longer tired, less
       | cranky. I felt cozy. I could cry with joy because I could finally
       | understand emotionally why people like the Christmas season.
       | 
       | I won the SSRI lottery I guess, the side effect are sweaty feet,
       | vivid dreams and a dry mouth. That's all.
       | 
       | This just goes to show that for me, they're extremely effective.
        
         | sheikhnbake wrote:
         | Same for me with buproprion. Night and day difference. Made me
         | wonder how different my life would be if I had been diagnosed
         | appropriately when I was a kid.
        
         | mvcosta91 wrote:
         | "God, I see what you're doing for others, and I want that for
         | me."
         | 
         | I had a very similar experience, except it killed my libido, so
         | I chose to endure the suffering of Winter rather than live with
         | emotional numbness.
         | 
         | Still, I strongly recommend it for people flirting with the
         | abyss. It was life-changing for me while I was raising an
         | autistic 2yo during the pandemic.
        
           | rco8786 wrote:
           | > except it killed my libido
           | 
           | Similar experience. Apparently pretty much ubiquitous with
           | SSRIs
        
             | isoprophlex wrote:
             | i'm sorry this happened to you, this was of the reasons i
             | held off trying them for so long. ubiquitous indeed, also
             | on this front I got lucky...
             | 
             | please people, take my post for what it is: anecdotal
             | evidence. SSRIs can basically give you any possible side
             | effect, including destroying your libido.
        
             | bflesch wrote:
             | hm
        
               | rco8786 wrote:
               | I don't relate at all to the latter part of your
               | question, so by process of elimination it must be the
               | former :)
        
           | michaelsshaw wrote:
           | Libido can be supplemented with Wellbutrin. Works great, even
           | better than before.
        
           | sixtyj wrote:
           | I have switched to lamotrigin, it helps to balance mood as I
           | had bad mood in months with less sunshine. Lamotrigin is not
           | an antidepressant, previously it was used for epilepsy
           | stabilisation but now it is prescribed for mood swings. (This
           | is not a medical advice.)
        
             | deskamess wrote:
             | It is still prescribed for epilepsy. I am actually hoping
             | for some medication stories if anyone/someone they know has
             | ADHD and epilepsy. It's for a juvenile, but your stories
             | can be for any age. Or pointers to any resources about the
             | combo.
        
           | bflesch wrote:
           | I have no experience about antidepressants myself so please
           | excuse my stupid question.
           | 
           | When I hear people say "it killed my libido" I always think
           | about the fact that hyper-sexuality can be a trauma response,
           | and if your body is healing the hyper-sexuality is most
           | likely also reduced.
           | 
           | It's like when you have a disease and then read the side
           | effects of a medication and notice that a lot of the side
           | effects are basically also something that can happen when
           | your overall condition is improving but still some people
           | report them as adverse effects and then these are added as
           | side effects to the package label.
           | 
           | For example you take antibiotics but bacteria can have toxins
           | in their body, and when the bacteria disintegrate you get
           | more sick from the released toxins. It's called the
           | Herxheimer effect: https://en.wikipedia.org/wiki/Jarisch%E2%8
           | 0%93Herxheimer_rea...
           | 
           | When I started methyl-B12 supplementation I also had
           | inflammation in sinuses for weeks but it was just from my
           | immune system starting up again and being able to attack
           | long-standing inflammation. Someone else would've put
           | "fever", "headache" and "stuffed nose" onto the side effects
           | medication label of methyl-B12.
        
             | subscribed wrote:
             | Stupid question - why do you keep suggesting that having a
             | libido equals hypersexuality?
             | 
             | Is this your trauma speaking, or do you automatically
             | associate _any_ sexual needs with a pathology?
             | 
             | You've done it twice in this thread alone.
        
               | hu3 wrote:
               | I'm not whom you asked. But it's a resonable association
               | for some cases.
               | 
               | But I understand that it would have been better to ask
               | and not associate because it's a fraction of the cases.
        
               | WarmWash wrote:
               | If I told you that I often have a fire in my fireplace,
               | it would be incredibly strange if you suggested that
               | pyromania can be a trauma response.
               | 
               | Either OP is confused about what libido means, or has
               | some kind of heavy shame around sexuality.
        
               | hu3 wrote:
               | Yeah, I agree with your sentiment.
               | 
               | Sex is awesome and liberating! Should be anything but
               | shamed.
        
               | toxik wrote:
               | That is not what this was. You have been firing your
               | fireplace, now you put on a sweater and you suddenly
               | don't want to fire so much. Maybe that's not bad, but a
               | return to normal. That was the proposition. Is it true,
               | who knows. Case by case question.
        
               | butlike wrote:
               | I didn't read their comment as insinuating libido is 1:1
               | to hyper-sexuality. I read it as: "consider if you have a
               | libido, and depression, you may also be hyper sexually."
               | 
               | The situation is PersonA has determined they need an
               | anti-depressant. So one thing is 'wrong.' It stands to
               | reason that they may be using sex as a painkilling
               | mechanism. After all, sex feels great. When the anti-
               | depressant kicks in, the body may determine it doesn't
               | have to use that painkilling method anymore, hence, the
               | decreased libido. It doesn't mean having a libido is bad,
               | it means that the person potentially was overdriving it.
        
               | bflesch wrote:
               | Thanks for reframing it. That's what I was trying to say.
        
           | jonasdegendt wrote:
           | > I had a very similar experience, except it killed my libido
           | 
           | Did you, as well as the other people seconding this, have any
           | libido left in the first place? I got on Sertraline because I
           | was depressed, and it actually brought my libido back, by
           | virtue of just bringing me back to a better emotional
           | baseline.
           | 
           | All to say, if it had affected my libido, it'd have been a
           | NOOP anyway in my case.
        
             | kranner wrote:
             | > All to say, if it had affected my libido, it'd have been
             | a NOOP anyway in my case.
             | 
             | Wouldn't a "NOOP" be the opposite of a "Nope"?
             | 
             | Sorry for the pedantry, but this forum seems an appropriate
             | place for this.
        
               | toxik wrote:
               | That's the point, killing an inexistent libido is a no-op
        
           | cael450 wrote:
           | Villazodone was created partly to address that. Once I
           | switched to that, I had no libido-related issues again.
        
           | larrywright wrote:
           | Speaking from personal experience, people react to different
           | SSRIs differently. I took a popular one that had significant
           | side effects without a whole lot of benefit, and so I stopped
           | it and didn't try anything else for 10 years. Then I spoke to
           | a psychiatric nurse practitioner who suggested trying several
           | others until we found something that worked for me. I had
           | (incorrectly) assumed that if you had e.g. sexual side
           | effects from one SSRI, that you'd have them for all. That is
           | not the case.
        
           | wincy wrote:
           | I spent $300 on high lumen output light bulbs. 28 200W
           | equivalent LED bulbs and 2 LED corn bulbs. Just a TON of
           | light. Depending on severity either run it all day (late
           | January and February tend to be the worst months), but even
           | 10 minutes in the morning helps substantially. Just a lot of
           | light. You can get hung up on high CRI and full spectrum but
           | just do it badly first, then if it works worry about
           | perfecting the setup. I just kept buying more bulbs and as I
           | bought, I felt better and better.
           | 
           | Edit: this was the blog that gave me the idea, it comes up on
           | hacker news a lot. https://www.benkuhn.net/lux/
        
         | krzat wrote:
         | If a drug has an 1% chance of 100% effect, it will look pretty
         | weak in those studies.
         | 
         | IMO it's pretty clear that depression is a symptom of many
         | independent issues, so it's really lame that we don't have a
         | more accurate way of diagnosing it.
        
           | compounding_it wrote:
           | The goal is to tackle it in every way. The medicines are
           | supposed to be supportive and not the solution. More often
           | than not people treat it as a solution.
           | 
           | Thats why they are eventually tapered and discontinued once
           | you are able to be on your own.
        
         | petesergeant wrote:
         | Yah. Measuring the effects of these drugs with a single effect
         | size number is ridiculous. They work exceptionally well for
         | some people (myself included). It seems as well that SSRIs work
         | much more reliably on anxiety disorders than on depression.
         | 
         | Getting on them can be a ball ache (or entirely painless;
         | escitalopram was easy on and easy off, Wellbutrin was a
         | nightmare to get on, but also easy off), but entirely worth a
         | shot for anyone symptomatic.
        
         | compounding_it wrote:
         | As someone who tried citalopram escitalopram and sertraline,
         | along with venlaflaxine and fluvoximine, I would suggest doing
         | a pharmacological test for psychiatric medications.
         | 
         | I am an intermediate metabolized for the first three and the
         | ones I was on most long. It did not suit me and made my orgasms
         | go from 'wtf' to 'that's it?' And they are still not normal 2
         | years after discontinuation.
         | 
         | I am still depressed and anxious to the point of serious
         | consideration of these medicines to save myself, but you can
         | save yourself the experimentation by doing a simple test and
         | avoiding those medicines.
         | 
         | Anxiety depression panic attacks are something I wish more
         | people studied along with sexual health.
        
           | anonymous344 wrote:
           | look my other comment for niacin
        
         | ghusto wrote:
         | The hate on antidepressants is not because they're not
         | effective, but rather that they're abused by psychiatrists.
         | Ideally, a professional will prescribe them as a necessary
         | helper to becoming (more) mentally healthy whilst tackling the
         | root cause. Most of the time however, it's more of a "here,
         | take these indefinitely".
         | 
         | It's like if we took sleeping pills every time we had trouble
         | sleeping. Having said that, I just realised I have the
         | impression that's exactly what people do in the USA?
        
           | isoprophlex wrote:
           | you're not wrong that pharmaceutical crutches are overused.
           | but as an outsider to these problems my 'ambient impression'
           | was always one of _haha antidepressants are for suckers_.
           | well, in my specific case, so what if i 'm a sucker...
           | they're super effective in fixing what appears to be a
           | defective winter brain.
        
           | michaelsshaw wrote:
           | > It's like if we took sleeping pills every time we had
           | trouble sleeping. Having said that, I just realised I have
           | the impression that's exactly what people do in the USA?
           | 
           | I'm not sure if it is common but I've definitely taken my
           | fair share of my dog's trazodone.
        
             | darvid wrote:
             | after being prescribed Mirtazapine, then Trazadone I
             | realized I don't think I've had restful sleep as long as I
             | can remember. I need a sleep study done probably but until
             | that the quality of life from taking something that has
             | virtually no negative side effects for me is insane.
             | 
             | meanwhile people are like "just take magnesium or melatonin
             | lol"
        
               | larrywright wrote:
               | Nobody should take this as medical advice, but from my
               | own experience, nothing has made a bigger difference in
               | my sleep quality than supplementing with magnesium
               | glycinate. I didn't even start taking it for that purpose
               | - I was taking it for something else and quickly noticed
               | that it made the quality of my sleep significantly
               | better. The only side effect from it is that sometimes I
               | have strange dreams (not nightmares or anything, just
               | odd).
               | 
               | Everyone should check with their doctor, but it's an
               | inexpensive supplement and the effects (if any) show up
               | pretty quickly, so IMO it's worth a shot.
        
           | hypeatei wrote:
           | > like if we took sleeping pills every time we had trouble
           | sleeping
           | 
           | Yes, that's normal in the US. I have multiple family members
           | who take Ambien (zolpidem) before bed every night.
        
             | lazide wrote:
             | Which knowing the side effects of Ambien is pretty bonkers.
        
               | lotsofpulp wrote:
               | I know zero people that have ever taken Ambien.
               | 
               | https://www.cdc.gov/nchs/products/databriefs/db462.htm
               | 
               | Seems like daily users would be less than 10%.
        
           | paufernandez wrote:
           | Agree. But sometimes there is no "root cause", the brain is
           | still a mystery. If you had been depressed even when you knew
           | there was nothing to worry about, you would see it
           | differently, because then you deduce that the black cloud is
           | produced within.
           | 
           | Chemistry trumps psychology. Good enough chemistry enables
           | cognitive treatments. But to fix the wrong chemistry you need
           | chemistry.
        
             | citrin_ru wrote:
             | If you view a world at a certain angle there is always
             | something to worry about: 1. World in not perfect, it
             | doesn't confirm to how we want it to be (and could not even
             | in theory given that different people want it to be
             | different) 2. The future cannot be predicted with 100%
             | accuracy so even if all is perfect today you can worry that
             | it will turn bad in the future.
             | 
             | When looking at the same reality one persons sees the
             | situation as OK and another as a an endless and hopeless
             | disaster it is hard to tell who is right. A depressed
             | person would tell that most people around him are wrong and
             | are optimistic only because they don't understand how bad
             | all is.
        
               | ajross wrote:
               | This is the "people with anxiety should just stop being
               | worried" attitude that failed to help for centuries.
               | Whether or not you believe SSRI's are clinically
               | effective, denying the existence of mental health
               | disorders is not helping.
               | 
               | No, anxiety and depression aren't simply a matter of
               | perspective.
        
               | citrin_ru wrote:
               | My point is that it's hard if not possible to objectively
               | tell if the situation you are in is good or bad. And I'm
               | not trying to deny anything.
        
               | IAmBroom wrote:
               | So your point is explicitly off-topic to the subject
               | matter (read the title above). Gotcha.
        
               | Forgeties79 wrote:
               | > A depressed person would tell that most people around
               | him are wrong and are optimistic only because they don't
               | understand how bad all is.
               | 
               | Or because of a legitimate chemical imbalance or some
               | other cognitive issue they can't control alone. Right?
        
               | jodrellblank wrote:
               | > " _There is no convincing evidence that depression is
               | caused by serotonin abnormalities_ "
               | 
               | - https://www.psychologytoday.com/us/blog/insight-
               | therapy/2022...
               | 
               | and
               | 
               | > " _the etiology of depression is incredibly complex,
               | the narrative that it is caused by a simple "chemical
               | imbalance" persists in lay settings. We sought to
               | understand where people are exposed to this explanation_
               | "
               | 
               | - https://pmc.ncbi.nlm.nih.gov/articles/PMC11752450/
               | 
               | and
               | 
               | > " _Onset of depression more complex than a brain
               | chemical imbalance. It 's often said that depression
               | results from a chemical imbalance, but that figure of
               | speech doesn't capture how complex the disease is.
               | Research suggests that depression doesn't spring from
               | simply having too much or too little of certain brain
               | chemicals._"
               | 
               | - https://www.health.harvard.edu/mind-and-mood/what-
               | causes-dep...
               | 
               | and
               | 
               | > " _Analysis: Depression is probably not caused by a
               | chemical imbalance in the brain - new study_ "
               | 
               | - https://www.ucl.ac.uk/news/2022/jul/analysis-
               | depression-prob...
               | 
               | (These are not thoroughly checked articles, they're the
               | first few search results; however claims that depression
               | _is caused by_ a chemical imbalance ought to be able to
               | show where that idea originated, how the imbalance is
               | measured in patients, where that hypothesis is supported
               | by evidence, why antidepressents don 't fix depression in
               | half of patients, and several more suspicious things).
        
               | Forgeties79 wrote:
               | I didn't say it was simply that. You're twisting my words
               | and these studies to discount all of behavioral health.
        
               | jodrellblank wrote:
               | Yes you did. No I'm not.
               | 
               | (I've written paragraphs and paragraphs thinking through
               | some of my views in this thread. You wrote three words
               | naming a thing which doesn't seem to exist. If you want
               | more engagement, engage more. What words am I twisting?
               | Where did you say it was anything more detailed than
               | that? What behaviour that people "can't control alone"
               | are you talking about?)
        
               | Forgeties79 wrote:
               | I did not and I am telling you I do not believe that it
               | is that simple. You do not need to waste time arguing
               | against your incorrect interpretation of my comment. If
               | you need me to say I could have phrased it better, sure,
               | I could have phrased it better. But I am now telling you
               | exactly what I mean and think so we don't need to do this
               | song and dance.
               | 
               | For emphasis: I do not think it is simply/exclusively
               | "chemical imbalance."
        
               | jodrellblank wrote:
               | But why do you think it is _at all_ "chemical imbalance"
               | when that doesn't seem to be an actual thing? What
               | evidence convinced you? What measurements were taken on a
               | human brain to diagnose the imbalance?
        
               | 16bitvoid wrote:
               | That's incredibly reductive. I'm sure some people's
               | depression can boil down to a matter of perspective, but
               | it's naive to extrapolate that to everyone with
               | depression.
               | 
               | I'm incredibly optimistic and am content with my position
               | in life. My default state is being mindful of the present
               | and I don't think about things too far into the future. I
               | very rarely ever feel stressed out over things in life.
               | 
               | However, none of that changes the fact that I feel
               | completely empty and find no joy in things. Interests are
               | nearly non-existent, emotions dialed to 1, and the only
               | thing I'm motivated to do is lay in bed staring at the
               | ceiling... unless I'm on sertraline.
               | 
               | Admittedly that's just anecdotal, but I worked in a
               | clinical neuroscience lab researching treatments for
               | severe treatment-resistant depression (read: people who
               | tried so many options including CBT that they even tried
               | electroshock therapy). The _only_ thing that helped those
               | subjects was a regimen of personalized neuroimaging-
               | guided transcranial magnetic stimulation for 10 minutes
               | every hour for 10 hours every day for a week. Even then,
               | it wasn 't permanent. Some saw improvement for months,
               | others only weeks.
               | 
               | For some people, it's not just a matter of "perspective".
        
               | kanbankaren wrote:
               | > I feel completely empty and find no joy in things.
               | 
               | Maybe the idea that we should find joy and feel full is
               | wrong?
               | 
               | We are on a random planet circling a random star in an
               | unfathomable Universe.
               | 
               | STOP looking for meaning and you are liberated. The quest
               | for meaning by itself might be exhausting and makes you
               | feel depressed.
        
               | 16bitvoid wrote:
               | Who said I'm looking for meaning? I'm not.
               | 
               | It's not as liberating as you might think. A joyless
               | existence is either suffering or nothingness. A life
               | without meaning, either internal or external, is one
               | where nothing is meaningful with no motivation thus one
               | of crippling catatonia til death.
               | 
               | All I can say is just that it doesn't feel good and if
               | you can't feel good about anything, your calculus of your
               | life inevitably leads to the conclusion that existence
               | isn't worth it.
        
               | trilogic wrote:
               | There is only one cure/hack for Nihilism or similar...
               | 
               | Go somewhere where you need to work physically you az off
               | to afford daily food. You will be so exhausted eventually
               | that: 1 you will not have any energy left for thoughts. 2
               | If you have any energy left, you will give it to
               | angriness which will lead to other circumstances which
               | are none related to find the meaning of life.
               | 
               | Ignorance may lead to happiness and friends :)
        
               | 16bitvoid wrote:
               | I think a lot of people are conflating depression with
               | "bad thoughts". That's just one possible symptom, usually
               | as a result of a combination of both anxiety and
               | depression.
               | 
               | I didn't have anxiety, just depression. I rarely thought.
               | I existed on autopilot. I was physically exhausted on a
               | daily basis as a division 1 athlete in college. Often
               | went days without eating either because I simply forgot
               | to eat or forgot to make time for it between classes and
               | training. Didn't change anything.
               | 
               | I think something people are forgetting is that
               | motivation is either driving you toward something you
               | want _or_ driving you away from things you specifically
               | don 't want. A complete lack of motivation means I wasn't
               | motivated to do anything to get something, _but also_ I
               | wasn 't motivated to anything to avoid something either.
               | I wasn't motivated to eat to avoid hunger pangs. I wasn't
               | motivated to quit my sport to avoid routine physical
               | exhaustion. Instead, my empty autopilot existence just
               | freely acted on the expectations of those around me as a
               | proxy for motivation.
        
               | trilogic wrote:
               | Interesting reply thanks. I would say though, If I were
               | programmed or a program or whatever you name it... I
               | would realize the under statement:
               | 
               | If One can't be happy with what One have now, One will
               | never-ever be in any circumstances.
               | 
               | This is not your case certainly but is connected with the
               | autopilot (meaning we don't get to choose.
        
