Psilocybin has been quite promising and many people report positive changes.
“No convincing evidence” that depression is caused by low serotonin levels
21–30 of 625 posts
Re: “No convincing evidence” that depression is caused by low serotonin levels
#22[deleted]
Re: “No convincing evidence” that depression is caused by low serotonin levels
#23My psychologist tells me that in his profession there is a significant gulf emerging between the ones who feel the prescribing is justified, and the ones (like him) with significant concerns:
1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it.
2. the drugs were tested inadequately across race, age, weight, sex.
3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal
4. almost all successful uses of the drugs are accompanied by CBT and like processes.
Re: “No convincing evidence” that depression is caused by low serotonin levels
#24So...why do SSRI users self-report efficacy?
Because psychiatric drugs don't necessarily work by counteracting specific deficits in the brain. That's a myth driven by unfortunate marketing campaigns and surface-level misunderstandings of the science.
This makes intuitive sense to people when discussing other topics. For example, when someone is in pain they don't need to have an "endogenous opioid deficiency" for opioid painkillers to alleviate their pain. They're just in pain, and modulating the opioid system with drugs is one way we can reduce that pain. Or COX-2 inhibitors. Or a number of other substances.
Likewise, modulating the serotonin system with SSRIs is one way we can modulate depression symptoms. People don't need to have a "serotonin deficiency" to see benefits from modulating their serotonin system.
Re: “No convincing evidence” that depression is caused by low serotonin levels
#25So...why do SSRI users self-report efficacy?
Depression has no common cause or common set of symptoms. I read a paper that likened it to a watershed, with tributaries feeding into a general pool of malaise. The watershed varies from person to person, and affects their internal “ecosystem” differently.
Maybe it’s a bit cute, but with this understanding, I think the headline is not shocking. We will never find the one cause of depression because there isn’t one.
In my opinion, our best bet is more personalized medicine: helping people identify which rivers are filling up their lake of depression. For most people it will be a weighted combination of many things, but I think there will usually be some principal components.
Re: “No convincing evidence” that depression is caused by low serotonin levels
#26No post body was provided.
Re: “No convincing evidence” that depression is caused by low serotonin levels
#27So...why do SSRI users self-report efficacy?
> ...two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits.
> ...A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness.
> These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied.
Re: “No convincing evidence” that depression is caused by low serotonin levels
#28There are probably a million different causes for depression and im convinced for all but the most extreme cases that usage of anti depressants is a mistake.
I think viewing depression as a disease instead of a symptom is a mistake. So many people eat food completely devoid of nutrition, stay indoors all day, have erratic sleep schedules, drink absurd amounts of alcohol and smoke weed all day. Why are we giving these people antidepressants when what they need is to go outside and walk and to take a multivitamin?
Re: “No convincing evidence” that depression is caused by low serotonin levels
#29Depression is caused by a shitty life. Most people with depression are trapped in an abusive relationship, though often it is with themselves. They're trapped by fear of admitting failure and making changes.
a lot of times its a abusive mindstate.... a lot of really really down bad people have went on to do great things. its all about your perspective
Re: “No convincing evidence” that depression is caused by low serotonin levels
#30One of the most interesting things I heard recently that really hit me like a bolt of lightning…
Depression is a disease of despair, and all these treatments are really just treating the symptoms.
In other words, people experience despair because of some underlying situation - examples: death of child, lonely, broken home. “Normal” things, and we try to treat it with pharmaceuticals. It would be like treating depression with cocaine or marijuana (they actually did and still do this btw) - might make you feel good temporarily; but it’ll never stop the despair.
The question is really how to address the despair. People often visit a therapist; I can see that helping some. But to many, they can’t seem to find the cause.
It reminds me of the post the other day about how people live over 100 [1]. It’s all about community:
> Belong. All but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy.
> Loved ones first. Successful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love. (They’ll be more likely to care for aging parents when the time comes.)
> Right tribe. The world’s longest lived people chose—or were born into—social circles that supported healthy behaviors, Okinawans created moais—groups of 5 friends that committed to each other for life. Research from the Framingham Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.
Yes some people have real hormone or other biological issues. But 99% of people likely need to address the root cause. I’d put money depression is on the rise as our communities are collapsing due to the industrial / technological nature of our world.