“No convincing evidence” that depression is caused by low serotonin levels • Hacker News Board

Re: “No convincing evidence” that depression is caused by low serotonin levels

#51

Post by ggm » Wed, Jul 20, 2022, 3:31 AM UTC

PragmaticPulp wrote: post #42

ggm wrote: post #23

My 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…

> 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. "Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist migh…

I'm not a psychiatrist or psychologist. He is, and has professional standing. You're judging him, on my paraphrases of what is said to me. Perhaps what you really should be saying is "don't try to represent the views of professionals in a field you are not an expert in" which btw, I would take as good advice.

None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use.

Do you disagree?

Re: “No convincing evidence” that depression is caused by low serotonin levels

#52

Post by rando14775 » Wed, Jul 20, 2022, 3:31 AM UTC

hackerlight wrote: post #10

kennywinker wrote: post #9

Earlier quoted context omitted.

When they test drugs, they test them against a placebo.

Yes, but according to Irving Kirsch, the benefit of anti-depressants above placebo is very small for anyone who isn't severely depressed, and the observed small effects can plausibly be explained by patients unblinding themselves (due to the presence of other side effects in the treatment group), or by things like publication bias. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

I'll add that side effects alone can influence depression scores. Any medication that de- or increases sleepyness will change the score of any questionaire when taken at the appropriate time of day.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#53

Post by mathgladiator » Wed, Jul 20, 2022, 3:32 AM UTC

As a member of the anti-psychiatry side after seeing primary care doctors wreck my mother... I think we will see a sea change in how we approach this with things like psychedelics.

I recently got treated with six weeks of Ketamine, and it works. If you ever thought about rebooting your brain, then I recommend it. However, you really have to surrender yourself to the experience; it is a very intentional act.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#54

Post by PragmaticPulp » Wed, Jul 20, 2022, 3:33 AM UTC

ggm wrote: post #51

PragmaticPulp wrote: post #42

Earlier quoted context omitted.

> 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. "Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist migh…

I'm not a psychiatrist or psychologist. He is, and has professional standing. You're judging him, on my paraphrases of what is said to me. Perhaps what you really should be saying is "don't try to represent the views of professionals in a field you are not an expert in" which btw, I would take as good advice. None the less, I think the substantive point stands: the field is not in unity about the applicability of the…

> None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use.

Which field? You said he was a psychologist. Your post was about psychiatry and neuroscience topics.

I don't disagree that psychologists have a lot of opinions, but it's not really their domain. I think it's a mistake to think that a psychologist is better educated on psychiatry topics than actual psychiatrists or neuroscientists who actually study these things and understand the research.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#55

Post by _yoqn » Wed, Jul 20, 2022, 3:35 AM UTC

ldjkfkdsjnv wrote: post #41

Too tired to type a cogent paragraph. Just that I have seen lives ruined by SSRIs.

Your comment is the most sensible I hav seen so far. I have seen lives utterly decimated by SSRIS. Suicides and murders caused by its side effects. Violent and suicidal tendencies are on the warning labels on many of these drugs.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#56

Post by bwood » Wed, Jul 20, 2022, 3:37 AM UTC

klodolph wrote: post #38

lettergram wrote: post #30

One 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 depress…

Bolts of lightning can be factually wrong, it sounds.

Sure, but it would be more constructive to explain why it's wrong. GP's comment has some interesting ideas and it would be better to directly refute them than just claiming they're "factually wrong".

Re: “No convincing evidence” that depression is caused by low serotonin levels

#57

Post by chx » Wed, Jul 20, 2022, 3:42 AM UTC

There's a significant population of science denying cranks and so those who want to raise legit concerns about the quality and alas, often motivation of medical studies are easily grouped with those. But:

1. There's no such thing as good / bad cholesterol. This is complete baloney and Pfizer lost a staggering amount of money when a drug raising good cholesterol got as far as human trials -- and failed them. There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. There's growing amount evidence though that cholesterol is a symptom and not a cause.

2. The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Last year there was a study pretty much confirming it is overdiagnosed in children. But even worse, whether ADHD is even a thing or multiple conditions wrongly bundled under a single name is basically an open question. We basically put labels on children with "problematic behaviors" like "autistic spectrum disorder" and "ADHD" and then eventually find that 30-80% of ASD children are meeting criteria for ADHD. First of all what sort of study is 30-80%? But if the higher end is true, the question strongly arises: are these even two things?

3. I would bet dollars to doughnuts in a few decades we will look at all current nutrition advice to something akin of medieval quackery. How is this not self evident: genes obviously affect how foodstuff interact with our bodies thus any sweeping generalization is inherently suspect or most likely complete baloney. Like, how can anyone seriously think only lactose intolerance is an inherited genetic trait.

