Calling for a new approach to depression • Hacker News Board

Re: Calling for a new approach to depression

#141

Post by aaavl2821 » Mon, Jan 08, 2018, 4:08 PM UTC

matt4077 wrote: post #135

aaavl2821 wrote: post #68

One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another important problem with mental healthcare in the US: shortage of mental health providers Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $…

You make a completely benign mechanism sound like a vast conspiracy... The simple fact, which you already mentioned, is that psychotherapy takes dozens of sessions with an expert to be effective. Cost of treatment is in the four digits, easily, while medication costs less than $10/week since most SSRIs are no longer protected by patents. Psychotherapy and medication have almost identical effectiveness, making the lat…

It may be rational for payers to minimize cost of care rather than try to find a better balance between cost of care and outcomes, but that doesn't make it benign. The preferable first line option would be medication + psychotherapy, or at least medication and regular follow up to ensure it's working and adjust dose if needed

6-12 sessions of CBT (NICE recommends 6-8 for mild to moderate depression) with a licensed clinical social worker would be comparable in cost to a year of generic SSRIs. However 55% of US counties don't even have a mental health professional (because payers stopped paying for it), so CBT isn't really an option for many

Re: Calling for a new approach to depression

#142

Post by seibelj » Mon, Jan 08, 2018, 4:58 PM UTC

eigenschwarz wrote: post #94

seibelj wrote: 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…

If you don't mind sharing, I am curious about some of the dietary interventions you tried.

Whole wheat only, no unnecessary sugar (no deserts / candy), lots of vegetables and fruit, no red meat, little dairy. Basically try to eat super healthy.

Re: Calling for a new approach to depression

#143

Post by mattmanser » Mon, Jan 08, 2018, 4:59 PM UTC

dsego wrote: post #51

justasitsounds wrote: post #35

There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that w…

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 used to work in the pharma industry a long time ago as an undergrad, my (now hazy) understanding of it is that anything that happens in a clinical trial they have to list as a potential side-effect.

As they're being tested on people with depression who have a higher chance to kill themselves, it's almost an inevitability that's going to show up as a side-effect, as unfortunately some of the trial people will kill themselves.

I'm trying to saying it's not necessarily causation that's it listed as a side-effect.

Re: Calling for a new approach to depression

#144

Post by mnm1 » Mon, Jan 08, 2018, 8:10 PM UTC

justasitsounds wrote: post #35

There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that w…

Doctors and scientists who bothered to conduct even the most cursory research on this topic have known that the chemical imbalance hypothesis, aka "serotonin hypothesis" is bullshit. There is no evidence for it and never has been. This mirrors the claims of the sugar industry telling us to eat sugar instead of fat. Completely unscientific advice becoming mainstream to the point where doctors are committing malpractice en masse and actually believe the stupidity they failed to verify. There should be some class action lawsuits based on this. The proponents of this idiotic, unscientific, unproven, unsubstantiated theory have ruined countless lives. Who knows how many people they have driven to hopelessness and suicide just to make money off of them? Just from personal experience, I know it's not zero. These are lives lost that didn't have to be. All in the name of profit. This is the kind of society we live in and we wonder why a huge percentage of the population is depressed?

Re: Calling for a new approach to depression

#145

Post by mnm1 » Mon, Jan 08, 2018, 8:15 PM UTC

mmirate wrote: post #96

justasitsounds wrote: post #35

There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that w…

> So, I guess that makes me complicit in all this too. No, that makes the salespeople, and your bosses at that communications company, complicit. We're just as neutral and tool-like as the computers we program.

"We're just as neutral and tool-like as the guns we shoot," was every Nazi's defense after WWII and it's not acceptable morally or legally. In no way does it defend immoral actions.

Re: Calling for a new approach to depression

#146

Post by mmirate » Mon, Jan 08, 2018, 8:32 PM UTC

mnm1 wrote: post #145

mmirate wrote: post #96

Earlier quoted context omitted.

