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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

#341

Post by fragcula »

varispeed wrote: post #337
fragcula wrote: post #336

> Other clinicians say, however, that the notion of depression being because of a simple chemical imbalance is outmoded anyway, and that antidepressants remain a useful option for patients alongside other approaches including talking therapies. This is the key line in the summary. The concept of attacking an idea no one really believes is really a straw man. More importantly the modern practice of medicine is "eviden…

> are tested as to if they work, not how they work Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests... Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...

The psychiatrists themselves don't need to do both, as doctors practicing EBM they are interested in proven results. The decision to recommend a treatment (and to accept it) is based on the pros and cons only.

What people really care about is side effects. That's one of the reasons modern pharmas are so fixated in testing old drugs for new disorders (the other reason is they might be able to get a new patent case in point when Eli Lilly made pink fluoxetine for girls with a new indication for PMS [0]).

Similarly, the best way to identify side effects is by looking at the molecule and guessing (static analysis), testing with cells, animals or other non-human biological systems (I guess this is alpha testing as we rarely think of the testers as human...), and then in human studies (early access).

Even then we roll out incrementally (phase 2), before widely testing in phase 3 and collecting feedback.

[0] https://money.cnn.com/2000/07/06/companies/lilly/

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

#342

Post by chalst »

cbxyp wrote: post #316
chalst wrote: post #309

Earlier quoted context omitted.

> without a doubt Not a mark of wisdom to use these words about such topics. I agree that SSRIs and bipolar are a tricky mix, but they work for some patients.

Divorce: https://pubmed.ncbi.nlm.nih.gov/23931947/ Mass shootings / violence: https://www.psychreg.org/antidepressants-ssri-mass-shootings... While they may provide benefit to some patients, the sheer volume of prescriptions and the quite clearly linked effect leads me to stand by my original statement - without a doubt, they are a leading cause of both.

The existence of studies attesting to a link does not demonstrate causation beyond reasonable doubt.

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

#343

Post by vkou »

varispeed wrote: post #337
fragcula wrote: post #336

> Other clinicians say, however, that the notion of depression being because of a simple chemical imbalance is outmoded anyway, and that antidepressants remain a useful option for patients alongside other approaches including talking therapies. This is the key line in the summary. The concept of attacking an idea no one really believes is really a straw man. More importantly the modern practice of medicine is "eviden…

> are tested as to if they work, not how they work Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests... Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...

> Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests...

If that were the criteria, then we would not have medicine at all, because biological systems are so incredibly complicated, nobody understands even a tiny fraction of how a particular chemical will affect them.

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

#344

Post by openplatypus »

fragcula wrote: post #336

> Other clinicians say, however, that the notion of depression being because of a simple chemical imbalance is outmoded anyway, and that antidepressants remain a useful option for patients alongside other approaches including talking therapies. This is the key line in the summary. The concept of attacking an idea no one really believes is really a straw man. More importantly the modern practice of medicine is "eviden…

IMO key quote the study you referenced:

> In conclusion, the anti-anxiety properties of SSRIs appear to be largely dependent on expectancy effects on dopamine signaling while SERT blockade is not sufficient for symptom remission.

Drug works, if you believe it does :)

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

#345

Post by im3w1l »

irjustin wrote: post #311
Etheryte wrote: post #281

Earlier quoted context omitted.

Have you considered that your comment may have been downvoted because you come across unnecessarily hostile, not because of some absurd attack on your person? Similarly, any space is a good space to discuss and spread awareness on mental health — even if only one person finds an idea to help them, whatever their situation may be, it's already a massive positive.

> because you come across unnecessarily hostile And possibly justified. A lot of us are armchair psychiatrist from reading articles. OP that you're replying to lives this type of medication and attributes being alive right now to it while a lot of us who have only read articles sit and debate. A number of these comments can come across as "just eat healthier" to an overweight person or "don't be sad".

About 15% of American adults are currently on antidepressants. I tried but failed to find how many people ever used it. But it goes without saying that it should be be even higher. In other words, antidepressant use is very common and many people will be drawing on personal experience. That might not feel comfortable divulging that about themselves.

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

#346

Post by rmbyrro »

boesboes wrote: post #339
varispeed wrote: post #337

Earlier quoted context omitted.

> are tested as to if they work, not how they work Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests... Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...

> shipping code that I don't know how it works, but it passes tests We call that machine learning

What isn't machine learning is sometimes called "tested code"

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

#347

Post by cameronh90 »

locusofself wrote: post #45

Anecdata, but I was often depressed for most of my adjust life. Around 5-6 years ago (age 33 at the time), I started taking 20mg Citalopram. I have experienced almost no depression since I started taking this medication, I'm far more focused and productive than I have ever been. It could be a factor of age and getting married as well, and just settling into my life. But my depression felt like something out of my con…

Sertraline has almost entirely fixed my panic disorder.

It had no obvious cause and months of therapy had no impact. Within a few days of taking sertraline, it was essentially cured. I still get anxious from time to time but I'm able to live a completely normal life again. I had a few side effects (GI especially) for a few weeks but now the only side effect I have is I yawn a lot more, which is pretty tame.

I'm a big believer in the gut-brain connection and wonder if maybe it was something to do with the drug's GI effects that helped, but ultimately I have no idea and it doesn't really matter.

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

#348

Post by Negitivefrags »

_moof wrote: post #291
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.

TMS gives me the creeps. I mean ultimately you are inducing current in the brain with magnetic fields.

It boils down to the same mechanism of action as electro-shock therapy. Presumably with a lot less destruction of neurons of course.

Now electro-shock is one of the most effective at treating depression, and I guess that might be why TMS might be effective too.

But I think the reason I ultimately wouldn’t do it is just that it feels like physically altering my brain and it’s a hard pill to swallow. Just like I would be hard pressed to accept a treatment like someone surgically excising a chunk of my brain matter even if a doctor told me it was 100% effective as a cure.

Perhaps this is irrational but I just can’t shake it.

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

#349

Post by grapeskin »

benevol wrote: post #321
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.

It's not that anti-depressants shouldn't be an available choice. It's that natural remedies such as psilocybin and LSD which have proven their worth for a very, very long time are still being blocked by you-know-which industry.

As much as I think LSD helps, I don't think it's ever been found naturally. It's synthesized.

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

#350

Post by dang »

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.

Please don't post offtopic flamewar comments, regardless of how wrong other people are or you feel they are. It just makes everything worse. Also, please don't go on about downvotes. That's in the site guidelines too: https://news.ycombinator.com/newsguidelines.html

Edit: I assume you're talking about https://news.ycombinator.com/item?id=32161183, which was correctly downvoted for being a flamewar comment. Please don't post comments like that or https://news.ycombinator.com/item?id=32161488 or https://news.ycombinator.com/item?id=32161557 to HN.

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