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

bmj.com

451–460 of 625 posts

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

#451
post #408

Earlier quoted context omitted.

They barely work better than placebo, from what I saw in my reading of the literature.

Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...

So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?

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

#452

Earlier quoted context omitted.

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.

They barely work better than placebo, from what I saw in my reading of the literature.

They work fantastically, from what I have seen firsthand many many times.

There is a very good reason for it's use in up to 20% of the population in some groups in the US.

Just because we haven't pinpointed why doesn't matter a bit.

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

#453
post #408

Earlier quoted context omitted.

Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...

So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?

I suddenly became allergic to SSRIs and had to go off of them cold turkey. I didn't have any withdrawal problems at all so it's not a universal issue.

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

#454

Earlier quoted context omitted.

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.

They barely work better than placebo, from what I saw in my reading of the literature.

There is also evidence that they might only work better than a typical placebo because the side effects make them an "active placebo", triggering a stronger placebo response. i.e. if you take a pill that doesn't make you feel any different, you may wonder if it's working, but if you feel weird and have unpleasant side effects then you know it's doing something.

This is particularly underappreciated in the research done on these drugs, because a double-blind study isn't actually double-blind if many of the participants can easily tell whether they're in the placebo group due to very noticeable side effects.

It's been mentioned in other comments, but I really recommend the work of Irving Kirsch on this; he's a brilliant scientist and his book The Emperor's New Drugs is a real eye-opener.

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

#456
post #392

Earlier quoted context omitted.

Please do not assert pet theories as established scientific consensus or fact.

Lack of citation does not make it a "pet theory". https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767816/ https://www.nature.com/articles/s41591-022-01744-z Go search it before being rude

Or, include the links yourself when making such claims? Unsupported comments are perhaps just as rude?

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

#457
post #408

Earlier quoted context omitted.

Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...

So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?

SSRIs have mild side effects after the first few weeks. Withdrawal varies but is generally manageable if you taper slowly.

I'm open to alternatives but I'm convinced that antidepressants help people.

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

#458

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…

The good news is you don't seem to suffer from serious depression.

If you did then you would know it is a very real physical problem that positive thinking can't really overcome. Not just physically in terms of brain chemistry but you often literally sink into your chair as if you were physically exhausted and don't want to move.

Depression enforces negative thought templates. No matter how good your life is going you will usually see the negative side of things and be depressed mentally and physically.

In a healthy person this is not the case. Your mood will vary widely by the situation you are in but most of the time positive thought templates will prevail and allow you to see the best even in difficult situations. It also gives you the mental/psycological energy needed to tackle difficult challenges/problems. In a fully depressed state you have no such energy no matter what your willpower is.

A healthy person has the mental and physical energy to tackle the day even when it involves hard/tedious or unpleasant work.

One paradoxical thing about depression is that it can sometimes actually feel good, in a comforting "oh it's that familiar feeling again" way. Usually that is just when you feel the onset of symptoms before the bad feelings/thoughts/feelings.

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

#459
Think we have known this for a while. For example Wellbutrin (Bupropion) works well for many people and it doesn’t work on serotonin levels at all. In fact it causes an increase of dopamine uptake in the brain.

Think increasing the dopamine levels causes a variety of changes to complex systems in the brain that are not really fully understood.

SSRi’s also cause changes to underlying systems in the brain that are not as simple as you are “low” on serotonin.

My two cents

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

#460

Earlier quoted context omitted.

They barely work better than placebo, from what I saw in my reading of the literature.

They work fantastically, from what I have seen firsthand many many times. There is a very good reason for it's use in up to 20% of the population in some groups in the US. Just because we haven't pinpointed why doesn't matter a bit.

Who should I trust? Peer reviewed literature, or one swampy boi?
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