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

bmj.com

241–250 of 625 posts

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

#242

SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time. The key thing to understand is that serotonin levels don't have to be low for SSRIs to i…

I think you’re throwing the baby out with the bath water here. Sure depression may not be linked to low serotonin levels but it almost certainly some chemical imbalance of some variety.

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

#243

Earlier quoted context omitted.

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 contr…

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

#244

When you look into the studies for antidepressants, the track record is abysmal. They’re not innocuous, trigger serious side effects, some are hard to quit, but more importantly they only make a difference in people with extremely severe depression. And doctors often downplay or don’t mention side effects honestly because they don’t want patients to not take them. The studies justifying antidepressants as effective t…

Yeah an unregulated and uncontrolled consumption of a poorly dosed hallucinogenic is totally better than a double-blind study of SSRI/SNRI.

I swear, I do not reject the possibility that hallucinogenics can cure depression better than existing meds, but the almost religious enthusiasm for such a poorly studied chemical is deeply concerning.

And yes, before you accuse me of being a pharma shill, I know that the lack of serious study is due to legal restrictions and not scientific evidence. But that doesn’t change the fact that they’ve not been studied rigorously. In my State, they are being actively studied, let us hold back the praise until the results are in.

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

#245
So maybe low serotonin levels are caused by depression? My naive understanding is that these amines play a critical role in our emotional response, social interactions and other complex psyche, so as a consequence, depressed person suffers decline in these functions, as well as a whole higher nervous system suffers regression. I always had a feeling that SSRIs are treating consequence, not the cause. Maybe I'm too naive and my understanding is very poor, I just architect systems in the end, so I'm looking at this problem like at a bug in the very root of an unimaginably complex system, while treating it by boosting one or another amine is looking like the most ugly hotfix.

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

#246

Earlier quoted context omitted.

It's very funny to describe SSRIs or SNRIs essentially as "happy pills". They are very unpleasant drugs to take, especially in the first month or so when starting to use them, and no one would be using them if they didn't feel there is a serious problem in their lives. Not to mention, depression takes several forms, and not all of them are related to unhappiness. A common form is related to anxiety, with people exper…

Would you rather be safe in prison for 100 years, or free in a world for 1 day where you could die?

I know for sure that I have much more anxiety when I'm in an unsafe environment than a safe one, regardless of how free I am in each. Lack of freedom does lots of bad things to your mind, but anxiety isn't one of them.

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

#247

Earlier quoted context omitted.

I'm finding the biggest impact from the psychedelic experience as a spiritual awakening, and the biggest thing I feel is that I'm no longer in the nihilism trap.

Can you articulate how your brain allowed you to escape from that trap? Did K affect you on some low-level inarticulable level? Sincerely curious. Nihilism is a struggle for me!

So, what I can surmise is that I felt a deep connection to the universe. You _feel_ the ramifications of not only being a part of the universe, but also the part of the universe trying to understand it.

I'd say I was an atheist before, but now I feel there is something and that something is curious. It's like consciousness is independent of the universe, and didn't create the universe. Instead, it's trying to figure out the puzzle. So, this tiny spark of faith cures nihilism because I'm part of the consciousness, and as long I as wake up and solve by piece of the puzzle, there is meaning in that.

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

#248

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…

Gonna attempt to short circuit the "you think WE have it bad? Whatabout 1700s?" argument by adding that the "broken interface" theory may be much more about the patient's perception and confidence of the trap we're in than the actual truth of relative conditions. There also might now be a greater philosophical understanding of the global picture than the average person back in the day. Back then we didn't have an int…

Yes, honestly I regret making the jab at "rich people". It's oversimplifying things.

I appreciate your take on this.

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

#249

SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time. The key thing to understand is that serotonin levels don't have to be low for SSRIs to i…

To add to this, SSRI onset efficacy corresponds with the downregulation of serotonin receptors in the brain. "Low serotonin" isn't what's being treated or changed, but the number of receptors and their activation rates. SSRIs can reduce emotional lability, which makes sense when you figure that downregulation and increased activation of serotonin receptors is a relatively stable system compared to an unmedicated brain with many receptors and widely fluxuating activation rates and lowered activation periods as serotonin gets recycled quickly without its transporter being inhibited.

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

#250

Earlier quoted context omitted.

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.

It depends on the timespan and comparative frame you are thinking about. If we limit ourselves to post-WW2 MAD world, there are much different overall trends in quality of life than starting in the middle ages or from colonial times, where many people did not enjoy the rights or luxuries modern people would, not in small part because they couldn't, technologically speaking. It's easy to compare modern poverty to peas…

> It depends on the timespan and comparative frame you are thinking about

There are few dimensions where pre-industrial life is better before than after. The quality of life for the average human is many standard deviations above what it was just a few centuries prior. It wasn't that long ago cholera was a death sentence.

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