> So, I guess that makes me complicit in all this too. No, that makes the salespeople, and your bosses at that communications company, complicit. We're just as neutral and tool-like as the computers we program.

"We're just as neutral and tool-like as the guns we shoot," was every Nazi's defense after WWII and it's not acceptable morally or legally. In no way does it defend immoral actions.

Our tools are computers not MP40s. For our tools to be as dangerous as Godwin's MP40s, someone else must connect an MP40 to a computer. And that person is the root of responsibility.

Re: Calling for a new approach to depression

#147

Post by mnm1 » Mon, Jan 08, 2018, 9:15 PM UTC

mmirate wrote: post #146

mnm1 wrote: post #145

Earlier quoted context omitted.

"We're just as neutral and tool-like as the guns we shoot," was every Nazi's defense after WWII and it's not acceptable morally or legally. In no way does it defend immoral actions.

Our tools are computers not MP40s. For our tools to be as dangerous as Godwin's MP40s, someone else must connect an MP40 to a computer. And that person is the root of responsibility.

I thought the tools were the programmers. Which one is it? Programmers are much more dangerous than any gun and using the "it was just my job" cop out to excuse atrocities like killing people is still immoral, regardless of what tools the people who do so use.

People aren't tools. No person is a tool, period. That's the point of my original reply. You can't excuse atrocities by saying people are tools and therefore not responsible for their actions. You also can't excuse atrocities by claiming people were just following orders. People are moral agents except in very extreme circumstances (such as lack of mental capacity, which the law does deal with). Programmers that helped big pharma ruin thousands upon thousands of lives are most certainly partially responsible for their immoral actions (working for big pharma) just like the Nazis who ran the concentration camps were partially responsible for the Holocaust. Hannah Arendt tackles this subject in "Eichmann in Jerusalem: A Report on the Banality of Evil."

Re: Calling for a new approach to depression

#148

Post by foobarbecue » Mon, Jan 08, 2018, 10:14 PM UTC

greenyoda wrote: post #34

foobarbecue wrote: post #14

Earlier quoted context omitted.

Oddly, it was upvoted twice /and/ flagged. I guess anyone with enough reputation can bury things just by hitting a "flag" button.

It could have been flagged multiple times (flags are additive). Even articles that have hundreds of upvotes can be killed by flagging if enough people flag them.

Is flagging the same thing as clicking the [-] button? Is this explained somewhere? My flagged comment has +2 points, and my unflagged version of it has -2 points. Very confusing, and if I did something wrong, nobody is telling me what it is. I can't find any documentation for HN, which is a little ironic...

Re: Calling for a new approach to depression

#149

Post by grzm » Mon, Jan 08, 2018, 10:20 PM UTC

foobarbecue wrote: post #148

greenyoda wrote: post #34

Earlier quoted context omitted.

It could have been flagged multiple times (flags are additive). Even articles that have hundreds of upvotes can be killed by flagging if enough people flag them.

Is flagging the same thing as clicking the [-] button? Is this explained somewhere? My flagged comment has +2 points, and my unflagged version of it has -2 points. Very confusing, and if I did something wrong, nobody is telling me what it is. I can't find any documentation for HN, which is a little ironic...

The [-] collapses your view of the thread. The flag link appears when you have sufficient karma (I don’t recall the threshold). Click on the time stamp for the comment you want to act on. If you have enough karma, the flag link appears between the “parent” and “favorite” links.

Re: Calling for a new approach to depression

#150

Post by TheSpiceIsLife » Mon, Jan 08, 2018, 11:43 PM UTC

nasredin wrote: post #129

blurbleblurble wrote: post #86

Earlier quoted context omitted.

YES to magnesium & vitamin D... they must be taken together and work wonders.

I HATE people who put IANAL and other acronym disclaimers everywhere, but I just feel these type of posts can negatively influence people. I am glad magnesium and vitamin D worked for you, but some people may need prescription medications from a psychiatrist.

I am not a psychiatrist, but if you think it will help I did study nutrition in a formal capacity for four years and obtain a certificate of some sort for doing so.