I don’t know why people jump from “no evidence that depression is caused by serotonin imbalance” to “SSRI’s don’t work.”

My anxiety isn’t caused by “not enough Xanax in my brain” but nobody questions that benzos calm you down.

It’s completely possible that the cause of depression is not low serotonin, and that SSRIs are an effective treatment.

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Yet again i am forced to say that "I myself would not say X" is not an argument that "no one is saying X"

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This is a topic where it’s difficult to find nuance. I have a lot of sympathies for the skeptic side on this, and it’s not because I think people should just bootstrap out of their mental illness, it’s because I’ve been personally harmed by this theory.

In my experience taking SSRIs for non-debilitating anxiety and depression: I got prescribed them after a 10-minute chat with my GP, they only helped for a few months, but going off them was a nightmare that caused the only severe psychiatric symptoms I’ve experienced in my life. No doctors would help me except to suggest reinstating the drug, often citing the same chemical imbalance theory — if it’s been out of vogue for years, I guess they didn’t get the message.

My therapist admitted to me that she couldn’t say how common my experience was, because there is a lack of quality studies about SSRI withdrawal. So for me, this “vibe shift” about medication is a good thing, because I feel that people who were hurt by these drugs or didn’t find them effective have been ignored by mainstream medicine.

I also have a family member with schizophrenia, and I completely believe medication is necessary for most people with severe mental illness. But I don’t think that means I have to believe it’s necessary for the apparent 20% of white American women on SSRIs. Diagnoses of things like depression, anxiety and ADHD have exploded in recent years. I know so, so many people who take medication, yet they often still seem to be depressed. Can I be skeptical of this trend without dismissing people with severe mental illness?

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Well, sure — in the ultimate sense, everything is physiological. That doesn’t mean, however, that the solution to many psychological maladies isn’t environmental, in more or less precisely the way that the solution to lead poisoning is to not put lead in the environment.

(As for your point that we all live under capitalism but only some of us are diagnosed with depression — I don’t think that’s inconsistent with an environmental hypothesis. It just means some people are more sensitive to the environmental trigger than others. But that doesn’t mean that, in the absence of the trigger, there’s an underlying “disease” that is caused by a “chemical imbalance” in the brain.)

And I think people would be less skeptical of pharmaceutical interventions if people didn’t keep radically over-claiming for them. “You’re not going to get COVID if you have these vaccinations” is just the dumbest and most extreme example of a long line of the public being told things about all manner of interventions that simply aren’t borne out by the actual science. The efficacy of SSRI’s was massively oversold. Now you’re mad at people for being skeptical? People are gonna be skeptical.

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Jul 26, 2022·edited Jul 26, 2022

When I was in my late teens, I found myself in a social situation that I hated, lost confidence in myself, and became extremely unmotivated and empty-feeling. I’d describe it as depression and, while I imagine my mind and body interacted in ways I don’t understand, I consider this period of my personal history an environmental and philosophical crisis that I slowly worked my way out of.

Later, I had a serious girlfriend with clinical depression. Her life was largely going well — long-held career dreams in the works, a great social circle — and then her brain seemed to basically malfunction over the period of a few months. She had environmental stressors (who doesn’t?) but the despair and anxiety they caused were scarily misaligned to thee psychological suffering she endured, and sometimes her psychological suffering seemed to have no environmental cause at all. It moved swiftly; came and went by the day; and attacked her psychology with a cruelty that I’d never seen up close. I feel 100% certain that — while plenty could be done in her life to mitigate the effects — her brain disease had a physiological explanation.

I’ve come to believe that depression is probably a broad umbrella that describes a mix of brain diseases, personal crises, and both.

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Of course we should be compassionate and not dismissive of those for whom the drugs work. But, that is not to say that we should not demand more from our doctors. As stated, "we know depressingly little about the brain," therefore, if doctors are to maintain their oath and "do no harm", they should not be prescribing drugs willy-nilly, and much less also conclusively parroting unproven theories, such as the serotonin re-uptake one they all authoritatively mouthed when this Prozac Nation period began, some 20+ years ago.

I, for one, am absolutely livid at the doctors who prescribed this to me, and many loved ones, throughout the last few decades, while authoritatively parroting the re-uptake b.s.

In this, and other areas of medicine (trans care for minors?) perhaps doctors should be more humble and just say, "This may work, but we don't know what the consequences may be, nor whether or how it works."

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"I am again left with the same basic question: why are so many people who do not suffer from mental illnesses or work with them professionally, both left and right-wing, so deeply eager to deny the physiological basis of mental illness and the efficacy of psychiatric medication. It’s one of the few elements of modern society that has true cross-ideological appeal, and the attitude tends to be reflexive and thoughtless and aggressive."

Because people who need these really need these medications are atypical. For most people, these medications are more harmful than helpful and people have learned, over time, that overprescription of antidepressants is the norm, that these drugs can have really bad side effects, and that it's better to avoid taking these even if your doctor recommends them. It's similar to way a lot of people do everything they can to avoid opioid medications. Doctors over prescribed it, it's really dangerous, and so a lot of people have become overly afraid of it. Doctors do lots of dumb stuff and you have to be careful. If you're a normal person feeling

Because doctors, at least American doctors, are very limited in what they can do. They have a very limited amount of time to diagnose you and, given the wide variety of medical conditions out there, limited information on your specific condition. So they're stuck reading medical journalism and summaries of medical studies that don't replicate and that they're not qualified to judge because what lunatic goes back to get a masters in statistics after becoming a doctor just to double check medical studies?

