“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

#361

Post by daniel_iversen » Wed, Jul 20, 2022, 10:23 AM UTC

fragcula wrote: post #358

openplatypus wrote: post #344

Earlier quoted context omitted.

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 :)

It's a shame that the imagining is so expensive, because I'd love to see a true control arm with placebos and follow up scans. i.e. if you are on a placebo and are told you will get better how many do?

Don’t they do truckloads of tests and comparisons on anti depression medicine all the time including blind trials etc?

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

#362

Post by daniel-cussen » Wed, Jul 20, 2022, 10:24 AM UTC

Suicidalism and depression come from having a bad life, basically. All these quacks are trying to find what little chemical they can pepper on or what little product they can market. And society and especially psychiatrizing parents or bosses keep looking for the one magic trick that fixes this strange illness. Just make their life better! The actual circumstances, stop oppressing them! Admit your subterfuge and your child or employee will not suicide.

But admitting the subterfuge would sometimes amount to suicide.

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

#363

Post by king_magic » Wed, Jul 20, 2022, 10:29 AM UTC

daniel-cussen wrote: post #362

Suicidalism and depression come from having a bad life, basically. All these quacks are trying to find what little chemical they can pepper on or what little product they can market. And society and especially psychiatrizing parents or bosses keep looking for the one magic trick that fixes this strange illness. Just make their life better! The actual circumstances, stop oppressing them! Admit your subterfuge and your…

I have (and have always had) an awesome life. I’ve still struggled with depression.

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

#364

Post by pastacacioepepe » Wed, Jul 20, 2022, 10:32 AM UTC

ThrowawayR2 wrote: post #142

asdff wrote: post #92

Earlier quoted context omitted.

Just because some people have suffered through worse doesn't mean that you can use that to invalidate someone else's suffering.

But when, for the vast majority of history, the population faced a much poorer, more monotonous, and less free existence than what the modern worker faces then you jolly well can.

> the population faced a much poorer, more monotonous, and less free existence

That's an over simplification.

People could still have more free time than we do now[1], while their life could be more monotonous on some aspect, I believe an average office worker life today can be even more monotonous than what a serf life could be. You also have to consider labor alienation, which is a something that didn't exist so much before industrialization.

Most importantly, life commonly revolved around tight communities, while today most people live in individualist societies.

Individualism certainly has a larger impact on happiness than most modern convenience has.

- [1]: https://groups.csail.mit.edu/mac/users/rauch/worktime/hours_...

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

#365

Post by daniel-cussen » Wed, Jul 20, 2022, 10:33 AM UTC

king_magic wrote: post #363

daniel-cussen wrote: post #362

Suicidalism and depression come from having a bad life, basically. All these quacks are trying to find what little chemical they can pepper on or what little product they can market. And society and especially psychiatrizing parents or bosses keep looking for the one magic trick that fixes this strange illness. Just make their life better! The actual circumstances, stop oppressing them! Admit your subterfuge and your…

I have (and have always had) an awesome life. I’ve still struggled with depression.

EDIT: Had and have always had an awesome life? The fuck? Sounds counterfactual. Yeah a perfect life with no problems. Wouldn't the depression make it not awesome?

But to narrow down, shrinks dream of some like sweetener or artificial coloring they can add to all the shit the give someone to make it taste good. A spoonful of sugar makes the medicine go down! No it doesn't. It tastes bad because it's poison. That is the point of taste. And the best medicine tastes really good, Paltomiel, aspirin doesn't taste particularly bad, there's another one but it doesn't taste bad just really bitter, ah...alkaloids taste uh...well they reconfigure your notion of sweet=good bitter=bad, then there's dex, blood sugar, now sugar tastes like treacle. But the whole thing of medicine tasting bad is just like toothpaste tasting bad (sodium flouride), it tastes bad because it is bad for you, you should avoid it, get a toothpaste that doesn't have fluoride in it. Of course little children have no way of stopping their parents from forcing them to use this toothpaste, so they complain. And the parents say no complaints, backed by violence. Coercion.

To the shrinks that said that to me, I say, you take all the shit since it tastes so good, give me your pay for doing your job for you, and yeah the seasoning...you'll need it.

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

#366

Post by harshreality » Wed, Jul 20, 2022, 10:40 AM UTC

vkou wrote: post #343

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...

> 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.

