“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

#431

Post by multiplegeorges » Wed, Jul 20, 2022, 2:13 PM UTC

tsol wrote: post #425

pineaux wrote: post #355

Earlier quoted context omitted.

Most effective treatment for depression = psychedelics. They have been used by shamans for eons for this reason. A lot of modern research into this (including 1000s of research studies from the 50s and 60s) confirms it. It was only because Nixon didn't like the fact that kids were not going to war, that the war on drugs was started.

Not everyone wants to trip in order to feel alright, and not everyone can handle it. Children and the elderly come to mind

When used for treatment, you don't "trip" in the recreational sense.

The medication is taken in a very controlled environment with a highly trained mental health professional.

There are also pre- and post-sessions to help people prepare for the experience and come out from it with positive outcomes.

Agreed that children probably shouldn't be given such strong drugs. I don't think you'd find a professional advocating for that.

As for the elderly, the drugs have been used in near-death therapy with elderly terminal patients. It has helped people overcome their fear and anxiety around dying and come to terms with their situation in a peaceful way.

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

#432

Post by rustybelt » Wed, Jul 20, 2022, 2:14 PM UTC

throwawayacc2 wrote: post #413

I have a theory which I can’t substantiate, just anecdotes and conversations I had throughout the years. But, I’m convinced a lot of depression/anxiety stems from thinking too much and that in turn is caused by an ever complex word with looser and looser guidelines or norms. I’m not making judgements weather this is necessarily good or bad but rather observing. In the past, even as recent as the 50s but certainly bef…

Similarly, I don't think we're equipped for the level of exposure to life-altering tragedy that mass/social media makes available. I swear my wife subscribes to a dedicated "small child dies in horrible freak accident" facebook feed. She is constantly sharing these types of stories with me from around the world. Logically, I know that these are actually extremely rare events, but the constant exposure still makes us both more anxious about the safety of our own children.

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

#433

Post by kayodelycaon » Wed, Jul 20, 2022, 2:18 PM 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.

Or chemical imbalance is the symptom, not the cause.

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

#434

Post by rustybelt » Wed, Jul 20, 2022, 2:18 PM UTC

Workaccount2 wrote: post #397

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…

Anytime I learn about bodily functions I become more and more aware of how shit it's engineering is. Works amazing, sure, but try and fix or debug anything? Good luck.

Are you saying God likes to yeet buggy unmaintainable spaghetti code directly into production?

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

#435

Post by scsilver » Wed, Jul 20, 2022, 2:22 PM UTC

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.

Have you ever wondered why the user is the product in so many internet companies?

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

#436

Post by fragcula » Wed, Jul 20, 2022, 2:24 PM UTC

ZeroGravitas wrote: post #406

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…

I don't think that's an accurate summary of the state of the art on ECT: https://www.nice.org.uk/guidance/ng222/chapter/Recommendatio... It sometimes works, it's contraindicated for certain people, comes near the end of the list of things to try (wait to see if you get better and get some excercise/sleep/sunlight being low risk interventions for mild depression) and even when it is used and does work, starting/contin…

I'm not sure what part of what I said you disagree with.

Nothing in the NICE guidelines explains how ECT works - because like the rest of the world NICE does not know.

Once odd aspect with ECT is that it seems to transiently improve parkinson's, again no one knows why.

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

#437

Post by martopix » Wed, Jul 20, 2022, 2:25 PM UTC

throwawayacc2 wrote: post #413

I have a theory which I can’t substantiate, just anecdotes and conversations I had throughout the years. But, I’m convinced a lot of depression/anxiety stems from thinking too much and that in turn is caused by an ever complex word with looser and looser guidelines or norms. I’m not making judgements weather this is necessarily good or bad but rather observing. In the past, even as recent as the 50s but certainly bef…

I actually read a book that made a similar claim, although I can't remember the title right now. It essentially said that depression as we know it is an illness for the contemporary world for the reasons you list. However, it made the point that there were "different" mental health problems in the past, which had to do more with the conflict against the more rigid social structure -- same but opposite to how today we suffer from the lack of direction that you describe well.

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

#438

Post by fragcula » Wed, Jul 20, 2022, 2:27 PM UTC

s1artibartfast wrote: post #414

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…

>That means treatments are tested as to if they work, not how they work. Ideally in multiple well run double blinded randomised controlled trials with at least some against treatment There are some concerning departures from this with medical approvals based not on treatment, but biomarkers. Without getting too political, two noteworthy recent examples come to mind. The first is abelacimab for alzheimer's, approved b…

abelacimab in particular was quite worrying. The BMJ (the journal OP posted) contained a criticism of that.

Similarly as you say is that because numbers are easy to think about antibody titres somehow took over the world when it came to covid vaccination. Despite good evidence t-cell activity is important for preventing severe disease.

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

#439

Post by PragmaticPulp » Wed, Jul 20, 2022, 2:28 PM UTC

tsimionescu wrote: post #240

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…

> Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field. The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that hi…

To be clear: The serotonin deficiency hypothesis has been floated for a long time as one of the possible underlying changes involved in depression etiology. It’s not even a stretch, given that we can find upregulations of the serotonin transporter in response to chronic unpredictable mild stress, the fact that 5-HTP (serotonin precursors) supplementation can boost mood, and the fact that many drugs of abuse operate through serotonin receptors to alter mood.

However, like I said in my post above, we’ve know for decades that it’s not the explanation because SSRIs boost extrasynaptic serotonin levels within hours but their therapeutic efficacy is famously delayed by weeks.

I suppose it’s possible that the author had some weird textbook that misrepresented the state of research, or that he misunderstood the relative confidence and significant of each theory presented. However, the state of research didn’t even believe that the serotonin hypothesis of depression was the full, accurate explanation when SSRIs were introduced for the reasons I stated above and more.

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

#440

Post by N1H1L » Wed, Jul 20, 2022, 2:28 PM UTC

rustybelt wrote: post #434

Workaccount2 wrote: post #397

Earlier quoted context omitted.

Anytime I learn about bodily functions I become more and more aware of how shit it's engineering is. Works amazing, sure, but try and fix or debug anything? Good luck.

Are you saying God likes to yeet buggy unmaintainable spaghetti code directly into production?

DNA is spaghetti code exemplified. We are carried around tons of dead viral DNA for example - what amounts to shipping code with older code commented out.