Experimental depression treatment is nearly 80% effective in controlled study

To immediately jump to the "chemical imbalance" problem/solution is like if you have a web app that's performing really slow, so you hire a consultant to take a look.

They tell you that you need to horizontally scale your app in order for it to perform better. In many cases, this would actually work (for a while anyway), but it probably doesn't explain the real issue.

In reality, the problem could be that you wrote your app to do way too many things per request rather than picking and choosing which things are going to be treated as first-class. Perhaps there's even one little thing that's O(n^2) and it simply is going to take a lot of time to work out.

We're all a product of our thoughts, our environment, and the mediating chemicals in our brains and guts. I'll throw in a different complex connection: the connection between hormones (estrogen and progesterone) and histamine. A woman can have seasonal allergies that wax and wane monthly due to the role estrogen plays in regulating mast cell release of histamine. The environment may stay the same over that month, but the chemical soup changes. This change may also be further mediated by what the person eats, as consuming high-histamine foods on top of that might be enough to really set off a physical reaction. Because we're talking about seasonal allergies here, few people would find this controversial.

So, let's move to the mind and emotions, which are certainly more controversial. All these factors are still there. Yes, CBT can be enormously helpful in getting you out of cognitive traps that decrease the quality of your life experience. At the same time, it can be true that you've been eating a diet that is not good for you and your stomach hurts all of the time not because of anxiety but because of your food. Let's take me for instance: I'm in grad school, I'm not feeling good, having trouble getting out of bed, I'm trying to drag myself through the thesis on caffeine and sugar, I keep beating myself up because I'm not as brilliant as Gauss or Kovalevskaya or even that guy who got that TT job at Virginia Tech and I have writer's block, I see the psych person at the health center 'cause why not. She says I have stress-induced stomach problems. Mindfulness doesn't help. What finally helps? An elimination diet that allows me to discover that one simple trick (eliminating a type of food) makes my stomach not hurt, means I don't wake up tired and hurting in the mornings, etc! Amazing to sleep and then wake up rested! Suddenly I have half the problems I had before and have more energy to deal with them. I'm still not Gauss, and that takes another 10 years of life progress to acknowledge. Whatever.

There are many ways to attack problems. Change the input, change the process, change the environment, decide the desired output isn't actually desired. Childhood experiences, diet and exercise (physical upkeep), the "shit life" phenomenon another poster mentions, hormones and chemical imbalances. Therapy is not the cure to everything. Neither is medication. Neither is diet. Sometimes we actually need reform so that people aren't stalked by medical debt or huge bills for having their kids put into foster care or whatever (lots of literature on the connection between financial instability and depression).

Antidepressants are strong stuff. Some years ago I hit a bit of a snag and went to a doctor and got just this, a prescription after five minutes of talking with helpful advice like "get a girlfriend" or "study something else". Stuff really worked... except in the wrong direction. Not an exception either, common enough they put "suicide" as a side effect in the fine print. I think if you're gonna take something like that you need some kind of feedback/monitoring and test different drugs until you might find something that works right. A hands off fire and forget prescription like I got likely won't work for most people.

While they have a "role", differences in neurotransmitter levels do not predict mental health state.

My understanding is that "chemical imbalance" theory was a popular misunderstanding of a more limited and specific theory called the ”catecholamine hypothesis" which has itself been pretty much debunked.

For decades the explanatory psychiatric theory behind depression has been the the "bio-psycho-social" model. While we know that biology is an import part of the picture, that part can include a bunch of different factors besides neurochemi cals, such as possibly inflammation, neuron growth factors and more.

[0] https://www.psychiatrictimes.com/view/debunking-two-chemical...

> Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

I believe that theory has been mostly disproven, but that doesn't change solid evidence behind the efficacy antidepressants that were developed using that theory.