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

bmj.com

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

#581

Post by ZeroGravitas »

fragcula wrote: post #580
ZeroGravitas wrote: post #489

Earlier quoted context omitted.

I was disagreeing specifically with this bit: > electroconvulsive therapy which has proven time and again to be the most effective treatment for depression Switch "the most" for "an" and we agree I think.

Oh I see. No ECT is most certainly the most efficacious treatment for depression we have. Talking therapies have a respone rate in depression of circa 40% [0], probably just slightly higher for antidepressants up to about 50% and faster [1], ECT respone rate is well over than even for those with treatment resistance but as high as 90% [2]. Vitally, the reposnse to ECT is fast and is often under 10 days. The fact that…

I think we're just disagreeing on different interpretations of the word effective.

If something works, but has so many negatives that you only use it when other negatives outweigh those, then it's effective in some sense of the word, but I'd maybe not phrase it as "the most effective treatment".

Kind of like pre-emeptive mastectomy for breast cancer, it's effective and it's the recommended treatment for people likely to have problems due to specific genetic factors, but saying "pre-emptive mastectomy is the most effective treatment for breast cancer" is missing a lot of important nuance and can sound extreme, even though it could be defended as a true statement.

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

#582

Post by fragcula »

ZeroGravitas wrote: post #581
fragcula wrote: post #580

Earlier quoted context omitted.

Oh I see. No ECT is most certainly the most efficacious treatment for depression we have. Talking therapies have a respone rate in depression of circa 40% [0], probably just slightly higher for antidepressants up to about 50% and faster [1], ECT respone rate is well over than even for those with treatment resistance but as high as 90% [2]. Vitally, the reposnse to ECT is fast and is often under 10 days. The fact that…

I think we're just disagreeing on different interpretations of the word effective. If something works, but has so many negatives that you only use it when other negatives outweigh those, then it's effective in some sense of the word, but I'd maybe not phrase it as "the most effective treatment". Kind of like pre-emeptive mastectomy for breast cancer, it's effective and it's the recommended treatment for people likely…

> I think we're just disagreeing on different interpretations of the word effective.

That's likely. I'm using the word in the sense of clinical efficacy, i.e. how likely an intervention is to produce the intended outcome. In this case the response rate to the intervention in those with depression [0].

Preemptive double mastectomy is the most effective way to date to prevent breast cancer [2] (~95% reduction). This is important for those at heightened risk, for example those with pathological variants of BRCA 1 & 2 which each independently increase the risk of breast cancer 5 fold (up to 70%!)[1]. Coupled with other factors some women are statistically almost certain to get breast cancer if they live long enough.

We can't mince words with peoples lives. People with severe depression deserve to know that ECT is a safe treatment and the most effective treatment available. And there should not be stigma in any treatment.

Similarly, pre-emptive mastectomy the most effective prophylactic intervention available for preventing breast cancer. And important for those who are at very very high risk.

[0] https://www.collinsdictionary.com/dictionary/english/clinica...

[1] https://www.cancer.gov/about-cancer/causes-prevention/geneti...

[2] https://www.macmillan.org.uk/cancer-information-and-support/...

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

#583

Post by jack_pp »

zasdffaa wrote: post #524
hammyhavoc wrote: post #512

Earlier quoted context omitted.

Anecdotal. n+1.

I'm not sure what you're saying?

> It doesn't sound like you have any direct experience of this

It doesn't matter if I have personal experience with this although I do. A very bad personal experience with the mental health service that was provided as well as the side effects I was talking about.

> I had to come off them and it wasn't a problem.

This just comes off as ignorant, there is established literature on the withdrawal effects. I was not speculating or spreading FUD. They are real, documented and more common than your anecdotal lucky experience

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

#584

Post by Eldt »

sizzle wrote: post #571
kemiller wrote: post #564

Earlier quoted context omitted.

