Live data from Hacker News

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

bmj.com

471–480 of 625 posts

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

#471
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 wonder why you say 'SEVERE' so severely. It doesn't sound like you have any direct experience of this. I had to come off them and it wasn't a problem. My biggest fear, and it was huge, was that the depression would return. It didn't.

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

#472
post #393

Earlier quoted context omitted.

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.

That's vague enough to be a totally useless description. Dehydration is also a "chemical imbalance of some variety".

I think that’s part of the point. Whatever it is, it’s a chemical imbalance. Just need to find which one. In the case of dehydration it’s water.

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

#473

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…

I'm on Wellbutrin (lowest dose) and it works great. I have no side effects whatsoever. Been on it since 2019. It's kept my depression in check and even helps with my ADHD a little. They say you can't drink alcohol with it, but I binge drink every weekend (I really love alcohol) with no problems.

SSRIs were an absolute train-wreck to be on; they made me angry and violent. I was on them for 10 years and I honestly don't believe it ever helped against depression. If I missed 1 day, I'd get the infamous "brain zaps". It took me about 3 months to taper off the damn things and it was a brutal 3 months. The last one was in October 2012 and I will never take them again. I did not experience any increase in depression either, so that makes a stronger case for them basically be worthless for me.

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

#474

Earlier quoted context omitted.

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.

Wow, just wow. Quitting them cold turkey 0 problems, incredible.

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

#475

Earlier quoted context omitted.

Gonna attempt to short circuit the "you think WE have it bad? Whatabout 1700s?" argument by adding that the "broken interface" theory may be much more about the patient's perception and confidence of the trap we're in than the actual truth of relative conditions. There also might now be a greater philosophical understanding of the global picture than the average person back in the day. Back then we didn't have an int…

Yes, honestly I regret making the jab at "rich people". It's oversimplifying things. I appreciate your take on this.

Don't feel too bad about it, you hit the nail on the head.

It might be helpful though to define the term "rich".

A rich person usually isn't your manager, or their boss, or even the owner of the business, because the people supervising you may have never had a raise in life either, and the owner might be in debt.

A rich person is someone who dismisses their dependence on others. They will act impeccably in all situations and often appear to have an untarnished reputation. A rich person will deny help to someone in need, and then justify their lack of empathy with something along the lines of tough love. A rich person will demand that others work and portray an image that they themselves work, while secretly delegating all work to others. A rich person will wear a suit, a lapel pin, all manner of regalia, to preserve their image at all cost. A rich person has an untethered ego that will go to any length to maintain control. A rich person will decide for others. A rich person will never question their own beliefs. A rich person achieves affluence by denying it to others.

Unfortunately the rich are in charge of all facets of our lives in the US and pretty much everywhere else. Their undying devotion to wealth inequality and the status quo is specifically the primary cause of suffering for the rest of us.

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

#476
post #404

There's two separate medical systems, one focused on making money and boosting financials where science does not matter, and the other focused on medical science where at least theoretically the financials do no not matter. Its up to the end user to figure out which system they're interfacing with and act accordingly. Hint, antidepressants make a lot of money for the correct people... People who make treatment decisi…

I understand where your cynicism comes from but I think it might be overblown in this case. These drugs do help people and psychiatrists want to help. The fact is that we just don't know that much about how higher cognition works. I have a neurobiology degree and was very surprised how little we actually know.

We don't know how to really measure things like depression, so we rely on animal models and medieval tests such as "Lets throw this mouse into a bucket and see how long it takes for it to give up treading water".

When we are able to take 'in situ' measures in a live person without risking their life, we may start to make progress on better treatments.

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

#477

I have a completely unscientific, subjective theory that some significant portion of depression in the population as a whole is caused by the economic circumstances that some people live in. Things like being trapped in a dead end job to keep healthcare benefits in the USA, living in a never ending treadmill of debt.

IOW: Are you ready for me to diagnose your totally normal reaction to our shitty society as mental illness so I can get you addicted to mind altering drugs for the rest of your life? https://imgur.com/Jb1mJyx Or as the Unabomber said, "Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness. Science fiction? It is already happening…

Brave New World and 1984 were near-future fiction, but were more near future than fiction. Drugs are soma.

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

#478

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…

I have a friend that's convinced that her ADHD 'causes depression' because her brain does not produce 'enough dopamine'. I'm noticing more and more among my peers a mythology around brain chemicals that's about as accurate as the four humors but with a scientific-sounding veneer. All brain function (and thus all bodily function, because the brain is the whole person /s) can be traced back to the presence or absence o…

I think ADHD causes depression because you get constant negative feedback from (many) teachers & bosses.

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

#479

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.

Perhaps it's not a literal imbalance but more of a flow problem, neural pathways fail to deliver and a portion is lost along the way. There are so many ways this could be going wrong, we have absolutely no clue unless we devise proper tools and methodology for data-mining everything up to a satisfyingly objective level.

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

#480

Earlier quoted context omitted.

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 wonder why you say 'SEVERE' so severely. It doesn't sound like you have any direct experience of this. I had to come off them and it wasn't a problem. My biggest fear, and it was huge, was that the depression would return. It didn't.

Because it's pretty damned severe with SNRIs. You probably only tried some SSRIs. Turns out not all medications are identical.
Post reply on HN