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Calling for a new approach to depression

theguardian.com

71–80 of 155 posts

Re: Calling for a new approach to depression

#71

Why did my comment get flagged? I assume this was a mistake, so reposting: tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame. (The article argues this point cogently, and I agree with it.) [I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]

Reposting a flagged comment is obviously an abuse of the flagging system, and complaining about being flagged falls under the same rule as "please don't comment about voting": it makes boring reading and does no good. So please don't do those things.

https://news.ycombinator.com/newsguidelines.html

Re: Calling for a new approach to depression

#72
post #36

Years of strict exercise, diet, meditation, breathing techniques, various forms of therapy, and numerous self-help books did not cure my anxiety and depression. 2 weeks after starting a low-dose (10mg / day) of Lexapro made me feel better than I had in 10 years. Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is s…

Glad it works for you. I took a small does for one week. First two days was great, everything had an aura about it. Also, I felt very warm all the time. After 3-4 days I lost erections and then just threw them into the trash bin. Didn't want to risk it. I have a family member who needs viagra because antidepressants messed up his nerves. Psyhcs will tell you it's temporary, well, not always, but they won't admit it.

Re: Calling for a new approach to depression

#73
post #51

Earlier quoted context omitted.

Almost all antidepressants list the increase of suicide risk as a side effect, which is frightening. Zoloft for example [1]: > An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. [1] https://www.drugs.com/sfx/zoloft-side-ef…

From my experience, it's because as they kick in, you suddenly have energy and motivation you didn't have before, but you still have the suicidal thoughts until they become properly efficacious.

IIRC this is also the most widely accepted theory for it.

Re: Calling for a new approach to depression

#74
post #51

Earlier quoted context omitted.

Almost all antidepressants list the increase of suicide risk as a side effect, which is frightening. Zoloft for example [1]: > An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. [1] https://www.drugs.com/sfx/zoloft-side-ef…

From my experience, it's because as they kick in, you suddenly have energy and motivation you didn't have before, but you still have the suicidal thoughts until they become properly efficacious.

I've heard that too. Along with the apparent external signs of an 'uptick in mood' (for want of a better phrase) when someone resolves to end it: IE. a lifting of a burden.

I'd also like to say, to anyone reading this who is entertaining thoughts of self-harm or suicide: Please, please reach out for help. In my mother's case her suffering was almost certainly compounded by an irrational shame and self-imposed stigma. I'm just an armchair critic, if you are taking medication and you feel like it is helping - it is. If it isn't helping, please talk to your healthcare professionals about alternative treatment - there are always other options that don't involve hurting those who love you

Re: Calling for a new approach to depression

#75

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a ris…

The author makes some specific claims, including that there is no landmark, replicated study showing depression is caused by low serotonin. The author and his claims can be discredited if someone here can cite such a study.

- Do we even have a way of measuring serotonin levels in a live human (as opposed to a dead lab rat[1])? Remember, we're trying to measure serotonin levels in the synapses between neurons in the brain (serotonin is a neurotransmitter, so its levels anywhere else in the body probably wouldn't matter), so you can't just draw someone's blood and test it. If the measurement involves drilling a hole through someone's skull, you can be sure it hasn't been done on lots of people (no ethics board would allow that experiment, even if you could find non-depressed people to volunteer for it). If it requires injecting people with radioactively tagged serotonin precursors and scanning their brains, it probably hasn't been done on a lot of asymptomatic people (risky and expensive).

- Assuming we can measure serotonin levels in humans, how do we determine whether someone's level is "low"? Does "low" mean "low compared to the average of non-depressed people"? Does it mean "low compared to the level the patient had before they became depressed" (if so, how would we know their baseline levels)? Levels of many chemicals (hormones, glucose, sodium, etc.) vary significantly between "normal" individuals.

[1] We can't talk to a rat to determine whether it's depressed. We can only observe certain aspects of its behavior, like appetite and activity levels, which we assume are proxies for depression, but could be due to unknown factors. We don't really know if rats have evolved to become depressed the way people do.

Re: Calling for a new approach to depression

#76

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a ris…

The author makes some specific claims, including that there is no landmark, replicated study showing depression is caused by low serotonin. The author and his claims can be discredited if someone here can cite such a study.

IIRC, the current consensus among the psychiatric community is that SSRIs do work but no one actually knows what mechanism could explain their effectiveness. The one thing that is known for sure is that it doesn't come down to simply high vs low levels of serotonin because while SSRI treatment immediately raise serotonin levels the therapeutic effect takes some time to "kick in".

I also recall reading that SSRIs have been found to be more helpful against anxiety than depression.