Well, first of all, I didn't say it was the only cause for depression; it's a condition that comes in lots of different flavors and this is only one. Second, to elaborate a bit more, having to constantly manage your brain in order to get it to do what you need can be exhausting. Any success you achieve feels like it's extremely tenuous, and I'd say most AD(H)D people have had an experience of doing well for a while a…

I co-sign everything written here as

I never invited you people into my head and I don't like it

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

#585

Post by zasdffaa »

jack_pp wrote: post #583
zasdffaa wrote: post #524

Earlier quoted context omitted.

I'm not sure what you're saying?

> It doesn't sound like you have any direct experience of this It doesn't matter if I have personal experience with this although I do. A very bad personal experience with the mental health service that was provided as well as the side effects I was talking about. > I had to come off them and it wasn't a problem. This just comes off as ignorant, there is established literature on the withdrawal effects. I was not spe…

So your bad experience is data, my ok experience is anecdote and is worth less than yours. Gotcha.

'I had no problem' means that bad problems aren't inevitable, which opposed the totally unqualified 'SEVERE' claim - they aren't always 'SEVERE'. That doesn't discount anyone's experiences when things do go bad as I acknowledged here https://news.ycombinator.com/item?id=32169654 - I'm not dissing anyone's experiences.

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

#586

Post by actually_a_dog »

andrekandre wrote: post #563
actually_a_dog wrote: post #116

Earlier quoted context omitted.

Now look at what it gets spent on. Specifically, take a closer look at housing, healthcare and higher education. All three of those have risen far, far faster than inflation for many years.

whats really interesting is, while some things like electronics and automobiles etc have been getting cheaper, intangibles like healthcare and education have been increasing in cost... whats the cause?

Obviously, I don't know the full story, but one thing the three things I named have in common is relatively inelastic demand. In the case of education and healthcare, I suspect Baumol's cost disease is also a factor.

Cars and other manufactured goods tend to get cheaper over time because they can take advantage of economies of scale, as well as global supply chains and free trade. We're seeing that very concretely right now as the global chip shortage has put pressure on the used car market.

Education, housing, and healthcare are largely unaffected by free trade, and Baumol's cost disease is literally a statement about how certain industries cannot take advantage of economies of scale.

Come to think of it, let's also toss childcare in the bucket of "things that have gotten more expensive faster than inflation over time" since, among households with children, we have a predominance of households where all parents who are present work. Again, we have inelastic demand and Baumol's cost disease rearing their ugly heads, so maybe there's something to this theory.

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

#587

Post by raducu »

pessimizer wrote: post #420
raducu wrote: post #415

Earlier quoted context omitted.

> but a cast does not heal a broken arm I don't know why people take such reductionistic stances. There are dozens of anti-depressants, I think most people get significant improvement after trying a few.

I don't think the number of different anti-depressants make it inevitable that some work significantly better than others. You can get casts in many different colors.

I'm sure they do but I only have anecdotal evidence from people that tried a number before the "ahaaa" moment.

I don't take them (well, except for sleep with a low dosage of Trazadone (which I can't anymore because it gives me priapism) and mirtazapine(which made me sleepy even the next day)), but my experience is with stimulants for ADHD. I've tried quite a few stimulants and while all worked for my ADHD (heck even pure nicotine works somewhat), some combinations were brilliant but illegal, and metylphenidate (Concerta) does an amazing job for my impulsivity and an ok-ish job for my focus.

Sure, I can't just snap my fingers, pop some low dosage meth (and I need to stress low dosage -- 15-20mg) or my favorite (3-1 isopropylphenidate + metylphenidate) and enter a flow state at will, but Concerta just changed my life for the better.

I'm sure that a lot(most) of people with depression just as with ADHD need more than just the medication.

If you're depressed because of your circumstances and have 0 power to change them, perhaps anti-depressants work less well, but I've read about numerous people who had a purely "chemical" depression -- there was nothing "bad" about their life and they changed nothing and after anti-depressants they were just not depressed anymore.

