“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

#291

Post by _moof » Wed, Jul 20, 2022, 7:32 AM UTC

eyelidlessness wrote: post #268

There’s no convincing evidence that discussing medical aspects of mental health is productive on HN. Currently my comment that I’m alive has been downvoted at least half a dozen times because I had the temerity to still be alive, be glad to say so, be grateful for my psychiatric care, and reject that any of that is “suspect”. This isn’t the place to discuss psychiatry. Talk to your doctor.

Indeed. And I can't help but notice that every discussion is rife with people singing the praises of psychedelics, but TMS is never, ever mentioned. If people were genuinely interested in alternatives to SSRIs for the sake of efficacy, you'd think an FDA-approved, non-pharmaceutical, non-invasive treatment would come up at least once.

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

#292

Post by klodolph » Wed, Jul 20, 2022, 7:33 AM UTC

lettergram wrote: post #196

klodolph wrote: post #124

Earlier quoted context omitted.

> No doubt, but this article is about how the SSRIs don’t seem to be effective. Where does the article say that? > Given that’s the case, some drugs may help ease symptoms (depression being the symptom), but finding and correcting the root cause (if possible) is important. It's not for lack of trying. > Unfortunately, the medical industry as a whole has very little reason to try and “cure” these diseases / disorders.…

> The disease is too complicated, or the cure is too difficult, or our understanding of depression is too primitive, or some combination of all three. I don’t think we disagree in almost any of this. I’m simply pointing out depression may be caused by environmental factors, one which can be treated. It could be why they found “nothing convincing” in the study. I have yet to meet a depressed person or almost any perso…

> I have yet to meet a depressed person or almost any person who couldn’t use more community.

Depression is known to cause this. Yes, it’s not that simple. But this reasoning is extremely dubious.

> The people I know who overcame depression all did the following: worked out, improved sleep patterns, joined some activities.

All the people I know who graduated high school got married and had children. Maybe we should encourage people to get married and have children to increase the graduation rate!

Sarcasm aside, this reasoning is just beyond dubious. Do you know what the symptoms of depression are? Are you familiar with the very basics of what depression is? All of the things that you described that people overcame are actual symptoms of depression.

Or maybe to abuse another analogy—everyone I know who got over chicken pox stopped getting those pustules. That doesn’t make “stop getting pustules” actionable advice!

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

#293

Post by imtringued » Wed, Jul 20, 2022, 7:34 AM UTC

inkblotuniverse wrote: post #261

missedthecue wrote: post #100

Earlier quoted context omitted.

All quintiles of the US population make more money (inflation adjusted) than they did 20, 40 or 60 years ago. Yet there are more depressives around than ever.

Yeah, nobody can afford a house.

People constantly shout how property values would go down if people could afford homes.

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

#294

Post by winocm » Wed, Jul 20, 2022, 7:34 AM UTC

carabiner wrote: post #233

tsimionescu wrote: post #221

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 prefer death.

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

#295

Post by taurath » Wed, Jul 20, 2022, 7:35 AM UTC

PraetorianGourd wrote: post #244

ornornor wrote: post #223

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…

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

Frankly, it could be and we’d have no way of knowing with the “rigor” we put through pharmacological stories, if your goal is effectiveness.

That the entire field of psychology is sort of In conflict over the mechanisms, validity, and treatment models of trauma and dissociation, which frequently underly depression and anxiety symptoms.

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

#296

Post by taurath » Wed, Jul 20, 2022, 7:38 AM UTC

gloosx wrote: post #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 na…

That’s my understanding and feeling as well. Psychiatric medication imo should be used to help stabilize for psychological work, not create a new chemical baseline.

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

#297

Post by agumonkey » Wed, Jul 20, 2022, 7:39 AM UTC

spaceman_2020 wrote: post #260

PragmaticPulp wrote: post #18

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…

Sertraline suplementation wiped out depression almost completely from my system within two months. I had been depressed earlier for half a decade. Its been nearly 8 years since I took sertraline (stopped within 3 months) and I haven't had a depressive episode since.

Was your ailment caused by events ? or something that creeped up invisibly ?

I'm often worried about neurochemical solutions if some part of your brain is still associating events/memories/ideas with pain.

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

#298

Post by bencollier49 » Wed, Jul 20, 2022, 7:40 AM UTC

bergenty wrote: post #242

PragmaticPulp wrote: post #18

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.

Metabolism and stress hormones both seem to play a role. It's going to be a very complex thing - the best treatment for a lot of brain conditions is just exercise.

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

#299

Post by taurath » Wed, Jul 20, 2022, 7:41 AM UTC

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…

Imagine a kid growing up in the US today, they are functionally under house arrest as neighborhoods are built for cars and not people. Everyone is isolated to their family unit almost entirely and all activity gated on parents time and willigness (or control).

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

#300

Post by am63517 » Wed, Jul 20, 2022, 7:41 AM UTC

This study shows (decide how convincingly) what has been suspected anyway. The causal direction of “chemical imbalance leads to depression” is just not a sensible assumption. SSRI are of course able to alleviate the symptoms as are other drugs or treatment that are not associated with serotonin. Tricyclic antidepressants, sleep deprivation, transcranial magnet stimulation, ketamine, exercise and many more. Also the efficacy of these other treatments does not depend on the performance in the Forced Swim Test. The multitude of different antidepressant approaches, the different and heterogeneous animal modeling leads me to believe that what we describe as major depression is a pathological alteration in the brain subnetwork activations, probably between frontal brain areas and formatio reticularis/pons. SSRI are a roundabout way of influencing network changes that take time to develop. And these chances happen to work via Sertonin paths but serotonin is not necessarily the cause of “depressed” state of the brain network.

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