               | moron4hire wrote:
               | Yeah, most folk get the causation backwards. They think
               | having meaning in life will pull you out of depression.
               | It's the other way around. You have to get pulled out of
               | depression to be able to find meaning in your life.
        
               | trilogic wrote:
               | Realizing that some "chemical reactions" can change your
               | destiny then further learning that when you want
               | something, all the universe is bound to conspires in
               | helping you to achieve it.
               | 
               | This one came out good :)
        
               | sameesh wrote:
               | If its not just a matter of perspective and only
               | medication can help, etc, then why do we call depression
               | a "psychological" or "mental health" concern? Why isn't
               | it just considered a neurological disease?
        
               | thewebguyd wrote:
               | Depression is increasingly starting to be seen as a
               | neurobiological disorder as we learn more.
               | 
               | In my own opinion, we need to stop viewing "mental
               | health" as a separate class of conditions from
               | general/physical health. A mental illness is a
               | health/medical condition just like any other and shifting
               | our views and diagnostic criteria in that direction would
               | do a lot to remove the stigma associated with mental
               | illness.
               | 
               | Someone with depression has a chronic illness, not a
               | temporary "it's just in your head" condition.
        
               | seba_dos1 wrote:
               | Not sure what your point is, many mental health concerns
               | are caused by neurological diseases.
               | 
               | In case of depression in particular, it appears to be a
               | label given to a big bag of various issues you may have
               | causing similar symptoms.
        
               | citrin_ru wrote:
               | I'm not telling it's a matter of perspective, my point is
               | that I see no objective metrics to tell apart if the
               | situation is bad so it's one expected to be depressed and
               | when the situation is good (so only medication / therapy
               | would help). And it makes discussions around this topic
               | harder.
        
               | sfn42 wrote:
               | Depression and pessimism are not the same thing.
        
             | arghwhat wrote:
             | > Chemistry trumps psychology
             | 
             | To nitpick: The mind is applied biochemistry. Psychology
             | intervenes in the chemistry, like many other activities do.
             | The goal of that is to solve the root cause so that your
             | future levels will be maintained at the right level,
             | instead of just forcing the level by sourcing the
             | respective chemicals externally.
             | 
             | A good rule of thumb in biology and particular any kind of
             | hormone production and balance is "use it or lose it" - if
             | you start regularly receiving something externally,
             | internal production will scale back and atrophy in
             | response, in many cases permanently.
        
               | Roark66 wrote:
               | >A good rule of thumb in biology and particular any kind
               | of hormone production and balance is "use it or lose it"
               | - if you start regularly receiving something externally,
               | internal production will scale back and atrophy in
               | response, in many cases permanently.
               | 
               | There are ways to "hack it".
               | 
               | For example, ~6 months ago I started trt (testosterone
               | replacement). It was the best decision health wise ever.
               | I feel way better psychologically, first time in my life
               | I managed to stick with cardio training for so long
               | (before 3 months was the most). There are other benefits
               | too.
               | 
               | So what about the "loose it" part? Well there is a
               | hormone called HCG one can take a twice a week to trick
               | one's balls into producing some natural testosterone. Its
               | use prevents atrophy and infertility.
        
               | fwipsy wrote:
               | Psychology can change neurochemistry but only in certain
               | limited ways. Many people are on antidepressants long
               | term because that's the only thing that works for them.
               | Taking antidepressants is already stigmatized enough.
               | People should just do what makes them feel best over the
               | long run. Your rule of thumb does not trump hard-won
               | personal experiences.
               | 
               | We don't really know how SSRIs work, but there's some
               | evidence that it's through desensitizing serotonin
               | receptors, not directly addressing the lack of serotonin.
               | If so, "use it or lose it" doesn't apply; long-term
               | adaptation is the point, and SOMETIMES does persist after
               | quitting.
        
               | pixl97 wrote:
               | >A good rule of thumb in biology and particular any kind
               | of hormone production and balance is "use it or lose it"
               | -
               | 
               | Very basic and very often wrong rule, so take it with a
               | grain of salt.
               | 
               | Insulin for example is the opposite. "lose it then use
               | it" would be a general rule for type 2 diabetics where
               | insulin resistance commonly due to weight gain is the
               | primary problem. Losing the weight leads to better uptake
               | and usage. For a type 1 "lose it then use it" you
               | typically lose the ability to produce insulin to an an
               | autoimmune disorder, then are stuck using insulin for the
               | rest of your life.
               | 
               | The body itself typically attempts to main homeostasis,
               | but at population scales this is something that is going
               | to have a massive range of ways it shows up. Evolution,
               | at grand scales, doesn't care if you survive as long as
               | enough of your population survives and breeds. At the end
               | of the day you might just be one of those people that was
               | born broken and to work properly you need replacement
               | parts/chemicals. A working medical system should be there
               | to figure out which case is which.
        
             | jodrellblank wrote:
             | The parent commenter describes seasonal Winter depression.
             | If the problem was brain chemistry, wouldn't it be with
             | them from birth until treatment? Who has Seasonal Type 1
             | Diabetes, or Seasonal Dwarfism, or Seasonal Missing-an-Eye-
             | From-Birth? Depression generally isn't something children
             | have from birth, it's something adults get temporarily.
             | 
             | A few HN submissions recently are in the style " _thinking
             | about doing the thing is not doing the thing. Planning the
             | thing is not doing the thing. <etc etc>. Only doing the
             | thing is doing the thing_". Comparing a brain to a large
             | software project with bugs hiding in it, in that vein
             | giving the computer 11 hours of 'sleep' each night is not
             | debugging the code; overclocking or undervolting the CPU is
             | not debugging the code; installing the latest updates and
             | patches is not debugging the code. 'knowing there is
             | nothing to worry about' is not debugging the code. Only
             | debugging the code is debugging the code. Reading a badly
             | explained idea on an internet comment and dismissing it
             | with a mocking "thanks I'm cured" isn't debugging the code.
             | Saying "I've tried everything" isn't debugging the code.
             | 
             | A more specific example, if you are going on a
             | rollercoaster and you are experiencing physical and mental
             | symptoms of worry - nervous, anxious, angry at the person
             | pushing you to ride, twitching and trying to back away,
             | eyes looking around searching for an exit, coming up with
             | excuses to do something else instead, nervous shaking,
             | dread tightness in the chest, affected breathing,
             | perspiring, gritted teeth, etc. etc. then washing over all
             | that with " _I know there is nothing to worry about so this
             | must be a problem of brain chemistry_ " seems a clearly
             | _incorrect_ conclusion.
             | 
             | Such a person clearly _has_ a worry. Quite likely one that
             | 's out of proportion (e.g. "rollercoasters kill thousands
             | of people every day!"). Possibly one that's completely
             | incorrect (e.g. "going more than 10mph makes people's
             | insides fall out!"). Quite likely a less clear and less
             | obvious one - which could be anything, e.g. they saw a
             | documentary about a rollercoaster which behaded a child and
             | that's their only thought about rollercoasters; they saw a
             | show about fighter pilots pulling high-G maneouvres and
             | passing out and think that will happen to them on a big
             | rollercoaster; they see the rollercoaster track and support
             | flexing and don't understand that a some flexibility
             | doesn't mean weakness; they went to a theme park as a child
             | and older children bullied them into riding a scary ride
             | and they wet themselves and figuratively died of shame and
             | buried the memory; they were pushed into learning to drive
             | at 15 by their wicked stepfather and this is pattern
             | matching to the same kind of experience; etc. etc.
             | 
             | Saying "there is nothing to worry about, rollercoasters are
             | safe enough and you know it, so your brain chemistry must
             | be broken" isn't debugging the problem. It isn't even
             | explaining the problem. Why would broken brain chemistry
             | particularly affect them at a theme park, or in Winter, and
             | not the rest of the time? How was this broken chemistry
             | identified and measured and quantified and that hypothesis
             | proven?
             | 
             | Likewise, just because the parent poster has tried sleeping
             | and exercising and taking Vitamin D, doesn't address that
             | humans evolved in Africa, connected to oceans and trees and
             | tribal living, and not commuting to a fluourescent lit
             | beige box filled with strangers writing JavaScript while
             | being bombarded with news items about wars and genocides
             | and stories of how everyone else is having a wonderful
             | Christmas, earning more money than you, with a cost of
             | living crises always on their mind, etc.
             | 
             | > " _Good enough chemistry enables cognitive treatments._ "
             | 
             | Drugs can force people to carry on with a life that's
             | making them miserable when they have no other available
             | options to find out why and fix it. That isn't evidence
             | that "there is no root cause"(!). Any more than turning it
             | off and on again can let you get on with your job, but that
             | doesn't show there's no root cause for a program locking
             | up.
             | 
             | > " _then you deduce that the black cloud is produced
             | within._ "
             | 
             | And you have a lifetime of your prior experiences affecting
             | your mood. When you remember that your aunt hit you when
             | you swore at the dinner table, or you saw someone slip on
             | ice and fall over and break their wrist, or watever, every
             | life learning experience is "the mood is produced within".
        
               | Noaidi wrote:
               | > If the problem was brain chemistry, wouldn't it be with
               | them from birth until treatment
               | 
               | Ha, of course it can be! Our brain chemistry is not
               | stable through our life! Many children are born with
               | epilepsy, but some people develop it later in life.
               | epilepsy, like all neurological disorders are nature AND
               | nurture, genes AND the environment.
               | 
               | Using your roller coaster analogy, there very well may be
               | genes that control; how much fear someone experiences
               | when riding a roller coaster. The problem society has is
               | telling people that they all should be able to not have
               | feear riding a roller coaster and if youa re too afraid
               | to ride a roller coaster you should take xanax.
        
               | jodrellblank wrote:
               | > " _Our brain chemistry is not stable through our life!_
               | "
               | 
               | Citation requested. Because, y'know, it's not like your
               | leg muscles suddenly don't work from age 40-50 and then
               | start working again and we say it's because of unstable
               | "leg chemistry". It's not like your stomach, liver,
               | kidneys, <organs> suddenly stop working after you lose
               | your job or your life partner and we say it's both
               | inexplicable and because of a deficit of "body chemicals"
               | and nod agreement with each other that "body chemistry
               | isn't stable" through a lifetime.
               | 
               | These are just unsatisfyingly crappy non-explanations.
               | 
               | And quick attempts to assume that Doctors,
               | Neuroscientists, Psychiatrists, Psychologists must have a
               | better detailed knowledge of brain chemistry and I'm just
               | falling for nonsense seems to find that they actually
               | don't, and they don't agree that "brain chemistry" is a
               | good explanation, and it can't be measured in a patient,
               | and the idea isn't strongly supported by evidence, and
               | even the mechanism of action of "drugs which correct
               | brain chemistry" isn't agreed on, and when given to
               | people to "correct brain chemistry" it often doesn't make
               | the problem that was blamed on brain chemistry go away.
               | 
               | > " _there very well may be genes that control; how much
               | fear someone experiences when riding a roller coaster._ "
               | 
               | I will lump "genetics" in as another pet-hate
               | unsatisfyingly crappy non-explanation that people tag
               | onto whatever they want so they can stop thinking about
               | it further. There probably are many genes which affect
               | how much fat bodies store, or burn, or food cravings, or
               | what constitutes hunger, or production of various leptins
               | and grehlins and insulins and stomach acids, but that
               | doesn't mean "I'm obese because of my genetics" is any
               | kind of explanation at all. Or "I have this personality
               | because my parents and grandparents had it, it's genetic"
               | is an explanation. Downe's Syndrome is a good use for
               | genetics as an explanation. "I have a macro-scale set of
               | vaguely related behaviours, symptoms and body effects and
               | no clear cause, it's my genetics" isn't.
               | 
               | Even if you have sequenced your genome, and have some
               | specific gene that is associated with extra fat storage,
               | genes can be turned on and off through a lifetime by
               | behaviours and environment. Having a gene from birth
               | doesn't mean it's being expressed and is therefore
               | causing a specific problem, or that the problem can't go
               | away and can't be fixed. ( https://www.cdc.gov/genomics-
               | and-health/epigenetics/index.ht... )
               | 
               | > " _The problem society has is telling people that they
               | all should be able to not have feear riding a roller
               | coaster and if you are too afraid to ride a roller
               | coaster you should take xanax._ "
               | 
               | I agree with this. Society likes assuming everyone is the
               | same. Imagine if we collectively noticed that Adrenaline
               | gives people "a burst of strength" and decided that daily
               | exercise, individual strength training plans, gym visits,
               | were all too much bother and that ageing adults were
               | suffering from "an imbalance of Adrenaline" and when they
               | struggle to carry their massive haul of groceries in from
               | their car they should carry an auto-injector of
               | Adrenaline to help their chemical deficiency.
        
               | Noaidi wrote:
               | > Citation requested. Because, y'know, it's not like your
               | leg muscles suddenly don't work from age 40-50 and then
               | start working again and we say it's because of unstable
               | "leg chemistry".
               | 
               | Ohhh, leg chemistry, good choice! You know that leg
               | "chemistry" is control by neurotransmitter release, yes?
               | So you must have never heard of Familial Periodic
               | Paralysis then. Let me tell you what happens with that,
               | because it happened to me while taking Seroquel. Familial
               | Periodic Paralysis is also called Hyperkalemic periodic
               | paralysis and is due to mutations in the gene that
               | encodes the alpha-subunit of the skeletal muscle sodium
               | channel (SCN4A).
               | 
               | https://www.ncbi.nlm.nih.gov/books/NBK1338/
               | 
               | "The paralytic attacks are characterized by decreased
               | muscle tone (flaccidity) more marked proximally than
               | distally with normal to decreased deep tendon reflexes.
               | The episodes develop over minutes to hours and last
               | several minutes to several days with spontaneous
               | recovery.
               | 
               | Some individuals have only one episode in a lifetime;
               | more commonly, crises occur repeatedly: daily, weekly,
               | monthly, or less often. The major triggering factors are
               | cessation of effort following strenuous exercise and
               | carbohydrate-rich evening meals. "
               | 
               | Look at that! Their muscles stopped and stared working
               | again!
               | 
               | And yes, this happened to me while taking seroquel
               | because it lowered my potassium so much it affected my
               | nervous system.
               | 
               | Any good psychiatrist will tell you that they have no
               | idea what is going on. But that does not mean
               | neurotransmitters cannot be changed and that they do not
               | effect behavior.
               | 
               | > I will lump "genetics" in as another pet-hate
               | unsatisfyingly crappy non-explanation that people tag
               | onto whatever they want so they can stop thinking about
               | it further.
               | 
               | As someone who, as an armature geneticist, helped design
               | a genetic study for Stanford, can I say that I put more
               | energy into thinking about these things over the last 45
               | years than you can even imagine?
               | 
               | >Or "I have this personality because my parents and
               | grandparents had it, it's genetic" is an explanation.
               | 
               | I have my hair color, height, skin color, all the
               | physical traits from my parents, so why do you think the
               | brain is not physical as well? Or or adrenal system? The
               | brain is effected by genetics, this is true as has been
               | shown clearly as a risk for schizophrenia. I have no idea
               | why people think our mood, which is dictated by our
               | thoughts which are created and sensed by our brain, which
               | is a physical organ, does not have anything to do with
               | genetics and neurotransmitters.
               | 
               | and then you go on to talk about epigenetics, like that
               | matters by genes don't? Do you know that genes control
               | the epigentic response? Genes like DNMT1? So people with
               | differences in DNMT1 will have different epigenetic
               | responses?
               | 
               | > I agree with this. Society likes assuming everyone is
               | the same.
               | 
               | So how are we different? nature AND nurture. Genes AND
               | environment. I agree the solution to these problems are
               | wrong, but your solution are just as bad as the ones your
               | are prescribing.
               | 
               | Listen, there are times when our neurtranmitters are
               | supposed to be different, like when we are in pain or
               | when some one dies. But some people, like me, have these
               | changes regardless of the situation and we can like them
               | to other environmental factors like diet, sunlight,
               | weather, etc.
               | 
               | I could tell you whey and why I think am so sensitive to
               | the world but I doubt you would listen, because no one
               | listens, because everyone knows.
        
             | bossyTeacher wrote:
             | Arguably specific chemical patterns don't emerge and
             | persist on their own. Basic causality will indicate that
             | something caused that pattern, whether it is a disorder or
             | a traumatic event. Chemical processes are not random.
             | Otherwise, carbon based life forms would have never lasted
             | this long
        
             | Wojtkie wrote:
             | The neurotransmitter model of mental illness is largely
             | incorrect. It's much more complex than just "Depressives
             | have less serotonin, therefore lets give a reuptake-
             | inhibitor to keep serotonin in the brain".
        
               | Projectiboga wrote:
               | The creator of the Serotonin hypothesis admitted it was
               | wrong, and he shifted to melatonin's precursor later in
               | his career. The challange with any research in this area
               | is Serotonin and Melatonin both affect biological
               | functions by gradient activity not lock and key receptor
               | models. This pair is how plants and animals respond to
               | seasonal changes which vary year to year. Serotonin is
               | the warm and light lide melatonin is for cool and or
               | dark.
               | 
               | My personal preference is to always suggest getting
               | actual daylight on your retina for 20 min three times a
               | week. Not through glasses, including eyeglasses, but can
               | be through eyelids. That loads transferatin, as in
               | transfer, this loads the enzyme that make serotonin. This
               | then allows the body a better chance to make the
               | intermediate between Serotionin and Melatonin, and is the
               | one believed to help. But the patents have expired so it
               | is like an orphan drug now.
               | 
               | https://pmc.ncbi.nlm.nih.gov/articles/PMC3779905/
        
             | naasking wrote:
             | > Chemistry trumps psychology. Good enough chemistry
             | enables cognitive treatments. But to fix the wrong
             | chemistry you need chemistry.
             | 
             | It's not at all clear that chemistry is the root issue. The
             | brain is a synaptic graph that does something. Some graphs
             | can have weird paths that lead to pathologies (maybe bad
             | feedback loops). Chemistry seems like fairly a blunt
             | instrument for bludgeoning a "bad" graph into one that's
             | "better".
             | 
             | Forced habits, like cognitive exercises from psychology,
             | can sometimes rewire the graph by themselves because that's
             | how the brain learns/adapts, but we still don't have a good
             | grasp on how to do this truly effectively in many cases.
             | 
             | That said, the blunt instrument of chemistry can sometimes
             | be useful, particularly if it enhances neuroplasticity, as
             | I think psychedelic research is beginning to show.
        
           | lossyalgo wrote:
           | Also they are often prescribed as a life-long solution,
           | instead of a temporary stop-gap to get through some bad state
           | of mind while, as you said, "tackling the root cause". At
           | some point they will potentially stop working which requires
           | switching meds and often the next one won't work as well,
           | plus, leaving the user stuck with withdrawal symptoms for
           | unspecified amount of time (potentially years) and anti-
           | depressant pushers don't usually warn about this, or even
           | acknowledge it when confronted with "since stopping I have
           | symptom x, y, z".
           | 
           | Source: multiple friends, family and forums (while
           | researching how to help friends & family get off of various
           | SSRIs).
        
             | IAmBroom wrote:
             | They allow me to function. I've gone through various
             | dosages of various types to find the ones that work best
             | for me, but they have never stopped working. They also
             | allowed me to stick with CBT therapy, and after 20 years my
             | therapist told me I didn't need him anymore ("Call if that
             | changes").
             | 
             | Your second paragraph reveals a biased motive behind your
             | opinion.
             | 
             | I'm really tired of reading anti-medicine testimonials from
             | people who had anecdotal bad results. Yes, penicillin won't
             | stop antibiotic-resistant strains of some germs, and in
             | fact may kill people like me if we take heavy doses. That's
             | worse than what you're describing for SSRIs; does that mean
             | doctors shouldn't prescribe it?
        
           | braiamp wrote:
           | > but rather that they're abused by psychiatrists
           | 
           | Doctors of all countries have been under a lot of pressure by
           | patients and health administrators to "fix the issue and
           | quick". The last thing that your doctor wants is giving you
           | pills so you go away, but that's what the context very
           | strongly incentivize. You want doctors to stop abusing pills,
           | stop asking them for immediate fix. Give them less patients,
           | more time and more resources to deal with the health of the
           | population. Also, prevention.
        