Re: Calling for a new approach to depression

#77

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a ris…

Tenured professor of psychiatry here. I'll give you the summary of research on depression:

1. Emotional state is like blood pressure. It's a continuously varying thing. There is no discrete depressive disease state, just an extreme end of a continuum.

2. Just like blood pressure, though, very high blood pressure (or low) represents an illness state, a potentially very serious one. The etiology is a different matter. It may be due to sociocultural processes, or existential threat, or genetics, or neurological insults, or all of the above, each in some measure.

3. When we talk about "depression," it's usually a shorthand for a broader set of problems, related to lack of well-being, malaise, despair, sadness, anxiety, fear, and so forth.

4. The particular cocktail of emotions for each person is different though.

5. The best meta-analytic evidence suggests that antidepressants work, but not nearly as well for people as we were led to believe, and there's huge publication biases. Some drugs might not work at all. Some drugs work for some people; those same drugs might not work for other people at all.

6. Serotonin per se probably has nothing to do with the effect of antidepressants.

7. Psychotherapy works as well or as poorly as drugs on average, with some of the same publication biases. This is considered against many different types of controls, including placebo controls and various types of behavioral controls. Being wait-listed is the worst intervention of all, though.

8. Different psychotherapies do not differ in efficacy on average. The superiority of cognitive-behavioral therapy, etc. is a myth. Different therapies might differ for particular individuals, though, and there are some basic ingredients that seem to be necessary for efficacious therapy. The effect of therapist dwarfs the type of therapy (that is, some therapists are really really good, and others are less good, and that is much more important to outcome than type of therapy per se).

9. The best outcomes are generally therapy and drugs in combination, and if one thing doesn't work, trying different things will often work eventually.

The recent history ("recent" being the last 30-40 years) of psychiatry and clinical psychology is dominated by economically and politically-driven reductionism and oversimplification, within the realms of therapy as well as pharmacology. A lot of these dynamics are driven by a desire to present as rigorously scientific, wrapping ones' selves in banners of other disciplines. The problem with this is behavioral science is its own thing; it resembles other disciplines in some ways, but not in others (much like every other domain of science).

Re: Calling for a new approach to depression

#78
post #66
post #51

Earlier quoted context omitted.

Almost all antidepressants list the increase of suicide risk as a side effect, which is frightening. Zoloft for example [1]: > An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. [1] https://www.drugs.com/sfx/zoloft-side-ef…

I am also very disillusioned with the psychiatric profession. The way they prescribe drugs seems no better than guesswork. Two years ago my dad having what I recognized as parkisonisms and akathisia but the psychiatrist said it wasn't possible because they had stopped giving him haldol. But then when she saw him, she said why we didn't come sooner (it's always the patient's fault) and quickly prescribed akineton. Thi…

Making money for big pharma, unfortunately. It's really ugly out there.

Re: Calling for a new approach to depression

#79
post #64

Earlier quoted context omitted.

>My life was ostensibly fine But you said in a previous comment "I was working 35 hours a week at a startup and studying two difficult subjects at my university (computer science and Latin) while maintaining an active social life. I kept pushing myself harder and harder, and essentially collapsed". I think most people would burn out with that amount of stress.

I was paraphrasing a period of my life. I didn't go on Lexapro for 2 years following that. Before Lexapro I was doing all of the non-medical stuff I mentioned. No need to tell me that what I experienced is false - it's my own life, afterall.

I wasn't telling you anything you experienced was false. I was simply pointing out that the stressful period you mentioned would definitely be a factor causing depression. Even if you are doing exactly what you want to do with your life and you're happy with it, excessive stress will still cause depression.

I've edited my original comment slightly.

Re: Calling for a new approach to depression

#80
post #44

Earlier quoted context omitted.

Or they have bi-polar disorder and are on a downswing. That alone will do it. Some forms of depression are medical, people need to be aware of this. Thinking that everyone can be cured by running off and finding one's true self is incredibly dangerous. For some people, that is the solution, but for others, running away from their support network is the exact wrong thing to do. All that said, soul crushing jobs are so…

I think a very large percent of people would be happy with your old time antidote, but it's more an issue of security in realizing that. I would personally change your word meaningful, to my word, sustainable. P.S. Who said anything about running away from support networks? Listening to your needs I suspect might look like asking someone for help, or something along those lines. But that's just it, everyone's needs a…

> P.S. Who said anything about running away from support networks?

The article, and popular mythos.

Leaving one's job, running off to explore one's true self. Society is full of stories of people fed up with everything so they leave behind all they know.

Heck sometimes it even works. But I'm countering the article's main thesis, which seems to be "depression is from having a crappy job" with the point that there are other causes as well.

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