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

#588

Post by sinecure »

hirvi74 wrote: post #562
sinecure wrote: post #535

Earlier quoted context omitted.

Belief dictates reality. This is the fundamental driver behind the common effectiveness of placebo. Which leads to the question, does depression exist as a flaw in the brain? A malfunction? Or is it like a mind virus, that it becomes an inescapable suffering because we are told we are broken and powerless to fight these feelings? If a person is feeling sad, often, and without reason, and you tell them "Sorry, your br…

How would you describe a condition like Bipolar Disorder where the brain swings in both directions? Depression is half of Bipolar, but is the brain broken in this case? What about the manifestation of psychotic features? Based on my understanding of the condition, typical anti-depressants tend to be a contraindication for Bipolar Disorder (can induce mania), so in some regards it seems like the medications not only w…

A childhood friend of mine developed schizophrenia at 25, so I am surely convinced of the existence of true mental illness. To me a mental illness is defined as a clear defect in the workings of the brain, such that you have uncontrollable hallucinations and mania. I am not as familiar with bipolar disorder, but my overall argument is not that mental illness is non-existent, it's that depression is either vastly over-diagnosed or should not be categorized in the same group as schizophrenia and the like. Where is the line between "I've abused my brain with the comforts and overstimulation of modernity and now I am not happy" with "I was born to be sad because I'm genetically broken"?

In the end psychology is just too political and too lacking in scientific rigor to handle these questions. the DSM is essentially a politically motivated group of academics voting on what is or isn't a mental illness. At one point homosexuality was a mental illness, seen as a deviance in brain function leading to the end of reproduction. But the political tides changed and now it is no longer classified that way. How can we drug people for a lifetime based on the changing tide of academic bureaucrats who vote on what is or isn't normal? Is it too cynical to believe that the pharmaceutical companies making massive profit off of the mental health drug industry are not backing the psychologists making DSM decisions?

A kid comes in saying he's depressed all the time. They ask him what's wrong, why he is unhappy? He complains about feeling sad all the time without reason. They give him anti-depressants. But what about the fact that he plays video games all day, watches porn constantly, is on booze and weed and stimulants, is constantly browsing novel media on his smartphone, constantly entertained with netflix, he's blasted with supernormal stimuli 24/7 and then wonder's why his brain chemistry is out of whack... yet the mental health industry would rather see him drugged up on profit making anti-depressants rather than struggle through the years of effort and therapy to change his lifestyle.

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

#589

Post by jack_pp »

zasdffaa wrote: post #585
jack_pp wrote: post #583

Earlier quoted context omitted.

> It doesn't sound like you have any direct experience of this It doesn't matter if I have personal experience with this although I do. A very bad personal experience with the mental health service that was provided as well as the side effects I was talking about. > I had to come off them and it wasn't a problem. This just comes off as ignorant, there is established literature on the withdrawal effects. I was not spe…

So your bad experience is data, my ok experience is anecdote and is worth less than yours. Gotcha. 'I had no problem' means that bad problems aren't inevitable, which opposed the totally unqualified 'SEVERE' claim - they aren't always 'SEVERE'. That doesn't discount anyone's experiences when things do go bad as I acknowledged here https://news.ycombinator.com/item?id=32169654 - I'm not dissing anyone's experiences.

You keep missing the point, there's a reason every doctor who prescribes these drugs will also make sure to taper you off because if you suddenly come off them there will be consequences. Now I'm not gonna troll the literature to figure out what the exact numbers are.

It's not about you dissing anyone's experience, it is about you ignoring the reality of this issue just because you were lucky.

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

#590

Post by pcmoney »

carabiner wrote: post #46
kayamon wrote: post #44

Earlier quoted context omitted.

> If people can be happy in concentration camps we can be happy in dead end office jobs. I don't think people in concentration camps are happy.

He's probably referring to the book Man's Search for Meaning. The book's conclusion is a bit controversial for this.

I was thinking more along the lines of the TenBoom sisters.
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