             | pixl97 wrote:
             | >Also, prevention.
             | 
             | Prevention is one of those things that when we actually
             | attempt to fix it would have to completely change the world
             | you live in.
             | 
             | Humans are social creatures and a huge part of our mental
             | health is dependant on the society around us. If the actual
             | problem is "wow capitalism is really broken and showing us
             | ads 24/7 that say were not good enough is killing us", then
             | taking a pill is a valid solution because changing the
             | system will take generations or very violent wars.
        
           | chasil wrote:
           | Every time I have a yearly physical, my GP will ask if I have
           | feelings of depression.
           | 
           | I know this road leads to SSRIs at the very least, so I
           | always reply in the negative.
           | 
           | The parent comment hints to me that this might be a mistake.
           | I do not want to become accustomed to an antidepressant, so
           | perhaps my course of action was correct.
           | 
           | I was measured low on Vitamin D, which I've hopefully
           | corrected, and I haven't always eaten fish regularly. Perhaps
           | I should pay more attention to that.
        
             | staticassertion wrote:
             | > I know this road leads to SSRIs at the very least, so I
             | always reply in the negative.
             | 
             | Seems odd. Your doctor can't force you to take anything. If
             | they say "do you want to try X?" just say "No". Not giving
             | your doctor full medical context seems like a mistake - for
             | example, maybe depression would be indicative of another
             | issue, or maybe people who are depressed really shouldn't
             | take a specific medication.
             | 
             | To each their own, and perhaps you have other reasons, but
             | this seems like a less than ideal solution to a very
             | trivial problem if the goal is just to not take an SSRI.
        
               | freedomben wrote:
               | Agreed. A friend of mine is a primary care doctor, and
               | it's remarkable how often people come in for depression
               | and after examination and labs it turns out their
               | depression is heavily influenced by other issues,
               | especially low testosterone or hypothyroid. A lot more
               | people have issues with these than most people realize.
               | There have also been people he has seen who were
               | reporting depression, often where nearly every anti-
               | depressant had been tried, where getting treatment for
               | ADHD massively improved their case and was life changing.
               | As much as people like to hate on Adderall nowadays, for
               | people with ADHD it is miraculous.
               | 
               | Getting treatment for "depression" doesn't always mean
               | SSRIs etc. Sometimes it means treating the underlying
               | condition(s) that are having downstream affects. I would
               | suggest everyone gets their Testosterone levels checked
               | among other common things.
        
               | kmos wrote:
               | I am in that case, low testosterone and hashimoto
               | (hypothyroid), ADHD and big Scolioses. Last weeks I am
               | dealing with insomnias, and had to take pills to sleep
               | and it seems my parasympathic system is in alert mode for
               | years, stress, divorce, ex-kid and older kid, etc.. I
               | stopped SSRI after 21 years for 5 months and its probably
               | causing my insomnias, the brain was not used for missing
               | serotonine and brain don't stop thinking, loop, alert
               | mode.
               | 
               | I am doing several blood analysis with a functional
               | doctor and lyme may be around or was in the body, and so
               | many other things. I was thinking I had lucky gut, but
               | seems negative..
               | 
               | I did get my Vit D up to 65 and I seems to be issues with
               | ADH hormone since kid and probably that makes
               | dehydration. It's a fucking nightmare..
               | 
               | I may only see a testosterone replacement as a solution
               | maybe..
        
               | pixl97 wrote:
               | >often where nearly every anti-depressant had been tried,
               | where getting treatment for ADHD
               | 
               | This is actually a somewhat difficult diagnosis to make,
               | especially when diagnosing adult ADHD without the user
               | documenting and bringing in a well defined log of their
               | behavior (and possibly another person to point out things
               | they don't know about themselves).
               | 
               | >ADHD is a highly heterogeneous disorder with a
               | significant comorbidity rate.
               | 
               | Is thing that you read about in literature around it. And
               | even more common than that is the comorbidity of all the
               | above symptoms, that is ADHD and depression + more in
               | autism.
        
               | grep_name wrote:
               | N=1, but last yearly physical my primary care doctor
               | asked me if I ever had anxiety. I said yes, but that I
               | wasn't really interested in treating it outside of
               | lifestyle change. They asked if I wanted a prescription
               | for prozac, without explaining anything about how to does
               | it or titrate up or down or a time frame. I said I wasn't
               | interested again, and that I particularly didn't want to
               | take any medications that you can't just stop taking one
               | day on a whim (a statement she didn't respond to).
               | 
               | She then proceeded to say "well I'll just write you the
               | prescription anyway and you can do your research later
               | and decide to fill it or not".
               | 
               | I was actually shocked by this interaction, and think
               | about it often. She's a regular family doctor with the
               | local hospital system, and this was just a regular
               | checkup. I answered one question with a "yes, but it's
               | manageable and I think I can handle it with lifestyle
               | change" and then said no twice to medication and ended up
               | with a prescription, which I ignored but don't appreciate
               | having on my record, since it's a false indicator for
               | future prescribing physicians.
        
               | staticassertion wrote:
               | Crazy. I hear such wild horror stories with doctors. I'd
               | never return to a doctor like that, sorry you had that
               | experience. Still, this feels like a case where the
               | lesson is "get a new doctor" not "lie to one" but I
               | understand that circumstances can make that a pain.
        
               | vikingerik wrote:
               | Likely the office was getting a kickback from the
               | supplier for writing that prescription. This is
               | shockingly common in the US. A straight cash payment is
               | prohibited, but it's easy to work around that legally and
               | provide equipment or "compensate" some other expense.
        
             | drumdance wrote:
             | There are also SNRIs, which don't have the sexual side
             | effects. I've done mostly SSRIs but in the last few years
             | I've been on an SNRI called Pristiq and it's the best by
             | far.
        
               | somehnguy wrote:
               | YMMV for sure - I was on an SNRI (Cymbalta) for a few
               | months as an attempt to eliminate nerve pain. It all but
               | destroyed my ability to climax both during and for maybe
               | 6 months after getting off of it.
               | 
               | The brain zaps were also hell if I was even like an hour
               | later than usual to take it
        
               | mrguyorama wrote:
               | Why do you think SNRIs wouldn't have sexual side effects?
               | They still inhibit the reuptake of serotonin just like
               | SSRIs. That's the part that causes (certain) sexual side
               | effects.
        
             | Fischgericht wrote:
             | You really should give some modern SSRI like Escitalopram a
             | chance. It has made my life so much better, and that of a
             | lot of friends, too. The two most common complaints I have
             | heard are:
             | 
             | 1.) It's killing my libido 2.) It's too strong
             | 
             | For 1.) - yes, this is a very very common side effect. And
             | it's logical - you simply get "triggered" less. Applies for
             | me, too.
             | 
             | And 2.) is the same that a lot of people fail to
             | understand: Then try a lower dosage!
             | 
             | Unlike most anti-depressants, where you have to constantly
             | increase the dose because your brain just generates more
             | receptors to fight back, SSRIs hardly wear off.
             | 
             | Also, relax about the "become accustomed" part. Should your
             | Serotonin levels be too low, then they are too low. Just
             | think about it like you think about table salt. It would be
             | just as unhealthy to try to "get off" salt.
             | 
             | All of this being said: There are tons of different kinds
             | of root causes for depression. A good rule of thumb is: Are
             | you depressed because bad things happened to you? Then seek
             | psychological therapy, and potentially combine this with
             | medication in case it would be too painful to uncover the
             | dark things. Are you depressed on a regular basis, but can
             | not name any valid logical reason? Then your brain has a
             | chemical problem, so stop treating it like this is an
             | illness, but do what you would do if your car would turn on
             | the "oil warning" lamp. You can not replace oil with
             | therapy or willpower.
        
           | PurpleRamen wrote:
           | Most forms of depressions have no "root cause" you can fix.
           | Sometimes they have amplifiers or triggers, you might be able
           | to work around, but that also demands first to reach a point
           | where the patient is able to work on something.
        
           | Forgeties79 wrote:
           | > The hate on antidepressants is not because they're not
           | effective, but rather that they're abused by psychiatrists.
           | 
           | I don't know how rampant that problem actually is, but I
           | don't think you should discount the impact of social stigma
           | when it comes to mental health. It is only in the past 10 to
           | 15 years, at least in the US, that mental health has entered
           | the public dialogue in any meaningful sense. Historically it
           | has been a source of massive shame with people expressing
           | embarrassment at their loved ones suffering from mental
           | health crises. And now we have a whole generation of
           | influencers and politicians who are trying to tell people to
           | pour out all their medications, reject doctors wholesale,
           | take their specific brand of colloidal silver, and be free.
           | 
           | I just think this is a lot more complicated than
           | "psychiatrists abuse the diagnosis."
        
           | fc417fc802 wrote:
           | > but rather that they're abused by psychiatrists
           | 
           | Well that but also they have poorly understood long term
           | effects even after being discontinued (in some people, not
           | others) and they don't work for everyone. The latter is
           | probably most of the reason they get hated on. I don't recall
           | the source but a given antidepressant only works for
           | something like 1/3 or less of the population. So take a
           | person not in a great place emotionally, who is also
           | statistically not in a great place in life overall, subject
           | them to an insufferable bureaucratic process, give them a
           | drug that doesn't end up working for them, add in some pretty
           | wild side effects, sprinkle on a few long term effects _that
           | persist after they discontinue the thing that didn 't work to
           | begin with_, and of course you end up with a bad reputation.
           | 
           | The tl;dr is that our understanding of the brain and mood
           | disorders kind of sucks.
        
           | pluralmonad wrote:
           | The US is heavily over-medicated, for sure. The pharma reps
           | are very intimate with our doctors and it expresses as one
           | might expect. If you go to the doc with nearly any
           | significant complaint, you will very likely come away with
           | some drugs. But it is not all doctors; people want easy fixes
           | that do not require any change in habits. Not an easy problem
           | to solve, systemically.
        
             | pixl97 wrote:
             | >people want easy fixes that do not require any change in
             | habits
             | 
             | Because it's easy to say change your habits when the
             | problems are systematic as you say. Cutting yourself off
             | social media, or stopping watching the news isn't easy.
             | Being bullied/stressed about work and not having other work
             | options isn't easily dealt with. Being bombarded with
             | advertising telling you that you suck is not something you
             | can personally deal with.
             | 
             | The US especially has this idea that we're all rugged
             | individualists and any problem we have is our own and not
             | one created by the larger society around us and therefor
             | communal solutions are bad, and you should toughen up.
        
           | Murfalo wrote:
           | The truth about antidepressants is that the majority of
           | people with depression that respond to an antidepressant
           | would also have responded to a placebo. This doesn't mean
           | that their depression isn't real or that antidepressants
           | "don't work". It just means that placebo has a relatively
           | high response rate in trials for depression. The hate is
           | (among other points) because they are only arguably,
           | marginally, better than placebo, and antidepressants also
           | have real side effects (activation syndrome, increased
           | suicidality, sexual side effects, withdrawals, etc.) over
           | placebo.
        
             | andruby wrote:
             | > The truth about antidepressants is that the majority of
             | people with depression that respond to an antidepressant
             | would also have responded to a placebo.
             | 
             | ^ citation needed
             | 
             | What does "would have responded" mean? Are you saying that
             | >50% of people with depression that are "helped" by
             | antidepressant, would have been helped _to a similar
             | extend_ with a placebo?
        
               | arghwhat wrote:
               | I believe that is indeed what they meant. The perception
               | of being given a remedy is very powerful indeed,
               | especially for issues ultimately linked to the mind.
               | 
               | That placebos can work should not be seen as undermining
               | the severity or pain of the depression, but rather
               | underline the power of tricking the mind into
               | improvement.
        
             | IAmBroom wrote:
             | > The hate is (among other points) because they are only
             | arguably, marginally, better than placebo
             | 
             | Only true for some. Inarguably, well-proven false for
             | others.
             | 
             | Likewise, placebos and aspirin are comparable at relieving
             | those headaches where aspirin doesn't really solve the
             | source, but that doesn't mean aspirin's well-documented
             | effects are meaningless in general.
        
           | raincole wrote:
           | > it's more of a "here, take these indefinitely"
           | 
           | And when you question this approach, the famous lecture
           | comes: "but diabetes patients take insulin for life. You
           | realize depression is a real condition and need to be treated
           | right?"
        
           | DauntingPear7 wrote:
           | Yeah some people pop a melatonin every night before bed
        
           | chickensong wrote:
           | > I have the impression that's exactly what people do in the
           | USA?
           | 
           | It's not a great idea to make general assumptions about such
           | a large and diverse country. Some drugs may be over
           | prescribed, I have no idea if Ambien is one of them, but
           | trying to fit 340 million people across 50 states into the
           | same box isn't going to be very accurate.
        
           | cameronh90 wrote:
           | I suffer from severe crippling OCD and anxiety. Years of
           | therapy and psychoanalysis have failed to find any cause,
           | and, if anything, made it worse. The best explanation has
           | been it's probably because I'm autistic, and these things
           | tend to happen to autistics.
           | 
           | Luckily, sertraline was an almost instant cure.
           | 
           | I can come off it for periods, but it tends to reoccur after
           | a while. So, it does mean I have to take a drug indefinitely,
           | but is that really a problem? It turns my life into one worth
           | living.
           | 
           | The reason we can't take sleeping pills daily is because they
           | stop working in fairly short order. But if, like
           | antidepressants (typically), they didn't lose their
           | effectiveness over time, would there even be a problem with
           | using sleeping pills if you had trouble sleeping?
        
             | Aerbil313 wrote:
             | Bit off-topic, but melatonin taken at right doses appears
             | to work very well. (commonly prescribed doses are 10-30x
             | too much and likely cause tolerance). See the post
             | https://slatestarcodex.com/2018/07/10/melatonin-much-more-
             | th...
        
               | corv wrote:
               | I've heard this before that common doses are
               | unnecessarily high but why is that? Patents?
        
               | zemvpferreira wrote:
               | Rather, lack of. Melatonin is over-the-counter, generic,
               | badly understood by the people taking it and dosed
               | according to personal preference which means marketing it
               | is all abouy big numbers. Bigger number on package = more
               | sales.
        
               | quietsegfault wrote:
               | > why is that
               | 
               | Why buy 1mg pill when you can buy 100mg pill?
        
               | temp0826 wrote:
               | Even funnier is that often 0.25mg or 0.5mg is closer to
               | the correct dose, and those sizes tend to be hard to
               | find.
               | 
               | There actually is a condition that calls for extremely
               | high (100mg+ doses), but it is a _very_ rare thing, no
               | one should ever consider that much without instruction
               | from a doctor. But you 'll find it right next to the
               | normal <=5mg doses without any explanation.
        
               | calfuris wrote:
               | The Natrol liquid isn't usually too hard to track down.
               | They advertise it as 1 mg or 2.5 mg, but it's the same
               | stuff, the bottle just direct you to take 4 or 10 mL
               | respectively.
        
               | Projectiboga wrote:
               | So 1ml (20 drops) would yeild an average dose of .25mg in
               | that form.
        
               | kstrauser wrote:
               | They're considered dietary supplements and not medicine,
               | so they're not meaningfully regulated in the way meds
               | are.
        
               | Projectiboga wrote:
               | The help aiding sleep is only one function for melatonin.
               | The reason for higher suggested doses is due to its anti-
               | oxident function. From personal experience melatonin
               | needs to be paired with vitamin e to really clear out
               | over night. I take vitamin e as I get into bed right
               | before I take a melatonin sublingual. Another benefit of
               | melatonin is that it upregulates our insulin receptors.
        
             | andai wrote:
             | I'm not an expert so maybe someone else can clarify
             | further, but in relation to sleep medications I've heard
             | that they should not be used for more than two weeks, or
             | they can permanently fuck up your sleep cycle.
             | 
             | They also give you low quality sleep, because they just
             | knock you out. It's not a natural kind of sleep.
             | 
             | At least that's how it was a while ago. Maybe the situation
             | has improved.
        
               | FuriouslyAdrift wrote:
               | I used ambien for sleep and provigil for mindfullness
               | (the go/no go packets) during long deployments in the
               | military and it took me years to get back to anything
               | normal after leaving the Army. These are very powerful
               | medications.
        
               | lII1lIlI11ll wrote:
               | > At least that's how it was a while ago. Maybe the
               | situation has improved.
               | 
               | Fortunately it has. Orexin antagonists don't cause
               | dependency and provide high-quality ("natural") sleep.
        
           | andrewl wrote:
           | "It's like if we took sleeping pills every time we had
           | trouble sleeping. Having said that, I just realised I have
           | the impression that's exactly what people do in the USA?"
           | 
           | Not that my personal experience is actually a statistically
           | significant sample, but I don't know anybody who takes
           | sleeping pills. Or maybe I do, but they haven't told me. I've
           | also never heard heavy sleeping pill use is one of the
           | stereotypes about Americans. There are an estimated 342
           | million people in the United States, so impressions aren't
           | always meaningful.
        
           | Aurornis wrote:
           | > The hate on antidepressants is not because they're not
           | effective,
           | 
           | But that's exactly what many claim. Even this article is
           | trying to claim that Vitamin D has 4.5X higher effect size
           | than antidepressants (e.g. that they don't work)
           | 
           | > It's like if we took sleeping pills every time we had
           | trouble sleeping. Having said that, I just realised I have
           | the impression that's exactly what people do in the USA?
           | 
           | USA is actually not the world leader in over medication in
           | this domain, even though it's popular and safe to hate on
           | Americans. The rates of benzodiazepine and Z-drug
           | prescription in some countries like France are substantially
           | higher than the USA.
        
             | mrguyorama wrote:
             | The "hate" on antidepressants is mostly from a place of
             | "The kids are taking pills for things that aren't diseases
             | and just need to get out more" and other stupid takes about
             | how "back in my day we didn't have this much mental
             | illness", which is why the hate is maintained even for
             | things like ADHD medications which are so thoroughly proven
             | scientifically that they are one of the best proven
             | treatments humans have access to for _any_ disease.
             | 
             | Similarly, SSRIs have much better evidence in treatments
             | for many other situations, like anxiety, and yet the
             | medicine itself is attacked, not using it to poorly treat a
             | disorder we barely even begin to understand.
             | 
             | The "hate" is not based in science, despite the fact that
             | SSRIs are objectively a mediocre treatment for depression.
             | 
             | We just don't really have much in terms of better
             | treatments because we know so damn little about depression.
             | 
             | The medical community _knows_ SSRIs are mediocre and have a
             | low success rate at treating depression. They don 't have
             | better tools. _Everything_ is a bad treatment for
             | depression because  "depression" is a loose collection of
             | symptoms and statistics that we have really poor
             | understanding of, and will certainly be broken up into the
             | actual _diseases_ that make it up when we figure them out,
             | and we will be able to medicate those diseases more
             | effectively.
             | 
             | Every single doctor that would prescribe you an SSRI for
             | your depression will _also_ prescribe vitamin D
             | supplementation if your blood shows low levels.
             | 
             | Someday we will also have a situation where we are going to
             | have to admit that for some subset of the population, their
             | depression has no cause other than "Your life is utterly
             | terrible, for reasons entirely outside of your control, and
             | nothing I can do as a medical professional can fix that".
        
               | pixl97 wrote:
               | >The "hate" is not based in science
               | 
               | The lingering roots of Calvinism in the US cause us all
               | kinds of problems.
               | 
               | "You were born broken because god made you that way,
               | don't make yourself better, and hurry up and die"
               | permeates huge parts of our culture. It's why lots of
               | other cultures look at us and what we do with relative
               | confusion.
        
               | wolvoleo wrote:
               | Yeah in Holland too. I deeply despise our Calvinist
               | roots. It's so depressing.
        
           | FatherOfCurses wrote:
           | "Imagine if we took insulin every time our pancreas failed to
           | properly process sugar."
        
