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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

#371

Post by fragcula »

asveikau wrote: post #67
PragmaticPulp wrote: post #42

Earlier quoted context omitted.

> 1. they prescribe both boosters, and inhibitors, to treat the same symptoms. This suggests the aetiology of disease here, is not well defined by a single behaviour because the same symptom (depression, anxiety) is responsive in some people to suppressing of a chemical imbalance, and in others to boosting it. "Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist migh…

> It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard. > I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry. Yeah, as someone who has been close to people who need antipsychotics, I sometimes feel the anti-antidepressant crowd extrapolates to all psychiatric drug…

It's interesting that anyone other than the R&D arm of the pharma industry even cares how it works.

From the medical side what's important is what risk/benefit which is independent.

Antidepressant as a term is really only for convenience which the medications themselves being quite broad in action.

Antipsychotics too are having a bit of a revolution, the first generation seemed to all be about D2 blockade, the second generation acting on 5HT-2a much more than D2. Finally, pimavaserin acting only on seratonin (5HT-2a) and not on dopamine at all [0] now there's SEP-363856 [1] which has action not at D2 or 5HT-2A but TAAR1 and 5HT-1A.

The point is that psychiatrists are not particularly married to any mode of action or mechanism. Only the results.

[0] https://nbn2r.com/search#drug/90

[1] https://en.wikipedia.org/wiki/Ulotaront

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

#372

Post by falafelite »

ChildOfChaos wrote: post #327

The book lost connections is a really good read on this. It points out the problems in modern society and our lives that lead to depression rather than it just being something that can be solved with a pill. Things like our lack of connection to meaningful work, our lack of connection to each other and our lack of connection to nature all play a big part.

I found the author to have cherry-picked and poorly-cited information earlier on in the book when talking about antidepressants, and then a complete lack of rigor when discussing the various lost connections. I think he has a point, but I just didn't find it very well done, and as another comment here has quoted: > 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.

It is also notable that the author has had plagiarism issues and other questionable behaviors in the past: https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism_and_fab...

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

#373

Post by MrDresden »

pineaux wrote: post #355
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…

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.

Psilocybin has done wonders for my anxiety and depression in the past.

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

#374

Post by workingon »

varispeed wrote: post #337
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…

> are tested as to if they work, not how they work Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests... Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...

Welcome to modern medicine.

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

#375

Post by webmobdev »

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…

> why not take a look at electroconvulsive therapy ... Yet we have no idea how it works ...

Or you can stick with something that has been already been scientifically studied and proven to be as effective as anti-depressants in curing depression - Cognitive Therapy. In fact, it even prevents relapses more than anti-depressants:

> Depression is one of the most prevalent and debilitating of the psychiatric disorders. Studies have shown that cognitive therapy is as efficacious as antidepressant medications at treating depression, and it seems to reduce the risk of relapse even after its discontinuation. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/

For those considering going to a CT therapist you can search for certified CT therapist from here: https://cares.beckinstitute.org/get-treatment/clinician-dire... (the Beck Institute was started by the founder of CT and is now run by his daughter who is also a professional in this field. Nowadays most therapist learn about CT during the education but only have the base knowledge of it and thus don't apply CT techniques properly during therapy, and remain ignorant of the advances in this field. Those who actually train and specialise in it are more effective.)

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

#377

Post by belorn »

bencollier49 wrote: post #298
bergenty wrote: post #242

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.

Metabolism and stress hormones both seem to play a role. It's going to be a very complex thing - the best treatment for a lot of brain conditions is just exercise.

The key word when using exercise to treat stress is that it need to be voluntary (ie, something that the person want to do). Forcing oneself to exercise has the opposite result with increased corticosterone levels. Exercise is great if and only if the individual is doing something they enjoy.

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

#378

Post by UK-Al05 »

astrange wrote: post #34
triyambakam wrote: post #31

Earlier quoted context omitted.

I'm puzzled by those who disagree with this statement. How is it surprising that depressing circumstances would lead to depression?

Major depressive disorder isn't the same thing as feeling sad about your job.

Bad jobs can cause suicide

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

#379

Post by UK-Al05 »

JamesBarney wrote: post #172
emodendroket wrote: post #164

Earlier quoted context omitted.

I've heard plenty of people involved in mental health care themselves lament the fact that they're often just trying to happy-talk people who genuinely have harrowing lives. I don't think the notion is absurd.

The idea that a terrible life can cause depression is not the limb he's going out on. It's the idea that somehow depression is caused by being way more exploited than our ancestors in the 1700's who were working on someone else's farms and factories as children is the limb he's going out on.

Is it exploitation that's the problem?

Or social isolation? People are very isolated these days. People can have good jobs, have lots of shallow acquittances but no true friends.

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

#380

Post by refurb »

walrus01 wrote: post #19

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.

I have a gardener. In fact, I have three gardeners. Three generations of men with no ambition, who are happier than I will ever be.
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