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

bmj.com

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

#171

Post by emodendroket »

tptacek wrote: post #170
emodendroket wrote: post #164

Earlier quoted context omitted.

I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.

All sorts of non-absurd-seeming notions turn out to be wrong, which is why people train for many years to conduct medical research.

How would you "medically disprove" the notion that some people are unhappy because the circumstances of their lives are bad rather than biological defects?

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

#172

Post by JamesBarney »

emodendroket wrote: post #164
tptacek wrote: post #148

Earlier quoted context omitted.

You're right: you've gone way out on a limb.

I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.

The idea that a terrible life can cause depression is not the limb he's going out on. It's the idea that somehow depression is caused by being way more exploited than our ancestors in the 1700's who were working on someone else's farms and factories as children is the limb he's going out on.

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

#173

Post by eurasiantiger »

arsome wrote: post #62
zeckalpha wrote: post #36

Earlier quoted context omitted.

Hence the first S and the I in SSRI. A filter in certain areas increases other areas. Doesn't change overall values.

The S for Selective actually means it only works on serotonin, compared with say, an SNRI, which works on both serotonin and norepinephrine. Impacting the overall values is in fact pretty much the only thing it does.

This is true, but inaccurate, as it only accounts for the direct effects.

However, increased serotonin receptor agonism also increases downstream dopamine and norepinephrine release.

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

#174

Post by phs318u »

whimsicalism wrote: post #93
eyelidlessness wrote: post #66

Earlier quoted context omitted.

> The diagnosis and treatment of ADHD in adults but most especially in children is extremely suspect. Go on… (I’m adult diagnosed, for disclosure, but please do go on and tell me how suspect my diagnosis was, how I shouldn’t have been diagnosed as a child, how my medication is harmful. Go on and tell me about my life which you know better than I do.)

e: [deleted]

This is HN not Slashdot. Please don't turn it into Slashdot.

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

#175

Post by eurasiantiger »

JamesBarney wrote: post #168
smolder wrote: post #122

I'm going to go out on a limb and guess the prominence of depression is largely caused by a broken interface with the world at large. The traps created by modern society wherein you struggle for other people's benefit are better designed than ever before. What our social machine procedurally treats as progress is advances in subjugation. Depression may often be an artifact of "efficiency" with respect to extracting v…

You must be reading very different history books than the ones I've read. The idea that we're somehow way more exploited than the people who came before us does not seem compatible with any history book I've ever read.

Before, the body was in chains, but the mind was free.

Now, the mind is in chains.

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

#177

Post by klodolph »

ggm wrote: post #60
PragmaticPulp wrote: post #54

Earlier quoted context omitted.

> 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 h…

Agree that the system is a bit fucked, in pretty much every country (as far as I can tell).

Unless you are involuntarily committed, you won't be put on the drug path if you don't want to. Psychiatric medications like SSRIs are generally awful. What I mean when I say "awful" is that the experience of taking them is awful. You may end up with symptoms that are under control, but you may still experience symptoms, or the symptoms can sometimes get worse, and the side effects are often just kind of shitty to deal with. These are generally not habit-forming drugs. These are nasty pills that you'll look at in the morning and dread taking.

Non-compliance rates are already high, when you have patients who want to take the medication. There is no way you're going to prescribe antidepressants to somebody who says they don't want to take them. It's just a waste of time.

Xanax is different. It's a benzodiazepine. The entire category of benzodiazepines is known to have a high rate of misuse, and Xanax in particular has a high rate of misuse. It's prescribed because it's an extremely effective and fast-acting. Very different from SSRIs.

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

#178

Post by tptacek »

emodendroket wrote: post #171
tptacek wrote: post #170

Earlier quoted context omitted.

All sorts of non-absurd-seeming notions turn out to be wrong, which is why people train for many years to conduct medical research.

How would you "medically disprove" the notion that some people are unhappy because the circumstances of their lives are bad rather than biological defects?

Nobody needs to disprove the notion that some people are happy for reasons having nothing to do with clinical depression.

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

#179

Post by emodendroket »

JamesBarney wrote: post #172
emodendroket wrote: post #164

Earlier quoted context omitted.

I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.

The idea that a terrible life can cause depression is not the limb he's going out on. It's the idea that somehow depression is caused by being way more exploited than our ancestors in the 1700's who were working on someone else's farms and factories as children is the limb he's going out on.

OK, well, that's an easy rhetorical maneuver but one that can be met with equally facile ripostes, such as "how do you determine that people weren't just as if not more depressed in the 18th Century when the concept was less familiar?" or "perhaps having the gulf between themselves and the wealthy rubbed in their faces every day is what causes the distress, since there can be little sense of exploitation if one is surrounded only by those in similar straits."

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

#180

Post by wpietri »

willcipriano wrote: post #146
eyelidlessness wrote: post #127

Earlier quoted context omitted.

> Don't take it personal Oh I take it personally. I’m alive today because I sought diagnosis and treatment. I very nearly wasn’t alive from the consequences of being undiagnosed and untreated. I very probably would be dead today if I had taken this “just person on the internet” more seriously than I already had. I’m more than tired of people offering their ignorant opinions about stuff they don’t understand.

On the other hand, the state threw a ADD diagnosis on me because I was bored in school, pumped me full of a methamphetamine analog and put me into classes with profoundly disabled people ruining my social life from a early age. I'd stare at the wall in my bedroom for hours due to the drugs, eventually my parents stopped giving them to me when I was at home, but that lead my dad to try them, and eventually get addicte…

As somebody who was diagnosed with ADHD in my youth and who has tried various medications, I've reached the point of suspecting that the disease model is just a poor fit here.

Does my brain work differently than other people? Yes. Would this have been a problem for me in any pre-industrial society? (Which, to be clear, is most of human history?) I don't think so. Is it a problem for me when I have a fair bit of control over the work I do? Not really! I only experience it as a problem when I am expected to function in contexts with industrial-age labor models, where there's a hierarchy that expects me to labor like a robot in line with how my betters have decided how the work should be done.

So I can entirely believe that authority figures over-use ADHD as a diagnosis so that their lives are easy. Reading through the DSM, it seems to me there are quite a number of diagnoses that could be used as Authority Inconvenience Syndrome. And I don't think I've ever seen one where people might need treatment for being too obedient.

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