           | elil17 wrote:
           | Wellbutrin can/should(?) be taken indefinitely and there's
           | nothing wrong with that, it doesn't pose big long term health
           | risks. As I understand it the issue is with SSRIs (they do
           | pose health risks, obviously there's nothing wrong with
           | taking them if it is a net positive for you).
        
           | jlebar wrote:
           | > Ideally, a professional will prescribe them as a necessary
           | helper to becoming (more) mentally healthy whilst tackling
           | the root cause.
           | 
           | I wish people would stop saying this.
           | 
           | Our understanding of the brain is not sufficiently
           | sophisticated to allow us to identify the "root cause"
           | (whatever that means) of depression in most people. Indeed we
           | have no reason to believe that there even _is_ a root cause
           | to most people 's depression.
           | 
           | If you take antidepressants, go to therapy (or meditate or
           | exercise or whatever), then go off them and still feel good,
           | that's great.
           | 
           | And if you take antidepressants indefinitely because doing so
           | improves your life, that's also great! Your life is improved!
           | This isn't an "abuse" of the drugs.
           | 
           | No psychiatrist is making you do anything. They're advising
           | you based on their clinical judgement and experience, but
           | ultimately it's your decision to take the pills or not. If
           | your goal is to go on antidepressants temporarily, any decent
           | psychiatrist will support you in that (because, again, they
           | understand that they can't make you take the pills one day
           | longer than you want to).
           | 
           | I've been on Lexapro and done evidence-based therapy for
           | years. They both have been helpful, but if I had to pick one,
           | I'd immediately pick Lexapro. For me it is a miracle drug.
           | And the miracle is, I can choose how I feel.
           | 
           | (I also added a small dose of Buspar to help with the sexual
           | side-effects.)
           | 
           | If you're on the fence about trying an antidepressant, I
           | really encourage you to talk to a psychiatrist. If you try it
           | and hate it, then you can stop. But a lot of people try it
           | and love it. And I think a lot more people would be willing
           | to try it if the notion that this is somehow "wrong" were
           | gone.
           | 
           | For further reading I recommend
           | https://lorienpsych.com/2021/06/05/depression/. I don't agree
           | with everything Scott Alexander says, but his writing about
           | mental health specifically has been useful to me.
        
             | tootie wrote:
             | I was diagnosed a while back with a chronic neurological
             | disorder. One that has a heavy effect on my mood and can
             | conversely be triggered by my mood. The underlying cause is
             | scientifically proven to be physiological. I lack a
             | specific neurotransmitter due to inactive cells in my
             | hypothalamus.
             | 
             | For a long time I wrote off my symptoms as being all in my
             | head. And after a formal diagnosis, I am 100% certain they
             | are all in my head because that's where my brain is.
             | Symptoms are also unequivocally psychosomatic. What I'm
             | feeling can influence my physical symptoms and rather
             | abruptly at that. It's right in the definition of the
             | illness. None of this means that disease is imaginary or
             | not real or I can talk myself out of it. It's as physically
             | irreversible as losing an arm. There are some very good
             | treatments, but I will never ever be cured (barring a
             | miraculous breakthrough).
             | 
             | While the causes of mood or personality disorders are less
             | well understood, it seems entirely plausible that they can
             | be just a physically inevitable. Every thought, feeling,
             | sensory input and motor output is a physical process
             | originating in your brain and your brain can malfunction if
             | it's ill. And we can treat illness with medicine.
        
           | andai wrote:
           | > It's like if we took sleeping pills every time we had
           | trouble sleeping. Having said that, I just realised I have
           | the impression that's exactly what people do in the USA?
           | 
           | I can't speak for USA but in parts of Europe a lot of people
           | have PTSD that prevents normal sleep, so they end up on these
           | pills, and then they end up with PTSD and _worse_ insomnia
           | caused by long term use of sleep meds.
           | 
           | I think it's just incentives. Easier to take a pill than to
           | deal with horrible trauma. And that probably stays true
           | forever.
        
             | pixl97 wrote:
             | The easiest way to deal with horrible trauma is to prevent
             | said trauma in the next generation.
             | 
             | What is either revealing or terrifying is seeing how many
             | people attempt to prevent that. Sexual abuse for example is
             | pretty rampant in the US. Sexual education at a young age
             | so people know they are being abused under no uncertain
             | terms is a good solution for this.
             | 
             | And yet you will run into far too many people that under no
             | uncertain terms want their children to be excused from sex
             | abuse education. What deeply concerns me is when you see
             | people with this position that you know where sexually
             | abused themselves.
             | 
             | I don't know, people really suck.
        
           | shermantanktop wrote:
           | > I just realised I have the impression that's exactly what
           | people do in the USA?
           | 
           | How would you have formed that impression? Whatever media and
           | culture you're consuming, or how you are interpreting it, is
           | leading you to incorrect conclusions. You should examine
           | that.
           | 
           | We all live in a cultural bubble but any time you find
           | yourself thinking that millions of people somewhere else do
           | something crazy, you should probably talk to someone from
           | there.
           | 
           | Sleeping meds might be prescribed at a higher rate in the US,
           | that wouldn't surprise me due to the specific incentives in
           | our health care system. But that's a far cry from your
           | impression.
        
           | LordDragonfang wrote:
           | It's not like sleeping pills at all actually. Sleeping pills
           | have a huge dependence and tolerance factor. Antidepressants,
           | generally, do not. Once you find one that works, they keep
           | working effectively forever.
           | 
           | It's _actually_ like statins. Ideally, a doctor will
           | recommend diet changes in addition to the pills. However,
           | relying on lifestyle interventions almost never is effective,
           | And the more we learn about it, the more we realize that
           | cholesterol is mostly genetic based rather than diet based
           | anyway. So the most effective thing they can do is say
           | "here, take these indefinitely". And thank God they do
           | because it saves thousands of lives annually.
           | 
           | For many people with depression, a neurochemical imbalance
           | _is_ the root cause. Just like with statins, addressing it
           | means taking some pills.
        
           | kstrauser wrote:
           | Sometimes the root problem is that your neurochemistry is
           | FUBAR and no amount of counseling with overcome a biological
           | cause.
           | 
           | Frankly, I see this as similar to telling diabetics that they
           | should use just enough insulin to get them to learn to stop
           | being diabetic. That's possible for a few type 2 diabetics
           | who could make lifestyle changes that got them back into good
           | ranges. It's completely useless for type 1 diabetics, or type
           | 2 who can no longer go back.
           | 
           | I'm neither diabetic nor depressed. I don't have a dog in
           | this hunt. I'm just always astonished at "have you tried not
           | being depressed?" Some people can "snap out of it". Many
           | times that number of people cannot.
        
             | thewebguyd wrote:
             | > I'm just always astonished at "have you tried not being
             | depressed?"
             | 
             | There's a lot of this attitude, at least in the USA, when
             | it comes to mental illness in general. I have ADHD, it's a
             | common trope/meme at this point of "Have you just tried
             | focusing?" "Gee thanks, I'm cured!"
             | 
             | It's a form of institutional ableism, particularly
             | prevalent in the US I think because of our hyper
             | individualist culture. A lot of people tend to assume that
             | you are just lazy, or not trying hard enough, as if it was
             | just a matter of willpower.
             | 
             | Kind of frustrating, because those same people would never
             | walk up to someone in a wheelchair and say "have you just
             | tried walking?" but for some reason mental illnesses get a
             | free pass to be ableist.
        
               | kstrauser wrote:
               | That was my experience with ADHD. In retrospect, I
               | clearly struggled with it my entire life, with it
               | starting to cause problems around middle school age. I
               | started getting treatment a couple years ago and it was
               | like someone flipped a light switch. Wait, this is what
               | it's like for everyone else? They can just decide to
               | start doing a necessary thing _before_ it becomes a
               | crisis?!
               | 
               | In before "of course things are easier when you're taking
               | stimulants!", which is another dumb thing I hear too
               | often. I feel basically nothing from taking Adderall, and
               | not in the least stimulated or more alert or more awake
               | or anything. I can just concentrate on boring things
               | afterward.
        
               | pixl97 wrote:
               | What is that they say, if you have ADHD then ADHD
               | medication doesn't act like a stimulant in the same way
               | it affects non ADHD people.
        
               | pixl97 wrote:
               | >in the US I think because of our hyper individualist
               | culture.
               | 
               | Calvinism.
               | 
               | There's been a number of papers written about how
               | pervasive Calvinistic ideas are in the medical community.
               | This tracks with the New England area of the US pumped
               | out the most doctors while medicine was 'growing up', and
               | protestant christianity was the most common form there.
               | When you view the creation of the US medical system with
               | that view many of our screwed up systems make sense. A
               | lack of willpower is a failure of man to be in touch with
               | god, and not a problem a doctor should solve.
        
           | htek wrote:
           | It's a symptom of the "health care" insurance industry. Many
           | people end up paying a specialist doctor's co-pay when they
           | see a psychiatrist. Some plans limit you to a maximum number
           | of sessions you can have (6, in my case) per year. Talk
           | therapy eats up sessions and co-pays like Pac-Man eats dots.
           | One doctor expected me to come in twice a week. Americans
           | don't get all the PTO and/or excused sick time they want to
           | accommodate such a schedule.
        
             | pixl97 wrote:
             | With that said, does anywhere have enough specialists to
             | cover as many sessions as would be needed for as many
             | people would seem to need it?
        
         | biofox wrote:
         | SSRIs saved my life. No exaggeration. They might be
         | overprescribed, only effective is some individuals, and they
         | certainly have their share of side effects, but they're still
         | the gold standard treatment for clinical depression and
         | anxiety.
        
         | graemep wrote:
         | If it is SAD have you tried bright daylight balanced lighting?
        
           | isoprophlex wrote:
           | Yeah, I have an extremely bright lamp designed to tread SAD
           | that I sit, or well used to sit, in front of every morning.
           | Daylight responsive led strip in my home office. And a pair
           | of glasses with blue LEDs for on the go. It did... 10%? of
           | what citalopram eventually did for me.
        
             | graemep wrote:
             | Thanks for the reply. Does the citalopram completely
             | obviate the need for the extra lighting or do you find
             | there is still a benefit to having the daylight lighting
             | too?
        
               | isoprophlex wrote:
               | I've stopped caring for my various lamps. I turn on the
               | bright panel out of habit while working at my desk... but
               | I don't feel "drawn" to it as before. I'd, for example,
               | set my phone to the highest brightness in a dark room to
               | motivate myself to get out of bed, or at least get to the
               | light switch. Now I don't care, I just get up.
               | 
               | And I can look at the dark world outside the kitchen
               | windows in the morning and not feel oppressed. It's just
               | a lack of light, no menacing presence.
        
             | wincy wrote:
             | Have you tried more light? Like, a lot more light? Like,
             | getting a light meter and aiming for 10-20,000 lux in your
             | room? This blog was a good start for me.
             | 
             | https://www.benkuhn.net/lux/
        
         | dizhn wrote:
         | I still think you should have tried eating a banana first.
        
         | luxuryballs wrote:
         | I experienced this but ended up getting off of them after
         | developing some back/hip issues but I didn't think it was
         | related, it wasn't until I quit the citalopram that my
         | shoulders were suddenly relaxed and the hip "looseness" or
         | constant need to be adjusted back into place went away, like
         | everything tightened back up, it is really strange, then I
         | looked up how SSRIs can impact this and even bone healing,
         | decided I couldn't risk my body falling apart.
        
         | kyleblarson wrote:
         | I had disk issues in my lumbar spine that caused nearly
         | unbearable pain and terrible quality of life. Tried everything:
         | PT, OTC painkillers, epidurals, massage, nothing worked. Was
         | prescribed pragabalin and duloxotine. Duloxotine is an SNRI
         | that also treats nerve pain. That combination helped some but I
         | was sleeping 11+ hours per day and generally felt like my head
         | was in a complete fog, was pretty much useless with work. I had
         | been trying to avoid surgery but finally had 2 procedures in
         | 2024 that helped immensely. Weaning off those 2 drugs was no
         | fun: sweating constantly, anxious, headaches for about 2 weeks.
         | Extremely happy I went the surgery route and stopped those
         | meds. I can't imagine living day to day feeling like that.
        
           | freedomben wrote:
           | Duloxetine was indeed a beast to get off of. It got so bad
           | that I would open the capsules and count the number of beads
           | to taper as slowly as possible. It was hell
        
         | Esophagus4 wrote:
         | Tangent... but for sweaty feet, try a ski boot dryer!
         | 
         | You can get them for $50... they dry out my shoes which makes
         | them last a lot longer before they get so smelly I have to
         | throw them away. Plus, who doesn't like warm shoes in the
         | morning?
         | 
         | That, and there are some creams called Sweat Block or whatever
         | you can rub on your feet which reduce sweating. Those work as
         | well.
        
           | aweiland wrote:
           | You can also 3D print them:
           | https://www.printables.com/model/194340-60mm-radial-fan-
           | boot...
        
           | larrywright wrote:
           | Also try wearing merino wool socks. It seems counterintuitive
           | to put wool on your sweaty feet, but they're quite
           | comfortable and they help you avoid that "clammy feet"
           | feeling when you are sweating in cotton socks. They also
           | don't develop odor the way that cotton does.
        
         | maximedupre wrote:
         | Imaging the number of people that this comment could inspire to
         | get on SSRIs lol
         | 
         | I'm not saying it's a bad.
         | 
         | But I'm also saying there are no magic pills...!
        
         | lr4444lr wrote:
         | They've been losing ground to placebo in more recent research.
         | 
         | Plus, most of the more serious side effects take a lot more
         | time to manifest than the typical length any given patient
         | remained in the older clinical trials that secured FDA approval
         | and grounded the official manufacturer literature.
         | 
         | I am glad we have these tools, but I suspect they are vastly
         | overused, and patients not well informed.
        
         | setgree wrote:
         | I'm glad to hear that. Another frame is that your depression
         | turned out to be "math hard" rather than bodybuilding hard [0].
         | Your disciplined, methodical approaches were steady
         | applications of effort, whereas what you actually needed was
         | easy to implement but hard to envision.
         | 
         | [0] https://www.alexcrompton.com/blog/2017/05/26/hard-is-not-
         | def...
        
         | welshwelsh wrote:
         | How do you know it was the SSRI?
         | 
         | To cherry-pick a quote from a review of SSRI studies:
         | 
         | >the magnitude of symptom reduction was about 40% with
         | antidepressants and about 30% with placebo.
         | 
         | That tells me that antidepressants have some effectiveness, but
         | placebos work shockingly well. You can give someone a sugar
         | pill with no medical properties whatsoever, and a good portion
         | of people will recover, likely crediting the pill for their
         | recovery.
        
         | ncasenmare wrote:
         | Hi, author of the blog post here! Thank you for sharing your
         | experience with antidepressants, I'm really glad it worked for
         | you & made your life better.
         | 
         | I _did_ mention the following at the end of the
         | "antidepressants" section, but reading your comment convinced
         | me to move it further up. The intro now reads:
         | 
         | > The "standardised effect size" of antidepressants on
         | depression, vs placebo, is around 0.4. (On average; some people
         | respond much better or much worse.)
         | 
         | Also, I wasn't expecting my article to do well on Hacker News;
         | thank you everyone for the comments & critiques! I'll edit the
         | blog post as I go along, to refine it in response to your
         | comments.
        
           | marcd35 wrote:
           | Thank you for the blog post! I live in New England and always
           | had the winter blues, always just assumed it was because of
           | the weather but never acted on it.
           | 
           | About a week ago, there was a reddit post claiming it's
           | actually geographically impossible for anyone where I live to
           | produce enough Vitamin D naturally from the sun alone, due to
           | the shorter days and lower angles throughout the day. I had
           | no idea.
        
             | ncasenmare wrote:
             | Thank you! I relate; I live in Montreal, close to New
             | England, with similar climate. The current UV Index for
             | Montreal is... 0. And the current UV Index for Boston is...
             | 0.6. (1.6 later today)
             | 
             | I can't find a rigorous academic source right now, but the
             | top web results all say we need at _least_ UV Index 3 for
             | our skin to be able to make enough Vitamin D. I guess
             | summer may work for us, in the Montreal /New England area,
             | but other than that, yeah, you and I will _need_ to get
             | Vitamin D from diet and /or supplements. And fish is
             | expensive, so supplements it is.
        
           | isoprophlex wrote:
           | My personerino let me be ridiculous and fawn a bit, and tell
           | you that you're one of my internet heroes.
           | 
           | Don't take it as criticism, more of a personal take on
           | figuring out what antidepressants do for me. Furthermore,
           | since posting that parent comment I've converted my vit. D
           | dose to IUs and I realised i'm only taking 800 IUs daily. So
           | a thank you for clueing me in on that, and who knows what
           | happens if I up that. Maybe you were right all along and all
           | i DID need was a _heroic_ dose of vitamin D. (... thats what
           | she said)
        
             | ncasenmare wrote:
             | Aw, thank you for your kind words! I hope the extra D
             | helps! ^_^
        
         | Aurornis wrote:
         | > I won the SSRI lottery I guess,
         | 
         | From reading internet comments you'd think so, but your
         | experience is more typical than anything.
         | 
         | Depression is deceptively common. As a consequence, SSRI use
         | over a lifetime is also more common than most would assume. Any
         | drug will come with negative side effects for some portion of
         | its users. Multiply that by the high number of people who have
         | ever taken an SSRI and it starts to become obvious why there
         | are so many Internet anecdotes about SSRIs not working.
         | 
         | Meanwhile, most people who take SSRIs successfully aren't going
         | around and advertising the fact that they're on psychiatric
         | medications. There is less stigma now than there was in the
         | past, but it's still not something most people like to
         | broadcast to the world. For patients on long term SSRIs in
         | stable states, the SSRI is just a routine thing they take in
         | the background and don't really think about. There's no reason
         | for it to come up in conversation.
        
           | zigman1 wrote:
           | To add to this discussion as someone who had above experience
           | this winter, after (literally) years of mood fluctuations,
           | fatigue and brain fog.
           | 
           | I have started taking SSRI after a harder-than-usual body
           | collapse, and after no matter what I did my mood hasn't
           | improved for a month. Regular running, meditating, writing,
           | crafting, coding etc were my antidote to my mood swings but
           | this time it didn't work. Started taking SSRI and continue
           | doing all this things, and I was reborn.
           | 
           | My therapist said that a big chunk of why i am feeling better
           | is also because I kept doing things that are good for me.
           | That she sees with a lot of her patients that they think a
           | pill will magically change the situation. It doesn't work on
           | itself, you need to show up and do things that release
           | serotonin in your body.
           | 
           | But seriously, unbelievable, years of frustration and
           | friction in my life disappeared and I have never felt better.
        
             | butlike wrote:
             | Why were you getting body collapses?
        
           | steve_adams_86 wrote:
           | > Depression is deceptively common
           | 
           | I didn't even know I had it, but when I was diagnosed, my
           | psychiatrist was very concerned and made a point of
           | encouraging me to keep in touch, making sure I worked through
           | things and engaged with the problem. I initially thought
           | something like "I'm fine, just a little down here and there,
           | I wonder if this person is inventing work for themselves?"
           | 
           | Same with anxiety. I would have told you something like "I'm
           | not an anxious person at all. I don't even know what that's
           | like, though I can sympathize with people who suffer with
           | it". As it turned out, I was suffering pretty severe anxiety.
           | In retrospect it's as clear as day, but at the time it was
           | just... The way life was.
           | 
           | The thing is, all of my assessments remarked that I
           | demonstrated relatively high self awareness and openness. My
           | experience being diagnosed with ADHD and depression made me
           | seriously concerned for people who 1) can't afford this
           | process and support, and 2) will just continue to grind like
           | I was, living half-dead without knowing it can be any other
           | way.
           | 
           | I suspect there are a ton of these people--I think I notice
           | them quite often--and I was arguably accidentally pulled from
           | that stupor and would likely still be there, unaware, if it
           | weren't for a chance encounter that caused me to think
           | slightly differently about the possibility of having ADHD.
        
