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Calling for a new approach to depression

theguardian.com

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Re: Calling for a new approach to depression

#41

Post by rwnspace »

EGreg wrote: post #9
foobarbecue wrote: post #6

Why did my comment get flagged? I assume this was a mistake, so reposting: tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame. (The article argues this point cogently, and I agree with it.) [I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]

I found, over the years of being on HN, that there's a sort of forceful response that always comes to these types of comments about depression, along with downvoting. The responses say basically, "Don't talk about what you don't know. Many people have real, chemical depression, and your comment that it's a product of life circumstances is not helpful ". I was always a but puzzled about the regularity with which that…

In my subjective experience, I am much more inclined to respond very negatively to others' discussions on depression, when I am myself depressed. My personal experiences with it are confused by PTSD and ADHD, but I've got a few (too many) years under my belt, and I have hit absolute zero multiple times.

The problem with reading online discussions, /I think/, is that it's super easy to end up with a polluted perspective and bipolar esteem/locus of control: everything sucks, catastrophically so, I'm stupid, and it's all entirely my fault; even if it isn't, everyone is stupid & the world has conspired to ruin me.

So a description of patterns of thought, of pitfalls hidden as cultural ambitions - patterns socially or environmentally derived - are parsed into "so it's my fault? F___ off -- or it's the fault of society, well I bear that crushing realisation daily, thank you". Our highly individualistic culture poisons perfectly good advice for the people it might benefit, and/or adds to the weight many others can do without. Although "you can change your environment by changing your perception of it" is definitely sound, for so many peoples' valuations it's just another string in the bow of uselessness.

There are also, in my experience, two gates that must be open at the same time to allow for slow repair work, or larger positive changes. Unfortunately, they also depend on each other, and when things are truly awful neither are plausible. These are a) a surplus of willpower, no matter how little above the level required to minimally function, and b) a regular sleep pattern. Since depression reduces willpower dramatically, and we are very poor judges of what drains our willpower, the repair process can often feel like Sisyphean whackamole... But eventually, at least for me, I found little willpower exercises I could do every day. At one point, this was quite literally just attempting not to visit my 'stim' websites on first impulse. Eventually I'd still visit them. Didn't matter. That was it. Not even every day. Just every day I could was enough. Until I could do a little more.

Re: Calling for a new approach to depression

#42

Post by ianamartin »

The part about funding studies and throwing away the ones that don't say what they want about a drug is worse than described because a lot of the funding goes to graduate programs where the students have no choice but to find results favorable to the drug.

I have an ex-girlfriend that went into the PhD program for Neuroscience at a reputable university. Her entire degree and living stipend was paid for by a pharmaceutical company. The company "suggested" that her PhD research revolve around a drug that lowered aggressive tendencies.

The sloppiness of the study appalled me. I couldn't say that much because she and I were dating at the time, but it was absurd. There was no funding for getting a reasonable sample of people. So they went to a halfway house and brought in 30 males and 30 females. All criminals, all on probation or parole, all with serious histories of substance abuse, and most of the women were pregnant.

Almost all of the males dropped out for one reason or another. Many of the women did as well. I believe the final tally was 3 males and 13 women. All of whom tested positive for some assortment of drugs.

The sample size is obviously problematic here. What was possibly even worse was when I would go to the lab and watch this person sift through ECGs. The test itself that defined aggressiveness was totally ill-defined, and the neural response to the test was basically, "Well, let's just take a look at it. Okay, this one looks aggressive. That one doesn't."

It was a total shitshow. The end result? A published paper in a prestigious journal about how this drug reduces aggressiveness, a PhD, and FDA approval for the drug.

I hate to identify with conspiracy theorists, and all that. But I literally watched this process happen with a person I was dating for almost all of it.

When it comes to drugs, you really have to do your own research. Your doctor isn't going to do it for you. That's the double burn of healthcare in the U.S. Even when you have it, you can't really trust it. You have to pay for it, you have to know what's wrong with you, and you have to know what you need. And if it isn't a drug, then fuck off. You have to pay for it anyway.

People say, "Fuck you, that's one story that probably went badly. Science is self-sufficient and self-correcting. The plural of anecdote is not data." Fair enough on all points.

But there is a systematic and broken way of doing science in the medical industry. And doctors are not scientists and don't really get trained to know the difference between good and bad science.

Re: Calling for a new approach to depression

#43

Post by rukuu_001 »

drumhead wrote: post #21

I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this. Interesting thing about the author. He was a ris…

The author makes some specific claims, including that there is no landmark, replicated study showing depression is caused by low serotonin.

The author and his claims can be discredited if someone here can cite such a study.

Re: Calling for a new approach to depression

#44

Post by com2kid »

nixpulvis wrote: post #22
whichdan wrote: post #12

Earlier quoted context omitted.

