Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

bmj.com

Post reply on HN
Print view View original

501–510 of 625 posts

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

#501

Post by s1artibartfast »

bergenty wrote: post #472
sneak wrote: post #393

Earlier quoted context omitted.

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.

I think the point is anything can be a chemical process because we are chemical beings.

Drowning or having your leg cut off leads to a chemical imbalance, but chemistry isn't always the most productive lens to analyze the problem

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

#502

Post by SkyPuncher »

VLM wrote: 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…

> People who make treatment decisions based on financials and kickbacks are not going to care about all this "science" and "logic" and "statistics" stuff where their wallet is concerned.

Can you elaborate on who these people are? You're casting a wide net here.

My partner works in mental health. The reality I've observed is mental health is incredibly challenging. Much of it is highly situational and requires hours and hours of extremely time consuming, labor intensive therapy to even begin creating a meaningful treatment plan. If mental health had unlimited time, many providers would love to be able to provide this level of care.

In practice, medications are a highly cost-effective means of improving people's mental health. They can increase people's baseline significantly with therapy (time and cost) focusing on rounding out the rough parts. Many patients are not interested in the therapy component if they can get "80%" better with some medication.

IMO, this is why we're seeing such a boom in "pill mill" mental health startups. A large portion of the affected population is content being "mostly better, quickly" rather than "fully better, slower".

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

#503

Post by bitexploder »

hirvi74 wrote: post #495
kemiller wrote: post #478

Earlier quoted context omitted.

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

It's true, and I alluded to this more in depth in a comment in this chain. Growing up in the semi-rural South East, USA, where kids didn't get diagnosed with ADHD. (Fun fact -- I had 5 boys who were my childhood friends that grew up with. We all lived within 3 miles of each other, and all of us have ADHD -- something in the water maybe?) I didn't know I had ADHD until I was in a dark dark place in my early 20s after…

There is a reason alcoholism (and drug addiction) and ADHD strongly correlate. Coping and self medication are a big deal when it feels there is no other tools available or the negative externalities just get to be too severe. Add in addictive personality traits common to ADHD folks and it is quite a thing to overcome for more significant ADHD sufferers.

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

#504

Post by [deleted] »

multiplegeorges wrote: post #428
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…

> And less thinking meant less depression and anxiety. That's a pretty big claim. I know you're just putting out your own personal theory and you're not trying to declare you have the "answer", but I don't see how that follows. A first step is establishing that depression is more prevalent now than in the 50s. You'd have to account for the lack of diagnosis then and find some other indicator of the true rate of depre…

[deleted]

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

#505

Post by MattRix »

zasdffaa wrote: post #471
jack_pp wrote: post #451

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.

I had horrible withdrawal effects coming off lexapro/escitalopram, it was literally the worst experience of my life. I spent a month with maxed-out anxiety, feeling like I was going to die any moment, waking up at night with electric shocks running through my body, etc. I wouldn’t wish it on my worst enemy.

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

#506

Post by malfist »

carlmr wrote: post #466
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…

>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. This for me doesn't seem logical. It could be that a long term imbalance makes you depr…

There's a lot of evidence around hippocampus size in depressed patients. They tend to be smaller than average. After 6 months to a year of treatment with antidepressants the hippocampus grows to a larger size.

It's speculated that hippocampus size might be one of the driving components of depression, but who knows. Mental illness is complex.

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

#508

Post by theptip »

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…

It’s really complex. For a partial survey of that complexity, see this SSC: https://slatestarcodex.com/2017/06/13/what-is-depression-any....

Part of the problem in describing/treating this condition is that depression is a huge constellation of overlapping causal mechanisms. You may be describing one set of mechanisms but it’s certainly not the only one.

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

#509

Post by d0mine »

SkyPuncher wrote: post #502
VLM wrote: 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…

> People who make treatment decisions based on financials and kickbacks are not going to care about all this "science" and "logic" and "statistics" stuff where their wallet is concerned. Can you elaborate on who these people are? You're casting a wide net here. My partner works in mental health. The reality I've observed is mental health is incredibly challenging. Much of it is highly situational and requires hours a…

> medications are highly cost/effective..

You are commenting on the article that says that it is BS. The most upvoted comment on the article at the moment says "it [the ineffectiveness] is old news hardly worth mentioning"

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

#510

Post by AlwaysRock »

rustybelt wrote: post #432
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…

Good lord. I try to tell folks all the time that to some extend you have to ignore news. Big world events are going to find their way to you. Russian invading Ukraine is going to end up being something you hear about regardless if you follow the news at all.

The tragic stories of children getting bombed in Ukraine? The photos? The gory details? That likely is only waiting for you if you go searching for it.

I'm not advocating being ignorant. I'm advocating limited the amount if tragedy you seek out on a daily basis. It isnt good for ones head. It certainly doesnt make anyones life better.

Post reply on HN