         | roody15 wrote:
         | Same I am in outstanding physical health and my diet / exercise
         | is excellent. Taking Lexipro has made a massive improvement on
         | my emotional bandwidth. I take vitamin D / fish oil and bits of
         | other supplements. At least for me no question this medication
         | even at a 10mg dose has made a major positive impact.
        
         | raffael_de wrote:
         | Bessel van der Kolk also mentions in his excellent book "The
         | Body keeps the Score" that the effect of antidepressants is
         | correlated with the source of the depression. If the depression
         | is a comorbidity from early childhood trauma then
         | antidepressants are limited due to trauma-related reshaping of
         | how the brain is organized. Cases like yours or those that a
         | related to traumatic experiences as an adult are more the
         | result of a shallow neurochemical imbalance which
         | antidepressants are able to impact beneficially.
        
           | anthonyrstevens wrote:
           | >> "The Body Keeps The Score"
           | 
           | Such a great book. Highly recommended.
        
         | wafflemaker wrote:
         | I'm guessing you can afford spending $300 on light therapy
         | glasses.
         | 
         | Disclaimer: I'm not a doctor, but saw 4 seasons of dr. House.
         | Moreover, few hours of Huberman Lab on sleep and light and most
         | importantly, this episode of Additude Mag Podcast on curing SAD
         | and ADHD day-rhytm shifting with light glasses:
         | https://www.youtube.com/watch?v=fu4mLgkNc6I
         | 
         | What happens in the seasonal affective disorder season is the
         | sunlight pattern diverges from 6-18 that we evolved with.
         | Without daily reminder of getting enough sun (or sun-like)
         | light at the 6 o'clock0, your body clock will drift.
         | 
         | It can start by feeling groggy instead of refreshed in the
         | morning, even if you've slept enough. And can escalate into
         | loosing the will to do anything or even live.
         | 
         | No wonder. You're still an animal. You need to be fed, put to
         | bed, etc. at a specific time. If you try to make your body
         | sleep during the day, and eat and work during what body expects
         | to be night, you won't really sleep and won't really live/work.
         | Enough of not really sleeping and not really living - you mess
         | up your body, your gut biome, your hormonal balance and your
         | brain chemistry. You kind of should get depressed when you do
         | it.
         | 
         | You can steer your body clock with light. Most of us do it, by
         | exposing ourselves to strong (strong enough it won't matter if
         | it includes blue wavelength or not).
         | 
         | But you can do it consciously (and in a way good for you) by
         | putting on light therapy glasses (I'm using Lumiere 31, and
         | they are not the only ones, find your own) at 60 everyday, or
         | right after you wake up if you're trying to readjust your
         | rhythm. Or if you have time and want to save $200, use a
         | stationary lamp and just sit in front of it doing nothing. I
         | don't have the time. When readjusting, small doses of melatonin
         | (0.5mg) 1h before sleep will accelerate body clock shift.
         | 
         | But don't listen to me, if you have SAD, you should really
         | listen to that ADHD experts episode.
         | 
         | I feel for you, struggling with that stuff for a long time. Vit
         | D, fish oil (lot of). All lights at home set to reduce
         | intensity after 18. Strict going to bed routine. Still sleep
         | poorly once in a while, but can do things in winter again. Hope
         | it will help :)
         | 
         | 0: choose whatever suits you. With small doses of melatonin and
         | discipline in using light glasses you can even flip day and
         | night. Just stay consistent, good farmer always feeds his cows
         | at the same time.
         | 
         | 1: at the time of buying ( fall '25 ) they were cheapest and
         | best overall in norway. Solid build, ok battery, can have them
         | on during yoga using attached rubbers and kind of can have them
         | over glasses. Mine are very large and have blue light filter,
         | but I manage 20min without eyeglasses. Medical certificate. Few
         | leds, holo strip, battery and some plastic - my inner Scrooge
         | says it's not worth $285, but everything else was worse and
         | more expensive.
        
           | wincy wrote:
           | I just spent $300 on LED light bulbs. Especially if you have
           | an older house the sockets are all wired up for incandescents
           | so you can just split the socket and run 7 bulbs per socket,
           | I have 30 light bulbs, including two 200W corn bulbs and the
           | rest are "100-200W equivalent"
        
         | Noaidi wrote:
         | Re "citalopram" and "SSRI lottery I guess"...in fact,
         | citalopram is not a true SSRI and in fact no SSRI is only an
         | SSRI as they also on, at increasing doses, many other
         | neurotransmitters like norepinephprine and Muscarinic
         | acetylcholine receptors.
         | 
         | However, citalopram specifically has a big effect on the
         | histaminegma the sigma-1 receptor. I will focus on the sigma-1
         | receptor:
         | 
         | https://www.sciencedirect.com/science/article/pii/S134786131...
         | 
         | Never heard of it? Yeah, don't be ashamed, it is the biggest
         | secret in depression. In fact they are finding that many
         | "SSRIs" are sigma-1 agonists, even prozac.
         | 
         | https://www.frontiersin.org/files/Articles/1691987/fnins-19-...
         | 
         | It tunrs out that Sigma receptors modulate glutamatergic
         | dysfunction in depression, and glutamate, being excitatory,
         | well, you can. make your assumptions from there.
         | 
         | https://www.frontiersin.org/journals/neuroscience/articles/1...
         | 
         | It seems the main function of the Sigma-1 receptor is Calcium
         | release. And calcium ion channels are one of the most studies
         | ion channels in mood disorders. By increasing calcium release
         | you increase neuronal activity, hence, the uplifted mood.
         | 
         | It is too bad that the sigma-1 receptor is just starting to be
         | studied and there is limited evidence of how omega-3 and
         | Vitamin D effect it. But I do know that Vitamin D has a huge
         | effect on SLC6A4 (SERT).
         | 
         | https://www.nature.com/articles/s41598-020-79388-7
         | 
         | I have Schizoaffective Disorder Bipolar Type (disabled) and
         | have been on no less than 14 types of meds. I knwo how they
         | work better than my psychiatrists, which I why I no longer take
         | them. I also know my genetics which gave me clues to what is
         | happening in my body. Now I eat a mostly seafood diet and my
         | needs for meds has mostly vanished. I am still an odd old
         | fellow, but at least I am not ranting in the streets or trying
         | to kill myself anymore.
         | 
         | Meds saved my life, but a diet high in Omega 3, D, and a bunch
         | of other things has removed so much suffering from my life,
         | more than any medication has.
         | 
         | (Also, if you want to get into the weeds of depression, you
         | might wat to look at ATP and depression
         | https://onlinelibrary.wiley.com/doi/full/10.1111/cns.14536)
        
           | anonymous344 wrote:
           | have u ever tried niacin?
        
             | Noaidi wrote:
             | Yes. Made me manic. You know we make niacin in our own
             | bodies, from tryptophan, down the kynurenine pathway. Sine
             | many of the enzymes that are in this pathway need B6 and
             | B2, being low in these may lower endogenous niacin in the
             | body.
             | 
             | https://www.researchgate.net/publication/353319033/figure/f
             | i...
             | 
             | Many people I know, when tested, were low in B6. That is
             | more important to me than niacin.
        
               | ulnarkressty wrote:
               | For others who want to try this, taking too much B6 is
               | associated with nerve damage -
               | https://en.wikipedia.org/wiki/Megavitamin-B6_syndrome
        
               | lII1lIlI11ll wrote:
               | From your link: "The common supplemental form of vitamin
               | B6, pyridoxine, is similar to pyridine, which can be
               | neurotoxic."
               | 
               | Vitamin B6 in p5p form is cheap and widely available
               | alternative.
        
         | throwforthings wrote:
         | The things that keep me away from SSRIs are the potential for
         | addiction and not being able to take psychedelics.
         | 
         | I had a friend on SSRIs not tell us they were on them when they
         | hit a DMT vape pen at a party years ago and they got serotonin
         | syndrome. Had I known I would have warned them not to.
        
           | nerdsniper wrote:
           | It's more "dependency" than "addiction". No one's waking up
           | jones-ing for another hit of their SSRI. Dependency works
           | well because some people are dependent on it like I am
           | dependent on glasses/contacts.
        
             | wincy wrote:
             | Whatever the word, getting off of them is not fun. It took
             | 6 months after getting of Paxil to stop feeling like I was
             | being dropped down an elevator shaft at random times day
             | and night.
        
             | throwforthings wrote:
             | Yeah, that's fair, there's not really a loss of control so
             | dependency is probably the better term. Still, if you go
             | off of them I've seen people get rocked with physical
             | symptoms. I really try to avoid anything that would have
             | such an affect on me physically.
        
         | shevy-java wrote:
         | > This just goes to show that for me, they're extremely
         | effective.
         | 
         | I am not so convinced. Perhaps your case was simpler, but
         | people can feel chronic depression. They may take some drugs to
         | modify that, but what if the external factors won't change? You
         | can see this issue for some people who have a disease that only
         | gets progressively worse. I think we can not unify all this as
         | "dislike on antidepressants" as a one-size-fits-all formula.
        
         | YeahThisIsMe wrote:
         | I had pretty much the same reaction after two days of taking
         | it.
         | 
         | Took a while longer to get the dose right so that my anxiety
         | also mostly disappeared, but the difference in quality of life
         | it made for me is hard to put into words.
        
         | quotz wrote:
         | Have you tried SAD lamp light therapy? But not those lamps you
         | get on amazon or other marketed SAD lamps, those are a scam.
         | Just buy a 2 floodlights that are pretty powerful, say 100 watt
         | each. Works like a charm. 15-30 mins a day its all it takes
        
         | dghlsakjg wrote:
         | As someone that falls on the side of "depression is real and
         | antidepressants can help" it is very clear that there are
         | people in this thread that need to hold their tongues because
         | they know not of what they speak. (Not you OP)
         | 
         | There are some forms of depression that you cannot think or act
         | your way out of. If you haven't experienced that, I promise
         | that you do not understand what it is like. You cannot really
         | understand unless you have experienced it. Your opinion on it
         | is irrelevant, and frequently offensive.
         | 
         | The same is true for people that say that antidepressants are
         | mostly placebo. They are not. When people say that
         | antidepressants saved their life, they aren't joking or
         | exaggerating in the least.
         | 
         | Yes, I understand that other therapies are also effective, and
         | that some people are non-responsive to some drugs.
         | 
         | Keep your pet theories to yourself if you are not a subject
         | matter expert or someone who has experienced it first hand.
         | 
         | Edit: I understand that the placebo effect is still an effect.
         | My point is that there are a lot of people being incredibly
         | dismissive of real lived experiences and outcomes on a VERY
         | serious issue.
        
           | monero-xmr wrote:
           | Lexapro saved my life
        
             | wincy wrote:
             | Lexapro made me feel like I was randomly being dropped down
             | an elevator shaft for 6 months after I stopped taking it.
             | I'm glad it worked for you, and am not minimizing that, but
             | these medications have a side effects profile a mile long
             | and should be a therapy of last resort in my opinion.
        
               | htek wrote:
               | The problem with antidepressants are that while we know,
               | more or less, what they do, we don't know why they work
               | for some and not for others. Escitalopram (Lexapro) was a
               | vast improvement for me over Citalopram. Then it
               | plateaued and a year later, left me anhedonic. Tried an
               | SNRI that would give me brain zaps every day a few hours
               | before my next dose and it was horrendous to quit using.
               | It also messed with my ability to meditate for a long
               | while. Basically, I could put myself in a mental state
               | that would trigger the same kind of painful brain zaps
               | that withdrawal from the SNRI caused.
        
               | avipars wrote:
               | They have a half life and you cannot stop taking them
               | cold turkey without these symptoms, your psychiatrist
               | should help you ween off of it slowly.
        
             | aaronbrethorst wrote:
             | I can't go so far as to say it saved my life, but I'm part
             | of that cohort of 10% of men who develop postpartum
             | depression. Taking a small dosage of Lexapro had zero side
             | effects for me and helped me deal with not just the anxiety
             | and depression I was experiencing but also a lot of pre-
             | existing anxious behavior that I didn't even realize was
             | abnormal.
             | 
             | Huge quality of life improvement. 10/10 would medicate
             | again.
        
           | bawolff wrote:
           | > The same is true for people that say that antidepressants
           | are mostly placebo. They are not.
           | 
           | In fairness, anti-depressants are a lot of drugs. The article
           | gives a list. 23 of them seemed to be better than placebo, 19
           | of them were much less clear.
           | 
           | > When people say that antidepressants saved their life, they
           | aren't joking or exaggerating in the least.
           | 
           | Placebos can also save people's lives.
        
           | marcuschong wrote:
           | I was incapable of the compassion you're talking about until
           | I had a bad shroom trip and felt some horrible, hard-to-
           | describe anxiety the next morning. It was some of the worst
           | hours of my life until my serotonin system rebalanced itself.
           | 
           | I'm not saying it's the same thing as depression or regular
           | anxiety, but it gave me tremendous perspective on how bad
           | these conditions can be and you just don't have the ability
           | to "shake it off" when things are unbalanced.
           | 
           | Maybe that's how my wife feels when she's off the meds. Shit.
           | Now imagine having a douchebag by your side second-guessing
           | your pain. Never again.
        
             | kayodelycaon wrote:
             | > Maybe that's how my wife feels
             | 
             | The good thing is it isn't necessary to know how someone
             | else feels to have compassion.:)
             | 
             | It's enough to accept you don't understand the other
             | person's thought process and stop trying to tell them what
             | they are thinking. You don't need to fix things, you just
             | need to listen and not make them justify or explain
             | themselves to you.
             | 
             | Doing nothing is better than doing the wrong thing.
             | 
             | This comes from my own personal experience. I can't relate
             | to people on an emotional level. Every relationship is
             | processed with deliberate, logical action. If I love a
             | friend, I need to figure out what would change their
             | internal state so they can experience that love.
             | 
             | From the outside, this looks like I can relate on an
             | emotional level.
        
               | marcuschong wrote:
               | Precisely. That's what I took from the experience as
               | well. If that's so hard and I had no idea about it until
               | now, maybe there are other things that I don't know, and
               | some that I will never learn, and I should tread lightly.
        
           | ifyoubuildit wrote:
           | A: The same is true for people that say that antidepressants
           | are mostly placebo. They are not.
           | 
           | B: When people say that antidepressants saved their life,
           | they aren't joking or exaggerating in the least.
           | 
           | Are placebos unable to save lives?
           | 
           | Not claiming antidepressants are or are not mostly placebo,
           | and don't mean to minimize the pain of depression in anyway.
           | I just don't think whether or not they saved a person's life
           | is an indication either way. The placebo effect is real,
           | right? As in the subject actually gets better after taking
           | it.
           | 
           | > Keep your pet theories to yourself if you are not a subject
           | matter expert or someone who has experienced it first hand.
           | 
           | This is the internet, friend. I wish you the best, but maybe
           | don't put too much hope into that one. I think you'll have
           | better luck cultivating the ability to be comfortable having
           | your own beliefs while others have different (possibly
           | wrong!) ones.
        
             | hombre_fatal wrote:
             | When you do this, you're just accusing people of having no
             | real evaluative power about their own experience. It's
             | pointless, and it's not really an opinion.
             | 
             | Placebo-controlled RCTs show that some people react well to
             | antidepressants with major variation from person to person.
        
               | ifyoubuildit wrote:
               | Maybe I wasn't being clear, since I didn't mean to accuse
               | anyone of anything.
               | 
               | I'm not disputing that someone had the genuine experience
               | of antidepressants saving their life. I'm asking if that
               | precludes antidepressants acting as a placebo.
               | 
               | In other words both things can be true: antidepressants
               | saved someone's life and antidepressants can act as
               | placebo (even in the case where they saved someone's
               | life). And notice I'm saying "can be true". I'm not
               | saying they are true, cause I have no idea.
               | 
               | This is a logic question, not some kind of moral attack.
        
           | thisislife2 wrote:
           | There are indeed some form of serious depression that are
           | non-responsive to psychotherapy alone. Those are however not
           | the norm. Dr. David D Burns, practising psychiatrist and
           | author of the book _Feeling Good: The New Mood Therapy_ has
           | written a whole chapter in it on the appropriate use case and
           | effectiveness of anti-depressants today. (If you are
           | considering using anti-depressants, I urge everyone to get
           | the latest revision of his book and read that chapter). He
           | believes anti-depressant has its use _during treatment_ but
           | also shares studies that suggest modern psychotherapy, like
           | Cognitive Therapy which he advocates, has now begun to
           | _surpass_ the effectiveness of anti-depressants in  "curing"
           | depression in the _long-term_.
           | 
           | A particular point he makes about depression in it is
           | insightful: _Although depression is conventionally viewed as
           | a medical illness, research studies indicate that genetic
           | influences appear to account for only about 16% of
           | depression. For many individuals, life influences appear to
           | be the most important causes._
        
           | zeroonetwothree wrote:
           | As a counterpoint, I experienced such severe negative
           | symptoms after taking SSRIs that I had to be hospitalized for
           | months. Medical treatment is not without its risks. I would
           | always advise trying NPIs before drugs.
        
             | detourdog wrote:
             | If only I knew what an NPI was.
        
               | dghlsakjg wrote:
               | Non pharmaceutical intevention
        
             | dghlsakjg wrote:
             | I don't in any way mean to discount adverse affects, or
             | negative experiences. Those are just as valuable points.
             | People should be aware of the risks when they take any
             | pharmaceutical, and there are doctors who will happily
             | prescribe these drugs without educating the patient or
             | themselves about downsides and alternatives.
             | 
             | My point is that a lot of the commenters here are saying
             | some variation of "have you tried being happier?" and
             | "these drugs do nothing". Both of which are absurd to the
             | point of offensiveness to people who have gone through it,
             | in the same way that it would be absurd (and offensive) to
             | claim that these drugs have no possible downsides and a
             | negative reaction is placebo.
        
           | tracerbulletx wrote:
           | The placebo effect is a statistical reporting effect. Not a
           | physical effect.
        
             | kevin_thibedeau wrote:
             | Somaticizers absolutely will change their behavior in
             | response to a placebo.
        
         | throwaway314314 wrote:
         | Thank you for saying this, I wholeheartedly agree.
         | Antidepressants have an excessively bad reputation.
         | 
         | I'm sure they have their problems too on occasion, but for me
         | the decision to start taking Escitalopram was one of the best
         | things I've ever done.
         | 
         | The side effects were totally negligible compared to the
         | benefits.
         | 
         | I've stopped taking it a year ago or so and... it's basically
         | cured me.
         | 
         | I'm not saying antidepressant are a literal pharmaceutical cure
         | for depression, but in my case it simply put me in a position
         | mentally to change habits and patterns of thinking in a
         | sustainable way.
         | 
         | My only regret is not doing this 10 years earlier; the poor
         | reputation contributed to that.
        
         | wojciii wrote:
         | It takes a 10 min talk with a doctor to get antidepressants
         | around here. Perhaps a test which looks like multiple choice
         | score of symptoms with some weights.
         | 
         | I had an old gf receive two different drugs each with terrible
         | side effects. To me it looked as poison.
         | 
         | I decided that I would rather hurt myself myself than fuck with
         | my brain chemistry this way.
         | 
         | During the dark northern Winters I lack vitamin D (your doctor
         | can measure this using a blood test). The symptoms are some
         | physical issues and probably something that can be described as
         | light depression which goes away if I remember to take the
         | vitamins.
         | 
         | We are all different. Some people might need anti-depressants.
         | I just need some vitamins.
        
         | chasd00 wrote:
         | I had a similar experience except instead of antidepressants it
         | was when i started taking Adderall as an adult. A sense of
         | peace and serenity in my mind that I had never felt before, it
         | was almost overwhelming.
        
         | QuantumGood wrote:
         | What dosage of Citalopram? 40 mg/day?
         | 
         | (Roughly equivalent to Lexapro 15mg/day; Saffron 30 mg/day if
         | Crocin+Safranal properly standardized)
        
           | isoprophlex wrote:
           | 10 mg a day, down from 20 but that made me feel wired, like I
           | ate a bunch of 9V batteries for breakfast. Big pupils,
           | trouble sleeping, manic thoughts, the works.
           | 
           | I'm a small, generally sensitive guy so ymmv...
        