I don't think that's quite accurate. We know first-order biochemical effects for a lot of drugs. There are always side effects, but they're side-effects, and those are largely understood as well.

Psych drugs have difficulties because they aren't used for their biochemical effects, they're used for their psychological effects, and psychological effects of biochemical processes are poorly understood.

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

#367

Post by ZeroGravitas » Wed, Jul 20, 2022, 10:41 AM UTC

nth_order wrote: post #335

Yeah, but thats hardly news, we have known that for decades. Otherwise direct serotonin releasers would be the most useful ADs. But these mostly give people nausea and serotonin syndrome. ADs work mostly by being FIASMAs, reducing inflammation and oxidative stress, increasing neurogenesis and neuroplasticity, increasing the activity of other monoaminergic systems, and the serotonergic portion is mostly explained by d…

And now the opposite happens with headlines that imply "your medication is suddenly revealed to be useless" when in fact we've been aware that we don't know how it works for a while, but we're still reasonably sure it helps, which perhaps explains the increase in prescription more than the "serotonin is the only thing that matters" theory which the experts ruled out a while ago.

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

#368

Post by skjoldr » Wed, Jul 20, 2022, 10:41 AM UTC

marincounty wrote: post #269

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'm pretty sure I'm hell banned, but forget about all the chemicals of the brain. Read anything by Irving Kirsch. He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All. He found they basically don't work better than Placebo. Personally, I think the "Happy" drugs have been the biggest con job the Americ…

You shouldn't talk about drugs you have zero experience with either as a doctor or as a patient. SSRIs do work.

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

#369

Post by bowsamic » Wed, Jul 20, 2022, 10:41 AM UTC

ornornor wrote: post #301

mellavora wrote: post #273

Earlier quoted context omitted.

Ok, so you have some control over quality. I'll also be generous and assume you have good estimate of dosages and/or some way to maintain consistency of dosages (anyone else reading this, the standard advice is to take less than you think you want and wait 45 min or so, then take more if needed to reach planned cruising altitude. This works if you have enough prior experience to calibrate by, otherwise is very diffic…

Yes I kinda assumed that if someone was considering giving this a shot, they’d research the subject very thoroughly before to get a good understanding of the effects, preparation, effects, doses, etc. The genera consensus seems to be that mushrooms (psilocybin) can’t kill you. You can’t OD on them. There is no known LD50 (that’s “practical” to achieve anyway), they dont cause addiction, and if you take them too often…

There are four main risks for most people:

- PTSD caused by bad trip. Bad trips are not uncommon, and it's not easy to let go. Part of the reason why psychedelics are so effective is that they basically force you to let go, otherwise you will have a bad trip. But some people can't do that, I couldn't, and you can end up causing long lasting psychological damage due to this. I had an existential crisis and became pretty suicidal for a few months after I had a couple of trips. I actually had to take up a religion to cope with it. The therapy services in the UK had no idea what to do to help me and made me feel alienated

- DP/DR (depersonalisation/derealisation). Can be short lasting, can be long lasting, can be flashbacks, can be constant

- HPPD (Hallucinogen persisting perception disorder). Described as anywhere between "visual snow" and "you never came down from the trip". No one knows why this happens or who it happens to, if it occurs differently with different psychs. Many people commit suicide over this one, since it can basically cause psychosis as some people never stop having intense hallucinatory effects for months or even years. If they can't come to terms with it it can be extremely disorientating and alienating. Andrew Callaghan of Channel 5 news / All Gas No Brakes has this. Kind of frightening since it's most trippers' worst nightmare to never come down from the trip, but that's actually a thing that happens to some people

- Flashbacks, which I would say are different to the other three, in that they are a sudden return to the tripping state of mind randomly, but not necessarily visual or DP/DR. I think this one is the least explored and least well known about

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

#370

Post by adamwk » Wed, Jul 20, 2022, 10:46 AM UTC

dang wrote: post #350

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 do…

Why is this an off topic flame war comment but “I’m too tired to write a paragraph but SSRIs kill” is fine? The moderation here rewards engineer’s disease where we first principling our way to warning people to ignore Dr.’s suggestions as long as everyone’s smiling at each other.

It’s like an anti-vax YouTube video where any dissenting opinion is flagged until mods give up and remove it from the front page. It’s the same thing with abortion or anything else that isn’t a Rust article.