It's entirely possible for someone to suffer from depression despite knowing that they have a good life.

Sure they have a good life when they try to enumerate the qualities of a good life, what they forget is that some "needs" may be unknown to them, though if they listen the needs aren't usually very quite.

Or they have bi-polar disorder and are on a downswing. That alone will do it.

Some forms of depression are medical, people need to be aware of this. Thinking that everyone can be cured by running off and finding one's true self is incredibly dangerous. For some people, that is the solution, but for others, running away from their support network is the exact wrong thing to do.

All that said, soul crushing jobs are soul crushing. The modern world's insistence that we all have true purpose in life has not helped things any. A lot of people used to just be happy getting married, having kids, and seeing their kids do well. Now, we all want some sort of higher purpose (I'm guilty of this as well), which makes obtaining happiness really hard.

For the longest time, success was "at least a few of your kids survived". Since then, standards have been raised to a point that only a fraction of the population can meet the current bar.

Re: Calling for a new approach to depression

#46

Post by mabbo »

nixpulvis wrote: post #11
com2kid wrote: post #5

This explanation does not work for all types of depression. There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed. We need to be more careful in our language, the word depression has become overused, much like the drugs used to treat it.

Seems to me this person has a secret issue you're not aware of then...

You're missing the point, I think. What they are saying is that some depression is just purely a disease and not caused by events in life, or not caused by any psychological problem. If you disagree, that's fine, but it sounds to me like you're simply dismissing that idea.

Consider it like this: most qualities in humans fall into some sort of normal distribution. Some 1% of the population are the 1% with the least natural serotonin production. Genetics play a large role in that. Could that cause of depression not exist?

Re: Calling for a new approach to depression

#47

Post by marian_ge »

Dismissing the scientific trials as flawed by cherry picking and then choosing an anecdotal cow to make a point seems ironic to me. The only thing I can get from this is that we may not have the whole picture regarding depression and focusing only on medication is the wrong thing. But as far as I know from people battling with this is that even in my country the doctors strongly recommend lifestyle changes and hours of therapy with a psychologist for long term success

Re: Calling for a new approach to depression

#48

Post by empath75 »

wu-ikkyu wrote: post #16

It still seems many people believe there is strong scientific evidence to the "chemical imbalance" theory as an independent cause of depression, which is a myth. It is a paradoxical issue though, because chemicals can indeed play a crucial role to overcoming depression.

‘Chemical imbalance’ pure marketing from the drug companies. It’s sort of amazing how much money we’ve wasted trying to get people to quit heroin, meth and ecstasy on the one hand while selling them OxyContin Ritalin and Prozac on the other.

Re: Calling for a new approach to depression

#49

Post by jdietrich »

blhack wrote: post #24

There are two things that both get called "depression". Like so many other confusing things, this all is the result of fuzzy language. There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables. There is also depression: the neurochemcial/neurophysiological disorder that has…

SSRIs are not miracle drugs. They work, but they don't appear to work especially well. The NNT for SSRIs is about seven, meaning that you need to give SSRIs to about seven patients to resolve one case of depression. That's not terrible, but it's a million miles from a miracle. That number is likely to be somewhat inflated by publication bias.

There is no evidence to suggest that Robert Sapolsky "knows more about it than anybody else who is currently alive". He has published four papers on depression, which are all highly speculative and do not involve novel primary research. The most recent of these papers was published 14 years ago. He is clearly an eminent neuroscientist, but he is by no means an expert in depression.

A cursory review of the linked lecture suggests that Sapolsky is making bold, weakly substantiated claims about the neurobiological basis of depression that would not be supported by the majority of people working in neuropsychology and psychopharmacology.

Your decision to link to this lecture is somewhat peculiar, given that it actually refutes your core claim. In Sapolsky's own words: "all of this knowledge winds up being effective for treating maybe 30, 40 percent of people... the vast majority of people, the antidepressant drugs don't do a whole lot" (timestamp 38:30).

https://doi.org/10.1002/14651858.CD007954 https://profiles.stanford.edu/robert-sapolsky?tab=publicatio...

Re: Calling for a new approach to depression

#50

Post by cpncrunch »

seibelj wrote: post #36

Years of strict exercise, diet, meditation, breathing techniques, various forms of therapy, and numerous self-help books did not cure my anxiety and depression. 2 weeks after starting a low-dose (10mg / day) of Lexapro made me feel better than I had in 10 years. Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is s…

>My life was ostensibly fine

But you said in a previous comment "I was working 35 hours a week at a startup and studying two difficult subjects at my university (computer science and Latin) while maintaining an active social life. I kept pushing myself harder and harder, and essentially collapsed".

I think most people would burn out with that amount of stress.

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