             | QuantumGood wrote:
             | Thanks. Ever try Saffron extract standardized to crocin
             | content (typically 2-3% crocin, dosed at 20-30 mg/day)?
             | 
             | One meta-analysis showed an antidepressant effect size
             | around 1.2-1.6 , and unlike pharmaceutical antidepressants,
             | saffron with standardized crocin has no well-documented or
             | commonly reported withdrawal syndrome in clinical studies
             | or reviews.
        
         | wincy wrote:
         | I had severe SAD to the point of having a mental break where I
         | told my wife I was flying that very day to Miami to get away
         | from the cold. I didn't end up flying to Miami, which is likely
         | why I'm still married...
         | 
         | So I ended up spending $300 on LED bulbs, both corn bulbs and
         | 200W equivalent, bought some 7-Way splitters for my ceiling fan
         | so it's holding 28 light bulbs (people have joked I have a
         | "biblically accurate ceiling fan" because it's so bizarre
         | looking, like a weird glowing biblical angel), and get about
         | 10,000 lux in my home office now. As a bonus, I don't have to
         | run a space heater in my home office (since I only need it in
         | winter, I'd have been using that electricity anyway via a space
         | heater). Solved the issue completely for me.
        
         | bossyTeacher wrote:
         | sweet feet seems so random, maybe some serotonin receptors down
         | there? are they noticeably sweety?
        
           | isoprophlex wrote:
           | something's fucking my hydro balance. i've done my fair share
           | of psychedelics, and i have to keep drinking water on shrooms
           | too. i dont know, something highly idiomatic haha. i also
           | sweat more in other places, but my feet are the moistest.
           | right now i just change socks often, it's hardly a
           | debilitating side effect...
        
         | randusername wrote:
         | Same story here, but different drugs. Every year Nov to Mar
         | means no lapses whatsoever in diet, exercise, sleep,
         | supplements, clutter, lighting otherwise the SAD will seep in
         | and erode me. I tried udosing ADHD meds this year and suddenly
         | subsistence is easy and I have gas left in the tank for
         | worthwhile things.
         | 
         | I feel like I speedrun Maslow's hierarchy of needs.
         | 
         | No anhedonia so far this year and my creative output is at all-
         | time high. Hope that helps someone get over their own biases
         | about prescriptions.
        
         | kranner wrote:
         | Similar story here but for ADHD and Atomoxetine.
         | 
         | I finally went and got diagnosed at age 46 for what had been an
         | childhood-onset issue in retrospect. All the signs were there:
         | inability to start work until enough challenge or novelty or a
         | state of crisis had come about, etc. When I spoke to friends
         | about considering treatment, they said they thought of me as a
         | hyperfocus kind of person. But they didn't see how many support
         | systems I had put in place to function normally, how I saw
         | others around me just doing things while I had to work myself
         | up to start and then keep checking and double-checking for the
         | silly inattentive mistakes I knew from experience I would keep
         | making.
         | 
         | I've had a meditation practice for a long time and it has
         | helped with anxiety but it hasn't really helped with getting
         | started on tasks, especially those perceived as boring. I even
         | had to psych myself up to sit down and start meditating, even
         | though I knew I would enjoy it.
         | 
         | I didn't know until a year or two ago that non-stimulant
         | medication existed to treat ADHD. I always thought it was only
         | Adderall and the like, and I couldn't risk anything that would
         | ramp my anxiety up, or take additional treatment for the
         | anxiety with SSRIs because I have severe hemophilia and any
         | additional risk of bleeding from SSRIs was an untenable
         | proposition.
         | 
         | After sitting on the idea for some time and just hoping that I
         | could fix it with more meditation, I finally decided to see a
         | psychiatrist. The doctor suggested Atomoxetine, but said it
         | doesn't work for most people and even then takes 3-4 weeks to
         | take full effect. I started on the absurdly low dose of
         | 10mg/day for the first month to be sure it wouldn't cause
         | additional bleeds. By day 3 I could see a huge improvement in
         | my working memory and ability to perform tasks. It gave me
         | insomnia for a bit but I would wake up at 3 AM, sit down
         | happily to work and write the best code I've written in years.
         | I could not believe the difference it made. There were quite a
         | few side effects initially but I was willing to put up with
         | them because of how smoothly my brain was functioning. I became
         | a nicer person to deal with. I felt this sense of possibility
         | and freedom that I haven't felt since my 20s. My only regret is
         | not having done this sooner.
         | 
         | So yeah, please don't avoid medication based on internet
         | reading.
        
           | MisterTea wrote:
           | Similar. I was on stimulants as a kid and hated them as they
           | did nothing but make me feel high then taper off leaving me
           | exhausted. Nevermind the total loss of appetite. Later on as
           | an adult I obtained adderall from a friend and experimented
           | with it and it seemingly worked for a few days but it never
           | stopped the intrusive thoughts or help with the anxiety. In
           | fact all I did was chase a high with cup after cup of coffee
           | when coming down. That put me off to meds for a long time.
           | 
           | More recently I was on a vacation where I took mushrooms and
           | had a nice trip. Two days later at work I felt very relaxed
           | driving in and sat at my desk BUT something was wrong, my
           | head was dead quiet (the GP explained this exactly like I
           | would.) So quiet that for a second I had a bit of panic as I
           | thought something was wrong. Then something wonderful
           | happened: I realized I was able to just do my work. There was
           | no stress, no worry, no nothing. Just a calm quiet confidence
           | to get the job done. Best day of my life.
           | 
           | After that I called a mental health center and connected with
           | an ADHD specialist who has been working with me. I am also on
           | Atomoxetine myself and while it has not brought me back to
           | that zen head space it brings me close enough. My only gripe
           | is at a higher dose it gives me sensations in my head.
           | However, I learned that eating a proper breakfast helps a lot
           | as I was taking it on a near empty stomach. Overall my life
           | has been slowly improving and I feel more confident at work.
           | 
           | > So yeah, please don't avoid medication based on internet
           | reading.
           | 
           | This - 100%
        
         | bjourne wrote:
         | > I won the SSRI lottery I guess, the side effect are sweaty
         | feet, vivid dreams and a dry mouth. That's all.
         | 
         | Yes, you did. Had the same medication and got tremors and
         | stiffness so bad I thought I had early-onset Parkinson. Could
         | hardly unlock the door without dropping the keys five or six
         | times. Fortunately, it ceased when I stopped the SSRI.
        
         | ericmcer wrote:
         | Same for me with Adderall.
         | 
         | I do wonder if being highly functional and feeling capable is
         | normal though, like as a species it seems almost dysfunctional
         | to happily plow through 8 hour workdays and bills and
         | appointments and all the little bureaucracies we have to
         | navigate. Sometimes a little voice screams "Run to the woods!"
         | when I sit down and look at a long todo list for the day, but
         | with Adderall I can generate some semblance of enjoyment from
         | ticking off the boxes.
         | 
         | Granted our world is what it is, and we are mostly helpless to
         | enact large changes. Finding some kind of peace with reality is
         | probably better than bashing your head against why you don't
         | fit into it well.
        
         | qxxx wrote:
         | and then the effects wear of. You just feel "normal" or the
         | same as before. I used to take ssri meds too. It was nice in
         | the beginning. Stopping was a nightmare, I needed to taper down
         | foe like half a year..
        
         | jollyllama wrote:
         | Do you take the citalopram year round, then?
        
           | isoprophlex wrote:
           | This is my first year, doc told me to wait until at least
           | march, April to start talking about tapering. I have zero
           | symptoms in summer, so I'm inclined to get off them outside
           | the darkest months... we'll see how bad the discontinuation
           | syndrome hits.
        
             | jollyllama wrote:
             | Here's hoping it goes well, whichever path you take.
        
         | drukenemo wrote:
         | Thank you for your comment. I think that can help many people.
        
         | thewebguyd wrote:
         | Similar story for me, but with Bupropion (Wellbutrin). None of
         | the SSRIs/SNRIs worked for me, spent years trying different
         | medications, Wellburtin was finally the one that worked, and oh
         | man what a difference.
        
         | pavel_lishin wrote:
         | > _Cold showers, ... no alcohol, strict sleeping rituals._
         | 
         | I feel like doing those three things would make me feel like
         | reheated cat shit, regardless of the weather outside.
        
           | wolvoleo wrote:
           | They do for me too. Alcohol gives me a huge downer the next
           | day but the party itself is amazing so I just waste the day
           | after with a pillow over my head.
           | 
           | And I hate strict rules and rituals, I love chaos. So that
           | also gets me down. I often stay up till 6am (the parties I
           | mentioned above only start at midnight)
           | 
           | So yah it might make some people better but for me the times
           | I break it are the ones that are exceptionally good.
        
       | fleebee wrote:
       | Please talk to a doctor if you're curious about this instead of
       | following this advice. Megadosing vitamins and supplements comes
       | with risks not addressed by the author.
        
       | lqstuart wrote:
       | The only problem here is that "going from an F to a C in mental
       | health" is vastly different than "going from a C to an A." It's
       | very well known and well documented that antidepressants have
       | very little effect on mild depression compared to say, exercise,
       | but that F grade of depression tends to be a different beast with
       | different causes.
       | 
       | That's not to suggest that exercise etc isn't great, just that
       | society has come a long way in destigmatizing mental health and
       | just being like "oh just take fish oil" to someone dealing with
       | that kind of depression, either through shitty genes or childhood
       | trauma or whatever, can be really harmful.
        
       | defraudbah wrote:
       | wait till they discover sex, drugs and alcohol :)
        
       | amai wrote:
       | Coincidence? "Vitamin D is currently the only Essential Vitamin
       | or Mineral which appears to have deficiency rates at a similar
       | level to Magnesium"
       | 
       | https://examine.com/supplements/magnesium/research/#nutrient
       | 
       | Dai (2018): Magnesium status and supplementation influence
       | vitamin D status and metabolism: results from a randomized trial
       | https://pubmed.ncbi.nlm.nih.gov/30541089/ "Our findings suggest
       | that optimal magnesium status may be important for optimizing
       | 25(OH)D status. "
       | 
       | So it might well be that general deficiency in Vitamin D is
       | caused by the deficiency in magnesium status. This would also be
       | an explanation why we see Vitamin D deficiency in sunny Africa:
       | https://theconversation.com/think-vitamin-d-deficiency-is-no...
        
       | elAhmo wrote:
       | To many people without relevant expertise give medical advice
       | online.
       | 
       | I remember a similar case with levelsio who was advocating people
       | to take melatonin and discussing how much grams is good vs bad.
       | When I said that people shouldn't take medical device from
       | someone who was successful in building web apps, he blocked me.
        
       | torcete wrote:
       | I would add that the issue with Omega-3, is the imbalance between
       | Omega-3 and Omega-6. It turns out that many of the food products
       | have been manufactured with Omega-6 rich oils and that is causing
       | some issues. One can ingest Omega-3 supplements, try to eat foods
       | rich on that fatty acid or reduce foods with lots of Omega-6 in
       | order to restore that balance.
        
       | dingdingdang wrote:
       | Confusing mg and IU units up front really do NOT inspire
       | confidence on the topic and conclusion as a whole.
        
       | comrade1234 wrote:
       | Before you start taking crazy amounts (or any amount) of vitamin
       | D just get a blood test. It's simple. As part of my insurance I
       | can get a bunch of different blood tests, but I did have to pay
       | about $50 extra to add the vitamin D test.
       | 
       | Based on the test I was just a tad under where I should be and so
       | now I am taking 800 IU per day. I may stop in the summer when I
       | get more sun.
       | 
       | I read somewhere that too much vitamin D has similar effects as
       | too little (permanent hair loss, anemia, etc) but that may have
       | just been on a blog similar to the linked blog on this
       | submission.
        
       | CafeRacer wrote:
       | I eat so much vitamin d and omega 3 i should be shitting fish
       | shitting sunshine... and yet, cold baltic winters with only a few
       | hours of sun still make me depressed.
        
       | shellkr wrote:
       | This made me think of Pauling
       | (https://en.wikipedia.org/wiki/Linus_Pauling) who was a famous
       | scientist and big proponent of high-dosage C-vitamin. He claimed
       | it could cure everything from a cold to heart disease and cancer.
       | Later studies did though not find any benefit of high-dosage
       | C-vitamin and that potentially had a higher risk of prostate
       | cancer. Pauling died of prostate cancer.
       | 
       | Edit: This may also be of interest:
       | https://en.wikipedia.org/wiki/Orthomolecular_psychiatry
        
       | vijaybritto wrote:
       | My dad if he was alive would have shouted "I told you so"
        
       | elif wrote:
       | Here you go HN commenters. Last month when I made the observation
       | that "from what I've read recently, I've started to get the
       | impression that the explosion in mental health problems
       | (depression, autism rates etc) has more to do with the western
       | diet than genetics"[0]
       | 
       | Y'all called me MAHA and down voted me into the negatives.
       | Please, insult your own analytical ability by doing the same
       | here. This time I'll just revel in your ideologically confined
       | science denial this time.
       | 
       | [0] https://scitechdaily.com/simple-three-nutrient-blend-
       | rapidly...
        
         | Cipater wrote:
         | A study proposing that diet can affect the expression or
         | severity of some autism-related behaviours is not the same
         | thing as claiming "80% of what people consider autism is
         | actually just the western diet's effect on normal brain
         | chemistry."
        
         | dartharva wrote:
         | Except depression rates are rising at similar or worse levels
         | in other places too, including sunnier/tropical regions and the
         | ones with "better" diets.
         | 
         | The main instigator of depression is still societal as the
         | postmodern era is pushing everyone into seclusion and addicting
         | them to constant individualized dopamine hits, increasing the
         | miserable effect on one's chronic mood and exacerbating one's
         | self-consciousness about it.
        
       | alastairr wrote:
       | While I agree with the general point
       | 
       | Vitamin D is toxic (and ultimately fatal) at high doses, which is
       | why the 'suggested' dosages of between 400IU and 1000IU are so
       | conservative. You _may_ need more, but you should get a blood
       | test.
        
         | bell-cot wrote:
         | _THIS_. And not just for Vitamin D. Not everyone absorbs  /
         | metabolizes / excretes vitamins or minerals in the same way.
         | Learning whether or not you're an outlier can be done either
         | the safe way, or the dangerous way.
        
       | zvqcMMV6Zcr wrote:
       | > So why are all the official sources still so paranoid about
       | Vitamin D
       | 
       | It is fat soluble vitamin, together with A, E and K. That in
       | itself makes in more risky in terms of overdose. I didn't hear of
       | any cases outside kids eating jars of vitamin gummies but it does
       | happen.
        
       | anonymous344 wrote:
       | can only say, if you have depression or mental problems: NIACIN.
       | not the niconinamid or whatever which is a scam. do not drink
       | alco or smoke! kidneys will suffer.
        
       | mda wrote:
       | I would take these articles about vitamin D with a grain of salt,
       | there is a big vitamin D supplement and testing market and most
       | of the studies about the miracles of it are dubious at best
        
         | buddhistdude wrote:
         | including the mentioned meta-analysis? if yes, can you explain
         | why you think that it's dubious?
        
       | lynguist wrote:
       | For a single time fix ("rewire brain to be healthy again") you
       | need psychedelics (psilocybin has seen multiple studies where its
       | effect is way better than psychopharmacological drugs). A single
       | dose can make you healthy for a year to come, potentially also
       | for life as you're no longer a potential victim to it ever again.
        
       | tiffanyh wrote:
       | Before anyone goes out and overdoses on Vitamn D (since lots of
       | multiple vitamin include too much), see this article on toxicity
       | from too much Vitamin D
       | 
       | https://www.ncbi.nlm.nih.gov/books/NBK557876/
        
         | cwillu wrote:
         | Juxtaposing with the quoted passage from the post: "Because
         | vitamin D is potentially toxic, intake of [1000 IU/day] has
         | been avoided even though the weight of evidence shows that the
         | currently accepted [limit] of [2000 IU/day] is too low by at
         | least 5-fold." --https://www.sciencedirect.com/science/article/
         | pii/S000291652...
        
         | seba_dos1 wrote:
         | It cites a study about vitamin D toxicity where the range of
         | cumulative intake causing it was identified to be 2.2 million -
         | 6.3 million IU. When you take 6000 IU daily for a whole year
         | you only reach the lower end of that range, and you definitely
         | shouldn't do that without checking your levels somewhere in
         | between. Taking it for a few months may get you above the
         | recommended blood levels, but is very unlikely to cause issues
         | unless you started with very high levels already (which you
         | most likely did not).
         | 
         | Toxic levels of vitamin D can be life threatening, so do keep
         | your levels in check, but you won't get there unless you really
         | try, so if you can't get out of the bed to have your blood
         | tested just start taking it and check it after 3 months when
         | things get hopefully easier for you. Just make sure to get the
         | number of zeros in the dose right.
        
       | samsartor wrote:
       | Several people in my family have a MTHFR gene mutation that
       | screws stuff up, including causing problems with
       | anxiety+depression. But a simple B12 shot every couple of weeks
       | does wonders.
        
       | RobotToaster wrote:
       | One flaw in this analysis is that the source he cites for
       | antidepressant effectiveness didn't include tranylcypromine (or
       | any MAOI class drugs), which the STAR-D trial found was one of
       | the most effective antidepressants.
       | 
       | (The STAR-D had a cumulative remission rate of 67%, I don't know
       | how to convert that to the format he used)
       | 
       | Otherwise I agree that vit D and omega 3 are underrated for
       | depression, it would be interesting to see if they have a
       | cumulative effect with antidepressants.
        
       | HisNameIsTor wrote:
       | Wrong unit in text, right? Graphs shows UI. 5000 UI would mean
       | 125ug of D-vitamin. Which is a bit smaller than 5000 000 ug from
       | the next
        
       | rollulus wrote:
       | Anecdotal, and even meta-anecdotal, but hey: four months ago I
       | started to supplement omega 3 thanks to this hyperbolic HN
       | comment: https://news.ycombinator.com/item?id=45169875
       | 
       | Unlike the commenter, I didn't suddenly turn into a chess
       | grandmaster, but I did notice that my winter blues didn't show up
       | this year, the first time in a decade!
        
       | dassarin wrote:
       | The article even states that nothing here is written in
       | certainty. It's just pure speculation. No, fish oil and vitamin D
       | do not have a larger effect than SSRIs for depression.
       | 
       | Not to say they don't help, but it's asinine to state that
       | nutrients are a replacement for selective serotonin reuptake
       | inhibitors, whose sole purpose is to help with depression, and
       | has been designed by an army of scientists, researchers,
       | psychologists, psychiatrists.
        
       | Forgeties79 wrote:
       | The amount of people in this thread rejecting behavioral health
       | as a legitimate science/field and calling for bootstraps to solve
       | depression et al. is wild to see. So many anecdotes and grand
       | statements saying that it's all nonsense. Very sad to see.
        
       | snickerer wrote:
       | If you look at the studies on which this post is based, you find
       | out that the (very) positive effect oft Vitamin D is only short-
       | term.
       | 
       | The effect after taking the Vitamin longer than 24 is not
       | significant anymore.
        
         | seba_dos1 wrote:
         | As one would expect when you get your blood level out of the
         | deficient range? It takes a while to get back down.
        
       | snickerer wrote:
       | If you look at the studies on which this post is based, you find
       | out that the (very) positive effect of a Vitamin D supplement is
       | only short-term.
       | 
       | The effect after taking the Vitamin longer than 24 weeks is not
       | significant anymore.
        
       | janpeuker wrote:
       | Super interesting, just sad that Omega-3 supplements are one of
       | the main drivers of unsustainable Krill overfishing
       | https://seashepherd.org/2025/02/25/protecting-the-oceans-vit...
        
         | mixmastamyk wrote:
         | Look for algae oil instead.
        