I would need to dig into my notes if someone needs them but a group of statisticians at a university started to look into medical studies and then FOIA the raw data and found like 80% of them cherry picking the data.

The incentives are not exactly at the right place.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#58

Post by PragmaticPulp » Wed, Jul 20, 2022, 3:43 AM UTC

mathgladiator wrote: post #53

As a member of the anti-psychiatry side after seeing primary care doctors wreck my mother... I think we will see a sea change in how we approach this with things like psychedelics. I recently got treated with six weeks of Ketamine, and it works. If you ever thought about rebooting your brain, then I recommend it. However, you really have to surrender yourself to the experience; it is a very intentional act.

Ketamine treatment is interesting, but it's not really a replacement for SSRIs. The anti-depressant effects of Ketamine are unfortunately relatively short-lived. Tolerance also seems to develop to the effects over time. There are some adventurous providers experimenting with frequent ketamine dosing over long periods of time, but the results haven't really been great from what I've seen.

Also, a psychedelic experience is definitely not necessary for ketamine's antidepressant effects. In fact, the more responsible providers and studies are careful to keep peak plasma levels low enough to avoid this, and it works just fine. A lot of unscrupulous providers are using excessively high doses to induce psychedelic experiences, but this isn't actually supported by the evidence.

SSRIs and other traditional antidepressants will continue to be mainstays of long-term depression treatment if for no reason other than their sustainability and long-term efficacy is so much better than ketamine.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#59

Post by _yoqn » Wed, Jul 20, 2022, 3:43 AM UTC

quacked wrote: post #39

tested23 wrote: post #28

There 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…

Completely agree with you, although I think that "going outside and taking a multivitamin" is an inadequate substitute for "live inside a prosperous, functional human-shaped society".

It's not society. It actually starts with the individual. In order to have nay kind of decent society, each individual needs to recognize that they are responsible for themselves and their own society. Going outside, exercising and consuming nourishing foods are the literal starting place. Then seek to find things you like doing and become competent in them. Find a good wife or husband. Don't cheat on them. Don't take alcohol to excess, etc. etc.

The point is, you cant start from the outside and work your way down the the individual. It starts with the person.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#60

Post by ggm » Wed, Jul 20, 2022, 3:45 AM UTC

PragmaticPulp wrote: post #54

ggm wrote: post #51

Earlier quoted context omitted.

I'm not a psychiatrist or psychologist. He is, and has professional standing. You're judging him, on my paraphrases of what is said to me. Perhaps what you really should be saying is "don't try to represent the views of professionals in a field you are not an expert in" which btw, I would take as good advice. None the less, I think the substantive point stands: the field is not in unity about the applicability of the…

> None the less, I think the substantive point stands: the field is not in unity about the applicability of these drugs, and their use. Which field? You said he was a psychologist. Your post was about psychiatry and neuroscience topics. I don't disagree that psychologists have a lot of opinions, but it's not really their domain. I think it's a mistake to think that a psychologist is better educated on psychiatry topi…

I think the gap between GPs, Psychologists and Psychiatrists lies at the heart of this. GPs can (and do) prescribe psychoactive drugs. What they do subsequently is subject to the constraints of the health economics which apply: In the UK (I am told) the delay to be seen by anyone other than your GP can be measured in YEARS because of the backlog in patents presenting. Many of these patients are young people. The GP has the determinant of the path. They can recommend something like CBT and a clinical psychologist, or they can recommend drugs and a psychiatrist. They can do either, for what is the same presentation of problem.

They get seen by a GP, with limited time and tools. They are prescribed SSRIs, and booked in to see "some other health professional" and what emerges is a delay of some significant time, before they get that next stage of engagement.

I was also triaged by my GP, in Australia, and was put into the non-drug path, and I am content. If my health practitioner prefers not to use drugs, and that is a bias, so be it.

I can say that my mother in law was treated in other ways, became addicted to Xanax, and narrowly missed being placed in "deep sleep" therapy which wreaked havoc on many people, although it was "peak treatment" at the time. She was a deeply unhappy woman. I cannot say she would have been better off without drugs, but I do know the process of managing her drug regime was intense.

Deep sleep therapy lasted a long time. It was credible for decades. Psychiatry is as capable as any other science of being led a long way down paths it subsequently walks back on.

ECT, which is much more "confronting" in some ways, remains a useful tool. If you ask most people in the streets, They react with horror.

I place great hopes in ketamine, and in psylocybin. Again, both require a context of use, and are still experimental. What I like about both, is that they appear to being considered as rapid-intervention therapies, not as sustained, long lived treatments. I like that because of the short duration. I guess I don't like the SSRI story precisely because of the long duration, and the consequences on young kids, especially on things like sexual dysfunction. (I'm not a young kid and that isn't an immediate concern for me)