       | Aeroi wrote:
       | Most commonly from lanolin, a grease extracted from sheep's wool.
       | 
       | It's processed into (7-DHC), the same compound in human skin.
       | 
       | 7-DHC is bombarded with UV light, triggering a chemical reaction
       | that creates Vitamin D3.
        
       | humanfromearth9 wrote:
       | The first thing I would do in case of depression is to make sure
       | that the patient's energy levels are good and that mitochondria
       | and other energy-related biochem phenomena work as expected.
       | 
       | I know first-hand that low energy-levels and lacking energy
       | production mechanically lead to depression.
       | 
       | Also, look at how people (children also) experience the world and
       | their relationships and their stresses when they are tired (or
       | even just hungry) compared to when they are fit...
       | 
       | Fix those, and the depression might be gone.
       | 
       | This is not bashing against anti-depressants, they play their
       | role to. But in some cases, energy-management is key.
        
         | nikolatt wrote:
         | Thank you for the comment. This is not in my area of expertise,
         | so I hope you can clarify - how does one test that
         | "mitochondria and other energy-related biochem phenomena work
         | as expected"?
        
           | StiviGee wrote:
           | Second the question
        
           | ibeckermayer wrote:
           | There are tests out there like https://www.chrismasterjohn-
           | phd.com/mitome
           | 
           | (No affiliation, just have been subscribed to the founder's
           | substack for a while)
        
             | Aurornis wrote:
             | Chris Masterjohn is a noted quack. He takes bits of actual
             | science and research and weaves them together into
             | narratives that make it sound like he has everything
             | figured out with his unique protocols, but it doesn't hold
             | up to actual scrutiny. People spend years following his
             | ever changing protocols without getting anywhere (beyond
             | placebo effect and a large bill for supplements)
             | 
             | I know I won't convince the parent commenter but hopefully
             | I can convince other readers not to go down this road or
             | invest any money in anything related to him.
        
               | ibeckermayer wrote:
               | Pure ad hominem FUD. "This guy sometimes disagrees with
               | scientists employed by the government, don't listen to
               | him!".
               | 
               | The technical details are beyond my understanding but
               | I've heard from a PhD in the field that Masterjohn's
               | understanding of metabolism is second to none. Whether
               | his protocols work or not is certainly a case by case
               | matter (like any health protocol), but he always appears
               | to substantiate it with well-cited lines of argument, and
               | is willing to engage with interlocutors.
               | 
               | As for spending years with changing protocols without
               | getting anywhere besides spending lots of money, well
               | that can be said for people with complex issues who go
               | the institutionally approved route as well. It isn't
               | discrediting in its own right that a protocol didn't work
               | for some.
        
           | Aerbil313 wrote:
           | Just as an example, here is a small part of it: MTFHR
           | mutation causes megaloblastic anemia:
           | https://news.ycombinator.com/item?id=45085439
        
         | francisofascii wrote:
         | It's interesting that one way to improve mitochondrial
         | dysfunction is getting sunlight, the same way you get Vitamin
         | D.
        
       | dennis_jeeves2 wrote:
       | How many of you feel worse when taking vitamin D supplements?
       | Alternatively how many of you feel only temporarily better?
        
       | Aurornis wrote:
       | Vitamin D and Omega-3 are the two supplements that consistently
       | appear to be super powerful in small studies and then fail to do
       | anything significant at all in larger studies.
       | 
       | Pause for a moment and consider the mere plausibility of the
       | claims in the first few paragraphs: The effect size for
       | antidepressants is 0.4, but the effect size for Vitamin D is 1.8?
       | Are we to believe that Vitamin D supplements have an effect size
       | 4.5X larger than antidepressant drugs, and nobody noticed this
       | massive discrepancy until now?
       | 
       | Effect size is also a favorite metric in this vein of supplement-
       | over-pharma writing because it's so commonly misunderstood and
       | it's so easy to find small supplement studies that have outlier
       | effect sizes.
       | 
       | To put it in context, even common OTC pain meds can have effect
       | sizes lower than 0.4 depending on the study. Have you ever taken
       | Tylenol or Ibuprofen and had a headache or other pain reduced?
       | Well you've experience what a drug with a small effect size on
       | paper can do for you.
       | 
       | Please be very careful when someone tries to tell you that
       | supplements are miraculous and pharmaceutical drugs don't work at
       | all. I know too many people who delayed trialing SSRIs for years
       | due to internet driven fears and lost many years of their lives
       | to depression based on content like this. People with cabinets
       | full of dozens of supplement bottles that were chosen based on
       | studies, too. Then they finally decided to try real
       | antidepressant medications and wished they'd done it sooner.
       | 
       | As much as I wish we could all just cure depression by taking a
       | simple Vitamin D supplement that has 4.5X higher effect size than
       | antidepressant drugs, this claim just isn't passable.
        
         | dec0dedab0de wrote:
         | Anecdotally, Vitamin D and B12 had more of a positive effect on
         | my mental health than therapy or any of the half dozen
         | prescription meds I tried.
         | 
         | Hiking has the biggest effect though.
         | 
         | I think maybe the problem is that therapists are diagnosing
         | people, and psychiatrists are prescribing pills based on those
         | diagnoses, but neither are ordering bloodwork to check for
         | deficiencies. Which leads to a lot of people suffering from
         | lack of basic health, and treating the symptoms with SSRIs that
         | have withdrawl symptoms a million times worse than most of the
         | problems they treat.
         | 
         | Now to your point, I seriously doubt that vitamin D will hold
         | up against anti-depressants and therapy if we control for other
         | health and quality of life issues. I just think there is a ton
         | of misdiagnosis, and lack of root cause analysis in the mental
         | health field, and health care in general.
        
           | NoiseBert69 wrote:
           | > Hiking has the biggest effect though.
           | 
           | Keeping the mind busy with beautiful things and being
           | physically exhausted can heal a lot of things.
           | 
           | Its like surfing on a big day - you are just too tired to be
           | depressive afterwards. It feels like a weight blanket.
        
             | wolvoleo wrote:
             | It's also endorphins. Natural drugs.
             | 
             | I don't have the energy to do all that when I'm down
             | though. I hate all sports though I do like hiking (there's
             | no team or competitive bullshit) but I'm too clumsy for it.
        
           | wincy wrote:
           | I bought an E-Bike two years ago and it's changed my life. I
           | want to ride my bike all the time, and am counting down the
           | days to spring. During the warmer months I run all the
           | errands I possibly can with my bike instead of driving, and
           | ride for pleasure often, going on multi hour bike rides. It's
           | just such a blissful feeling, and as I've gotten more fit
           | I've been able to turn down the bike assist and built a lot
           | of leg muscles.
        
             | klondike_klive wrote:
             | Are you riding on roads or trails? How are you treated by
             | other road users? I'm tempted by ebikes but live in semi-
             | rural UK with very poor (and getting worse) road surface
             | and lots of blind bends.
        
               | wincy wrote:
               | I largely ride on paved bike trails that are wholly
               | separate from the roads, or suburban residential roads
               | that have a Swiss cheese of bike trails interconnecting
               | via parks. It's never the fastest way, but there's almost
               | always a "safe way" to bike somewhere, due to a lot of
               | effort by our city council. I'm more avoidant of the
               | major roads, an elderly man was extremely close to me and
               | my kid in her bike trailer when he made a right turn, I
               | think I'd be more cautious if I didn't have so many
               | accessible ways to bike separate from the roads.
               | 
               | Oddly a lot of the "guys with road bikes wearing full
               | gear" seem to just ride on the road anyway. I have no
               | idea why, I've double checked the laws and I'm allowed to
               | ride there.
        
             | LazyMans wrote:
             | Getting an e-bike has got me out getting exercise way more
             | than a regular bike ever did. Being able to dial my effort
             | up and down pushes me further, quite literally in distance
             | and fitness goals. I'm by no means fit and almost did a 5
             | hour 40 mile ride one day. I completely used up the battery
             | in that time, my legs were cooked from the effort. I would
             | have never attempted something like that on a regular bike
             | unless I was fit.
        
             | matsemann wrote:
             | I do understand there are many things that can make it
             | infeasable to bike during winter, but if you miss your bike
             | absolutely give it a try! I bike year around in Norway.
             | Studded tires help tons, and that the city maintains the
             | bike infrastructure during winter.
        
           | alexpotato wrote:
           | > Hiking has the biggest effect though.
           | 
           | I remember reading that pine trees give off a chemical that
           | is a natural human bronchodilator.
           | 
           | One thought of why people love hiking, especially in piney
           | woods, is that the chemical allows humans to process more
           | oxygen which in turn helps them feel more "energized".
           | 
           | I point this out for two reasons:
           | 
           | 1. It's a fascinating bit of trivie
           | 
           | 2. It highlights that there are MANY confounding variables so
           | it will always be tough to figure out the isolated impact.
        
           | Nevermark wrote:
           | I go on regular long walks and it is a huge help.
           | 
           | A few months ago I tried walking with a weighted vest, and my
           | body and brain got completely shocked in a really good way.
           | Wakes up everything. So that is in my mix now.
           | 
           | Walking with 20 then 40 lbs was a lot easier than I expected,
           | and the results were much greater.
        
           | directevolve wrote:
           | I will say that my LMHNP ordered a blood test for me during
           | my ADHD evaluation. I live in the Pacific Northwest and had a
           | serious vitamin D deficiency, apparently like everyone else
           | who doesn't supplement. also got me started monitoring my
           | blood pressure.
           | 
           | I can definitely tell that the Adderall I was prescribed had
           | an immediate, huge benefit. Not sure about the vitamin D.
           | 
           | But I really appreciated that he took a wide angle look at my
           | health.
        
         | ncasenmare wrote:
         | Hi, author of the blog post here! Thank you for writing in with
         | your concerns. First:
         | 
         | > Please be very careful when someone tries to tell you that
         | supplements are miraculous and pharmaceutical drugs don't work
         | at all.
         | 
         | I'll concede I unintentionally gave the tone that one should
         | _replace_ antidepressants with supplements, even though the
         | conclusion specifically writes:  "(Don't quit your existing
         | antidepressants if they're net-positive for you!) you may also
         | want to ask your doctor about Amitriptyline, or those other
         | best-effect-size antidepressants."
         | 
         | I have now edited the intro to more explicitly say "you can
         | take these supplements alongside traditional antidepressants!
         | You can stack interventions!"
         | 
         | ===
         | 
         | > and nobody noticed this massive discrepancy until now?
         | 
         | Researchers have noticed it for 13 years! From the linked
         | Ghaemi et al 2024 meta-analysis (
         | https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ):
         | 
         | > Several meta-analyses of epidemiological studies have
         | suggested a positive relationship between vitamin D deficiency
         | and risk of developing depression (Anglin et al., 2013; Ju,
         | Lee, & Jeong, 2013).
         | 
         | > Although some review studies have presented suggestions of a
         | beneficial effect of vitamin D supplementation on depressive
         | symptoms (Anglin et al., 2013; Cheng, Huang, & Huang, 2020;
         | Mikola et al., 2023; Shaffer et al., 2014; Xie et al., 2022),
         | none of these reviews have examined the potential dose-
         | dependent effects of vitamin D supplementation on depressive
         | symptoms to determine the optimum dose of intervention. Some of
         | the available reviews, owing to the limited number of trials
         | and methodological biases, were of low quality (Anglin et al.,
         | 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al.,
         | 2014). Considering these uncertainties, we aimed to fill this
         | gap by conducting a systematic review and dose-response meta-
         | analysis of randomized control trials (RCTs) to determine the
         | optimum dose and shape of the effects of vitamin D
         | supplementation on depression and anxiety symptoms in adults
         | regardless of their health status.
         | 
         | ===
         | 
         | > even common OTC pain meds can have effect sizes lower than
         | 0.4 depending on the study. Have you ever taken Tylenol or
         | Ibuprofen and had a headache or other pain reduced? Well you've
         | experience what a drug with a small effect size on paper can do
         | for you.
         | 
         | I must push back: that's an effect of 0.4 _plus placebo effect
         | and time_.
         | 
         | There's now RCTs of open-label placebos (where subjects are
         | _told_ it 's placebo), which show even open-label placebos are
         | still powerful for pain management. So, I stand by 0.4 being a
         | small effect; even if you took a placebo _you know to be
         | placebo_ , you'd feel a noticeable reduction in pain/headache.
         | 
         | EDIT: Here's a systematic review of Open-Label Placebos,
         | published in Nature in 2021:
         | https://www.nature.com/articles/s41598-021-83148-6.pdf
         | 
         | > We found a significant overall effect (standardized mean
         | difference = 0.72, 95% Cl 0.39-1.05, p < 0.0001, I2 = 76%) of
         | OLP.
         | 
         | In other words, if the effect on antidepressants _vs placebo_
         | is ~0.4, and the effect of a placebo _vs no placebo_ (just
         | time) is ~0.7, that means the _majority_ of the effect of
         | antidepressants  & OTC pain meds is due to placebo.
         | 
         | (I don't mean this in an insulting way; the fact that placebo
         | alone has a "large" effect is a big deal, still under-valued,
         | and means something important for how mood/cognition can
         | directly impact physical health!)
        
           | Aurornis wrote:
           | > Researchers have noticed it for 13 years! From the linked
           | Ghaemi et al 2024 meta-analysis
           | 
           | You're cherry picking papers. Others have already shared
           | other studies showing no significant effects of Vitamin D
           | intervention.
           | 
           | For any popular supplement you can find someone publishing
           | papers with miraculous results, showing huge effect sizes and
           | significant outcomes. This has been going on for decades.
           | 
           | With Omega-3s the larger the trial size, the smaller the
           | outcome. The largest trials have shown very little to no
           | detectable effect.
           | 
           | I think a lot of people are skeptical about pharmaceuticals
           | because they see the profit motive, but they let their guard
           | down when researchers and supplement pushers who have their
           | own motives start pushing flawed studies and cherry picked
           | results.
           | 
           | > In other words, if the effect on antidepressants vs placebo
           | is ~0.4, and the effect of a placebo vs no placebo (just
           | time) is ~0.7, that means the majority of the effect of
           | antidepressants & OTC pain meds is due to placebo.
           | 
           | You keep getting closer to understanding why these effect
           | size studies are so popular with alternative medicine and
           | supplement sellers: They're so easy to misinterpret or to
           | take out of context.
           | 
           | According your numbers, taking Tylenol would be _worse_ than
           | placebo alone! 0.4 vs 0.7
           | 
           | Does this make any sense to you? It should make you pause and
           | think that maybe this is more complicated than picking
           | singular numbers and comparing them.
           | 
           | In this domain of cherry picking studies and comparing effect
           | sizes, you've reached a conclusion where Vitamin D is far and
           | away more effective than anything, placebo is better than OTC
           | pain medicines, and OTC pain meds are _worse than placebo_.
           | 
           | It's time for a reality check that maybe this methodology
           | isn't actually representative of reality. You're writing at
           | length as if these studies you picked are definitive and your
           | numeric comparisons tell the whole story, but I don't think
           | you've stopped to consider if this is even realistic.
        
             | ncasenmare wrote:
             | > You're cherry picking papers.
             | 
             | I just picked the most recent meta-analysis I could find,
             | which also _specifically_ estimates the dose-response
             | curve. (Since averaging the effect at 400 IU and 4000 IU
             | doesn 't make sense.)
             | 
             | > Others have already shared other studies showing no
             | significant effects of Vitamin D intervention.
             | 
             | Yes, and the Ghaemi et al 2024 meta-analysis addresses the
             | methodological problems in those earlier meta-analyses.
             | (For example, they average the effects at vastly varying
             | doses from 400 IU and 4000 IU)
             | 
             | > According your numbers, taking Tylenol would be worse
             | than placebo alone! 0.4 vs 0.7
             | 
             | No, I understand this fine. Taking Tylenol would give you
             | active medication + placebo + time, which is 0.4 + 0.7 + X
             | > *1.1.* Taking open-label placebo is just placebo + time =
             | *0.7* + X.
             | 
             | (Edit: Also, these aren't "my" numbers. They're from a
             | major peer-reviewed study published in Nature, the highest-
             | impact journal. I don't like "hey look at the credentials
             | here", but I bring it up to note I'm not anti-science, see
             | below paragraph)
             | 
             | ===
             | 
             | Stepping back, I suspect the broader concern you have is
             | you (correctly!) see that supplement/nutrition research is
             | sketchy & full of grifters. And at the current moment, it
             | seems to play into the hands of anti-establishment anti-
             | science types. I agree, and I'll try to edit the tone of
             | the article to avoid that.
             | 
             | That said, there still _is_ some good science (among the
             | crap), and I think the better evidence is accumulating (at
             | least for Vitamin D) that it 's on par with traditional
             | antidepressants, possibly more. I agree that much larger
             | trials are required.
        
               | svara wrote:
               | > They're from a major peer-reviewed study published in
               | Nature, the highest-impact journal.
               | 
               | No, the domain name is nature.com because it's in a
               | Nature Publishing Group journal, _Scientific Reports_ ,
               | which is their least prestigious journal.
               | 
               | It's a common mistake, and they do that on purpose, of
               | course, to leverage the Nature brand.
               | 
               | It's also a mistake that implies a complete lack of
               | familiarity with scientific publishing, unfortunately,
               | which makes it a bit difficult to take your judgements
               | regarding plausibility very seriously.
        
               | directevolve wrote:
               | It's less prestigious because it doesn't judge papers on
               | novelty, only on technical accuracy. For incremental
               | research like this, it is an appropriate choice. The
               | lower prestige has no bearing on the accuracy of their
               | findings.
        
               | keybrd-intrrpt wrote:
               | Hello, there is another study that might be relevant to
               | you
               | 
               | https://pubmed.ncbi.nlm.nih.gov/28768407/
               | 
               | > A statistical error in the estimation of the
               | recommended dietary allowance (RDA) for vitamin D was
               | recently discovered
               | 
               | > ... This could lead to a recommendation of 1000 IU for
               | children <1 year on enriched formula and 1500 IU for
               | breastfed children older than 6 months, 3000 IU for
               | children >1 year of age, and around 8000 IU for young
               | adults and thereafter.
        
               | ncasenmare wrote:
               | Thank you! I'll give this a read.
        
             | kadushka wrote:
             | _the larger the trial size, the smaller the outcome_
             | 
             | I find this a bit surprising. Could there be something else
             | affecting the accuracy of larger trials? Perhaps they are
             | not as careful, or cutting corners somewhere?
        
               | hirvi74 wrote:
               | Just my hypothesis, but I wonder if larger sample sizes
               | provide a more diverse population.
               | 
               | A study with 1000 individuals is likely a poor
               | representation of a species of 8.2 billion. I understand
               | that studies try to their best to use a diverse
               | population, but I often question how successful many
               | studies are at this endeavor.
        
               | kadushka wrote:
               | _use a diverse population_
               | 
               | If that's the case, we should question whether different
               | homogeneous population groups respond differently to the
               | substance under test. After all, we don't want to know
               | the "average temperature of patients in a hospital", do
               | we?
        
               | lamename wrote:
               | Maybe. Those could be the case. But ignoring all
               | confounding factors, this phenomenon is possible with
               | numerical experiments alone. One of the meanings of "the
               | Law of Small Numbers".
               | 
               | Basically, the possibility that the small study was
               | underpowered, and just lucky...then the large studies
               | with more power are closer to the truth.
               | https://en.wikipedia.org/wiki/Faulty_generalization
        
               | kadushka wrote:
               | Sure, could be just lucky. But if there are several
               | successful small studies, and several unsuccessful large
               | ones (no idea if this is the case here), we should
               | probably look for a better explanation.
        
               | svara wrote:
               | It does not require more explanation: publication bias
               | means null results aren't in the literature; do enough
               | small low quality trials and you'll find a big effect
               | sooner or later.
               | 
               | Then the supposed big effect attracts attention and
               | ultimately properly designed studies which show no
               | effect.
        
           | directevolve wrote:
           | A point I think is crucial to mention is that "effect size"
           | is just standardized mean difference.
           | 
           | If a minority of patients benefit hugely and most get no
           | benefit, then you get a modest effect size.
           | 
           | This is probably why this discussion always has a lot of
           | people saying "yeah, it didn't help me at all" and a few
           | saying "it changed my life."
           | 
           | I believe we should be focusing on more relevant statistical
           | methods for assessing this hypothesis formally. Basically,
           | using mean differences is GIGO if you assume you're comparing
           | a bimodal or highly skewed distribution to a bell curve.
        
         | CGMthrowaway wrote:
         | _> Vitamin D and Omega-3 are the two supplements that
         | consistently appear to be super powerful in small studies and
         | then fail to do anything significant at all in larger studies._
         | 
         | That statement is broadly true for most outcomes studied, but
         | specifically for depression the larger study results are pretty
         | mixed.
         | 
         | VITAL (the heavily cited metastudy) shows no effect.
         | https://pubmed.ncbi.nlm.nih.gov/32749491/
         | 
         | But there are other large metastudies like this one for Vit D
         | (https://pubmed.ncbi.nlm.nih.gov/39552387/) and this one for
         | Omega 3 (https://pubmed.ncbi.nlm.nih.gov/31383846/) that do
         | show robust moderate effects.
        
         | Nevermark wrote:
         | > The effect size for antidepressants is 0.4
         | 
         | What the article states, then fails to take into account, is
         | that is the mean effect size, and there is huge variation.
         | 
         | Anti-depressants are notorious for producing different effects
         | for different people.
         | 
         | What that high variance means in practice, is for any anti-
         | depressant, the people who get good results are getting a much
         | higher effect than 0.4. And the other people move on to try
         | something else.
         | 
         | So to keep comparing 0.4 directly to the effect of Vitamin D
         | and Omega-3 directly is very misleading.
        
         | seba_dos1 wrote:
         | I believe presenting vitamin D supplements as effective in
         | treating depression is kinda misleading. It's rather vitamin D
         | deficiency that is super effective at making you miserable, but
         | it's not the only thing that can do it to you. And since a lot
         | of us are in fact deficient (and the threshold of being
         | categorized as deficient may be placed too low too), it will
         | appear as being quite effective overall, especially compared to
         | other drugs that act on less common and poorly understood
         | causes.
        
           | perrygeo wrote:
           | Thank you. Fixing a vitamin deficiency is an obvious benefit
           | to physical health. But does it "cure depression"? To the
           | extent that your depression was caused by vitamin deficiency,
           | sure. But then didn't you just cure a vitamin deficiency? I'm
           | sure a lot of things starting improving once your body starts
           | getting proper nutrients after years of neglect! That doesn't
           | indicate causality.
        
       | _aleph2c_ wrote:
       | A very important article for the hacker news community. Maybe we
       | should pin this on the top for a couple of days.
        
       | jlebar wrote:
       | Scott Alexander observes in this piece
       | https://www.astralcodexten.com/p/all-medications-are-insigni...
       | that the effect size for even EXTREMELY EFFECTIVE medications are
       | remarkably low.
       | 
       | > Zolpidem ("Ambien") has effect size around 0.39 for getting you
       | to sleep faster. Ibuprofen ("Advil", "Motrin") has effect sizes
       | between from about 0.20 (for surgical pain) to 0.42 (for
       | arthritis). All of these are around the 0.30 effect size of
       | antidepressants.
       | 
       | ...
       | 
       | > Some of our favorite medications, including statins,
       | anticholinergics, and bisphosphonates, don't reach the 0.50
       | level. And many more, including triptans, benzodiazepines (!),
       | and Ritalin (!!) don't reach 0.875.
       | 
       | As for why, read his essay I guess. But I wouldn't take at face
       | value the interpretation of effect sizes in the original article.
       | 
       | (I also couldn't say why the effect size of vit D and Omega-3's
       | is so large, although per Scott Alexander's article if fewer
       | people drop out of the treatment group, that should increase the
       | effect size, so maybe the relative tolerability of the treatments
       | is part of the story?)
        
       | joshhart wrote:
       | Vitamin D toxicity is absolutely real, causes hypercalcemia, and
       | can occur even at the 4,000 IU dose. I would really recommend you
       | be getting regular bloodwork done if you go beyond that. Here's a
       | fun podcast on a case study.
       | https://www.barbellmedicine.com/podcast/episodes/episode-381...
        
       | benterix wrote:
       | > "mild hypercalcemia" increased from 3% to 9%. IMHO, that's a
       | small cost for reducing the risk of major depression & suicide."
       | 
       | - I believe this crucial bit is missing from TLDR
        
       | NathanielBaking wrote:
       | Why does this keep popping up?
       | 
       | "Evidence does not support the use of vitamin D supplementation
       | for the prevention of cancer, respiratory infections or
       | rheumatoid arthritis. Similarly, evidence does not support
       | vitamin D supplementation for the treatment of multiple sclerosis
       | and rheumatoid arthritis or for improving depression/mental well-
       | being."
       | 
       | https://pmc.ncbi.nlm.nih.gov/articles/PMC4907952/#:~:text=Bo...
        
       | shevy-java wrote:
       | I am taking so much Vitamin D and I can confirm!
       | 
       | It is depressing ... :(
       | 
       | (Note: my own real therapy is to do what is fun. That is, humour.
       | This can occur via social interaction; it can also happen to some
       | extent by studying human behaviour via ... youtube videos! There
       | are some surstromming videos that are just epic display of human
       | behaviour. If aliens ever arrive here, I'll show them the Top 3
       | videos there. Either they will laugh too - or flee from this
       | strange planet.)
        
       | Roark66 wrote:
       | I used to take a supplement with 10k vit D units. Made by a
       | reputable company here in Europe.
       | 
       | I did a blood test for vit D metabolites (oh 25 or something). It
       | turned out I was deficient.
       | 
       | The doc gave me 8k units as a prescription drug. In theory
       | weaker. After 2 months I was no longer defiecient (kinda
       | borderline). After 4 months the doc decided to go down to 4k iu.
       | 
       | Now I wonder why some experts are telling people to take 10k iu?
       | Is it because the supplements are crap and contain 10% of what
       | they claim? (I've been taking vit K as well)
        
         | Aurornis wrote:
         | > Now I wonder why some experts are telling people to take 10k
         | iu?
         | 
         | Taking 10K per day is a bad idea. I went into the excess
         | Vitamin D range with half that dose even in winter with an
         | indoor job.
         | 
         | More is not always better.
        
         | dec0dedab0de wrote:
         | I think the general idea is that the stats labs use to decide
         | what is normal is not necessarily ideal, and like everything
         | else will vary per person.
         | 
         | Too much Vitamin D3 can be toxic, so doctors are reluctant to
         | tell you to go over published guidelines. but if you don't have
         | other issues, and stick to what you can get OTC from a normal
         | vitamin brand and follow the instructions, you're probably
         | safe. There was a story a while ago about a woman who died from
         | too much D3, but it turned out she was taking a whole bottle's
         | worth every day for years.
        
       | SubiculumCode wrote:
       | Precision Medicine is the way, and maybe we will get there one
       | day Too many effective agents are averaged away because the
       | population for whom it is effective is just a subset of the
       | population with the targeted symptom.
        
       | bevan wrote:
       | A useful way to look at the effects of vitamin d and omega-3s:
       | supplementation isn't really a hack, it's more that their removal
       | is a handicapping of our "normal" state. Our evolutionary
       | conditions would have been more rich in both of those things.
       | Also see light exposure during the day, proximity to green space,
       | etc.
        
       | Geee wrote:
       | You might want to take magnesium with Vitamin D, because taking
       | vitamin D depletes magnesium. Not sure if it's strictly
       | necessary, but if you're already low on magnesium it might be an
       | issue. I once got tinnitus (which lasted a few months) when
       | supplementing Vitamin D, the only explanation I've figured is
       | that my magnesium was very low, which can cause tinnitus. Might
       | be something else too, who knows.
        
       | sreekanth850 wrote:
       | I had sleeplessness that eventually led to depression and
       | gastritis. I took medication for two years to recover. The root
       | cause was a vitamin D deficiency my level was 8 ng/mL, which was
       | far below the required range. There was a period when i was only
       | able to sleep with medicines. Now coming back to normal life.
        
       | empressplay wrote:
       | Also magnesium! Magnesium bisglycinate, in particular. Great
       | stuff.
        
       | JohnMakin wrote:
       | I have seasonal affective disorder and was taking a medication
       | that sort of helped, but was causing mood swings if taken even
       | slightly out of rhythm, increased my blood pressure, and was just
       | generally not that effective, but it was better than nothing.
       | Last winter I switched to vitamin D (it was already uncovered in
       | blood tests I had a deficiency, which is what turned me onto it -
       | when I started taking it, I felt a lot better) and omega 3 and I
       | won't go back. I wish someone had told me a decade ago, probably
       | would have saved a lot of damage to my organs (another reason I
       | got off of it)
        
       | dimitrov wrote:
       | To add another data point: 4,000 IU (two Kirkland capsules) daily
       | keeps my Vitamin D levels at the high end of the reference range.
       | I also take six Kirkland fish oil capsules which happens to hit
       | the 1,500 mg DHA+EPA target suggested in the article.
       | 
       | Honestly, Costco supplements are hard to beat since they're both
       | USP certified and are usually the cheapest.
        
       | maerF0x0 wrote:
       | I saw a thing from HealthyGamerGG youtube[1] that he said one of
       | the things about depression is that it causes/influences one to
       | avoid the things that would make their life less depressing.
       | 
       | eg just to paint the picture: you're depressed so you don't get
       | out of bed, therefore you don't go do your workout, therefore you
       | lack endorphins and look in the mirror and see squishy, you're
       | sad about how squishy you are and so you get more depressed.
       | You're more depressed so you also don't do your dishes, when you
       | do get out of bed you are depressed you feel like a slob and
       | you're squishy, so you get more depressed...
       | 
       | Whereas adding anti-depressants, and other virtuous cycle things
       | like vitD/O3, exercise et al. Give the boost necessary to _make
       | your life less depressing_ ...
       | 
       | So if you know someone who's depressed, it might be helpful to
       | help them make their life less depressing too. (in addition to
       | all the best medical advice!)
       | 
       | [1]- he's a real Dr... Dr. Alok Kanojia (Dr. K), a Harvard-
       | trained psychiatrist (MD, MPH) specializing in modern mental
       | health
        
         | witherk wrote:
         | >he's a real Dr.
         | 
         | Careful, he is also a believer in Ayurveda[1]. Which basically
         | basically categorizes people into different elements like fire
         | and water and then tries to change their diet and habits to
         | match their elemental style or something. You can hear him
         | talking about it here [2]. Kinda reminds me of Humorism [3].
         | Dr. K seems like a nice enough guy but don't get too lured in
         | by the "Harvard-trained" credentialism.
         | 
         | [1] https://en.wikipedia.org/wiki/Ayurveda [2]
         | https://www.youtube.com/watch?v=rQ2xnThRGPg [3]
         | https://en.wikipedia.org/wiki/Humorism
        
           | maerF0x0 wrote:
           | I agree there's nuance, but he's way above the "has a webcam
           | and yeti blue" bar that most of youtube falls under, that was
           | my point in putting his credential up. Not to rise him to a
           | perfect status, but to not allow him being on youtube to fall
           | to the minimum bar of youtube.
        
       | tracker1 wrote:
       | At this point, I mostly avoid prescribed medications and don't
       | take very many things at all regularly. Mostly because I've had
       | some of the worst interpretations of the side effects of most
       | medications I've ever been on. These include hospitalizations and
       | side effects I'm still dealing with years after (looking at you
       | Trulicity/Ozempic)...
       | 
       | I'm usually able to reason or force my way through depression and
       | the like, but have had a few deep bouts in my life. The
       | medications have ranged from ineffective to building a tolerance
       | quickly, to just plain worse than the symptoms being treated.
       | Nothing like missing your highway exit multiple times back and
       | forth because you get lost "in" the drive on medication, or
       | having 140 browser tabs open and losing 5 hours of work time.
       | 
       | Everyone is different. I am amazed at how much western society
       | has so many hormonal issues that come down to the lack of quality
       | or appropriate fatty acid intake and a lack of something as
       | simple as more outdoor/sun time. I think the "low
       | fat/cholesterol" advice for most of the past half century
       | combined with the increase in snacking and junk foods have been
       | massive disservices to humanity as a whole. I wouldn't be
       | surprised if some of the effects are multi-generational in the
       | making either.
        
       | bawolff wrote:
       | > The twisted kink is caused by the hydrogens being on opposite
       | sides, hence "trans". (And yes, if they're on the same side it's
       | "cis". Latin was a mistake.)
       | 
       | Why you being mean to latin? ;)
        
       | meroes wrote:
       | I used to have very rough winters. Despite the fact that I ate
       | well and was outside 2+ hours every day. I got my blood tested
       | and I had very low vitamin D, two tiers below normal. This was
       | the first winter being on Vitamin D, and my energy and hunger
       | levels stayed normal. I never crashed or had extreme hunger or
       | trouble sleeping.
       | 
       | Getting Vitamin D from food is a fools errand, and since
       | sunscreen and protective clothing slow vitamin D from the sun
       | drastically, it's in most people's best interest to get it
       | tested.
        
         | strontian wrote:
         | You may consider that you have a dust mite allergy. If you have
         | any of: chronic coughing, frequent sickness, eczema, or IBS
         | then that is even more evidence this is your problem.
        
           | meroes wrote:
           | Not a bad suggestion, I live in the country so it's very
           | dusty here and my digestion has always been wonky. Thank you.
        
       | hmhrex wrote:
       | This is all in a book called The Depression Cure by Stephen S.
       | Ilardi (https://bookshop.org/p/books/the-depression-cure-
       | the-6-step-...)
       | 
       | I read this years ago and it's fascinating. Looks like it's been
       | updated for a second edition last year.
        
       | lazarus01 wrote:
       | I've personally found meditation, exercise and healthy food
       | intake are more effective for self regulation and coping with
       | tough emotions over medication and supplements.
       | 
       | Each human being is unique, as is the recipe for sustained
       | positive metal health.
       | 
       | I think it's helpful to consider and experiment with different
       | ideas and strategies.
       | 
       | I strongly disagree there is one single solution that can provide
       | significant lift for a large population.
        
       | fairytalemtg wrote:
       | Homemade Avocado toast is easy and inexpensive
        
       | buildsjets wrote:
       | Anecdotally, I've been taking a 5,000 IU vitamin E supplement
       | this winter. Seattle area, indoor desk job, I am a vampire. It
       | does seem to help, I would rate it as going from a C to a B
       | grade. I'd prefer not to use antidepressant medications to fix a
       | problem that for me is mostly caused by living at a different
       | latitude than I grew up in.
       | 
       | Do be aware that not all vitamin E supplements actually contain
       | the dosage that they are labeled at, and that inclues both no-
       | name brands and some big name brands. I'm having trouble finding
       | a good reference on google due to AI and SEO pollution. But I
       | recall Nature Made was labelled accurately and that is what I
       | buy.
       | 
       | My wife on the other hand has struggled with life-long
       | anxiety/depression even when living in Atlanta. For her a fairly
       | low dose of lexapro enables her to live her life like a normal
       | person. We wish we could get her mother to give it a shot for a
       | few weeks, as she now can see a lot of similarities in both their
       | personality traits that were affected by a life of untreated
       | anxiety.
       | 
       | We also have cat that would probably have been put down for fear-
       | biting of people and attacking our mild and mellow dog until we
       | got his aggression under control with kitty prozac. I kid you
       | not, it's a transdermal fluoxetine cream we put in his ear each
       | day. Without the constant anxiety stimulus in the way, his real
       | personality came through and he is actually very sweet. To me at
       | least. Still bites my wife, but not hard anymore, just enough to
       | keep her alert.
        
         | basch wrote:
         | >caused by living at a different latitude than I grew up in.
         | 
         | or society in its current incarnation. its an underexpressed
         | opinion that maybe depression is a justified reaction to ...
         | life, as humans across a lot of earth in 2026.
        
         | y1n0 wrote:
         | Do you mean vitamin D? Humans don't produce vitamin E at any
         | latitude.
        
       | ece wrote:
       | Staying awake is an antidepressant, up to a limit.
        
       | devops000 wrote:
       | On mobile a padding would make reading better. Add px-4 if you
       | use tailwind in the article body.
        
       | jsolomon wrote:
       | I was an RA at the RAND Corp who put together literature reviews
       | for mental health interventions like this. The Vitamin D result
       | is implausible. If true it would be the biggest breakthrough in
       | the history of psychiatry.
       | 
       | This is the referenced meta-analysis:
       | https://www.cambridge.org/core/journals/psychological-medici...
       | 
       | The largest N study (N=18,353; more than half of the entire 31
       | study sample) included is
       | https://jamanetwork.com/journals/jama/fullarticle/2768978, which
       | found: "Risk of depression or clinically relevant depressive
       | symptoms was not significantly different between the vitamin D3
       | group...and the placebo group."
       | 
       | The highest dose study (100,000 IU/week) included is
       | https://pubmed.ncbi.nlm.nih.gov/30532541/, which found: "...the
       | treatment response or BDI scores did not differ significantly
       | between groups."
       | 
       | The paper/supplementary materials doesn't include a simple table
       | of the depression outcomes for the 31 included studies, which is
       | a glaring omission.
       | 
       | I think someone just messed up here. Maybe missed a decimal
       | place?
       | 
       | For a more realistic perspective, here's another careful meta-
       | analysis of RCTs of Vitamin D for depression that found null
       | result:
       | https://www.sciencedirect.com/science/article/abs/pii/S08999...
       | (granted, 2015). And another from 2025 that found a .36 effect
       | size, which is plausible and still fantastic:
       | https://www.frontiersin.org/journals/psychiatry/articles/10....
       | 
       | I don't mean to dissuade people from trying these given the low
       | risk profile, just don't expect to go from a C to an A.
        
       | hirvi74 wrote:
       | I started back on Vitamin-D and Omega-3 (with extra EPA & DHA)
       | about 2 months ago or so. Sadly, I don't feel much of a
       | difference, but I believe the potential harms are quite minimal,
       | so I am going to maintain supplementation for the purposes of
       | self-experimentation.
        
         | seba_dos1 wrote:
         | It took me more than 3 months to get to the lower edge of the
         | desired range with my blood level on about 8000 UI daily. There
         | was no instant improvement, it takes time.
         | 
         | Do keep your levels in check though.
        
       | RankingMember wrote:
       | Hey OP, kudos for being so engaged in the discussion + making
       | edits and not just firing the link off and then going AFK. Makes
       | the comments more interesting and ( _I_ think) the actual work
       | better.
        
       | Fischgericht wrote:
       | I can only provide anecdotical evidence, which is ... not
       | evidence, really.
       | 
       | Within my peer group of people on the spectrum (which very often
       | comes with a depression, which is logical) we've discussed
       | Vitamin D studies for years. And multiple of us decided to give
       | it a try for a couple of months. And neither those who tried it
       | INSTEAD of an SSRI, nor those that took both (SSRI + D) could
       | report any measurable difference.
       | 
       | I have a theory on why is that: It is known that low levels of
       | Vitamin D is one likely cause for depression - in Northern
       | Europe, where during winter time people do not get enough
       | sunlight, that correlates very clearly with the suffering of
       | depression.
       | 
       | But potentially it simply does not work the other way round: I
       | moved to near the equator, and I therefore basically have
       | sunlight shining out of my butt, but still am depressed. It makes
       | sense that in this case Vitamin D makes no difference at all.
       | 
       | In summary my theory would be: Vitamin D only has an effect on a
       | depression that was _caused by a lack of Vitamin D._
        
       | tsoukase wrote:
       | As a neurologist I cannot be persuaded. Their is a huge placebo
       | and confounding component in the spectrum stress-depression.
       | There are syndromes where AD drugs make wonders, literally saving
       | lives, and others where they are useless. But taking 150000 IU of
       | vitD per month definitely doesn't have the effects it promises.
        
       ___________________________________________________________________
       (page generated 2026-01-29 23:01 UTC)