I mean, at a base level, psychologists just admitted they don't really understand how depression works and we've known for awhile that their studies have an abysmal replication rate. How eager are you to let these people prescribe you really powerful drugs that mess with your brain? I mean, if you're literally suicidally depressed, yes, antidepressents are probably a good idea. But, as an example, do you really think the benefits of antidepressents outweigh the risks and costs for, say, a depressed teenager or a middle-aged office worker with ennui? Honestly, a lot of people would be better served by regular exercise than medication.

I think aggressive is unfair but reflexive and thoughtless kinda are. It's not like most people get into the details. It's more like Joe's girlfriend's mom has been on antidepressents for 10 years and it kinda didn't make a difference and Amy's best friend tried to get off Wellbutrin and it really messed her up and it shows up as a "vibe" to just tough it out is better than getting involved with doctors.

So, just spitballing, about 13% of adults are on antidepressents (1). Maybe 5% of that population really needs medication. So ~60% of the time "tough it out" and "try yoga and exercise" really are the best advice but that's also really bad advice for the ~40% of people who really need medication. And our psychologists, and more importantly psychological research, is not competent enough to reasonably differentiate between people who really need it and people who don't. So we end up with a lot of people having a gut level feeling to "tough it out and try yoga" which is useful for the median person but horrible advice for the minority with real issues.

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"Why are so many people who do not suffer from mental illnesses or work with them professionally, both left and right-wing, so deeply eager to deny the physiological basis of mental illness and the efficacy of psychiatric medication?"

You cannot ask that question without acknowledging that there are evil people with a financial incentive to oversell the phsyiological basis of mental illness and the efficacy of psychiatric medication. The reason the serotonin theory of depression took such deep hold in the popular consciousness despite dubious scientific grounding is because of an enormous marketing campaign to convince people that medication was the best and perhaps only answer to depression. You are absolutely right that the issue calls for nuance and compassion to people who are suffering, but I think you are wrong to cast outrage and backlash over the success of profiteering in health care as some kind of mean-spirited "eagerness" to invalidate people's pain.

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A lot of people are very uncomfortable with the idea that the brain could malfunction. In discussions about homelessness some say they are choosing to be homeless. But in many cases the choosing part of the brain is the part that’s malfunctioning. That idea freaks a lot of people out.

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Jul 26, 2022·edited Jul 26, 2022

"Depression is capitalism's fault" is undeniably stupid, but the intersection of capitalism & health care is a very American issue - one benefit of more socialized health-care models is it mitigates (though doesn't entirely eliminate) the profit-seeking incentives. The most extreme example in recent times is probably the Oxycontin fiasco, but there have been others.

A doctor telling someone with depression to eat a healthier diet, get more exercise, and practice better sleep hygiene isn't going to generate the same downstream revenue for Big Pharma that a lifelong prescription for antidepressants will. So while many people would prefer doctors err on the side of less pharmacological intervention, profit motives can and will push doctors to err on the side of writing more prescriptions as the default treatment approach (which is exactly what happened with Oxy).

Addiction is big business in America, and psychiatric medications tend to at the very least resemble addictive substances. I've heard antidepressants in particular have a withdrawal process that can rival quitting heroin cold turkey. If there are nonaddictive treatment options available, those should probably at least be explored by doctors before jumping straight to lifelong pill dependency.

That said, medications also shouldn't be ruled out entirely for the same reason doctors shouldn't be worried about getting diabetics "addicted" to insulin.

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In my opinion, more than half of the people treated with these drugs are having their symptoms masked where the symptoms are the result of psychological dysfunction due to some historical trauma or PTSD, or general unresolved childhood issues, where they feel disconnected and in a state of constant brain fog. They need therapy, not drugs. Or maybe they need drugs to help while they get therapy.

Also, I think as marriage and families and God are being shunned by the secular educated cohort, more people are lonely, and loneliness is absolutely connected to depression.

There was a study in the UK where patients for depression were prescribed gardening with others instead of drugs and the gardening was significantly more effective at reducing depression.

We have to be careful to not categorize people dealing with depression and mental health that "it is all in their head", as some require drug treatment. However, we are way too far on the opposite side of this today with doctors prescribing these drugs at the drop of a hat.

Also, we have a severe shortage of qualified therapists. Frankly, because of the corruption of critical theory fake scholarship into the social science and health science fields, many of the new MDs are those that most need therapy.

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Also worth pointing out: Dr. Joanna Moncrieff, who led the metastudy, is a known critic of psychopharmaceutical interventions, it's kinda her life's work. Sometimes, when you look for something, you find you what you are looking for.

I think most people in the mental health field want broader adoption of a bio-psycho-social approach to treatment, but it's been wild to watch New Age bypassers celebrate this study like SSRI/SNRIs do not massively benefit people

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“ Since the 1970s, U.S. doctors have prescribed lithium to treat patients with bipolar disorder. While the drug has a good success rate, scientists are still unsure exactly how it achieves its beneficial effects.”

All we know is that it works.

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When I was studying neuroscience at university it was shocking to me when we discussed the chemical.imabalance theory. Shocking because there had *never* been any evidence behind it. Even so, much of the field treated this as a settled fact.

Obviously there's something neurological going on causing mental illness. People who say otherwise are simply lying or don't know enough to even lie about it.

But this study is very important. The pharmaceutical industry has massive sway in the field, funds tons of research, funds many of the major international conferences, and has even bought some of the major periodicals (where, incidentally, they publish non-peer reviewed research).

That's not to say pharmaceuticals play no part in treating illness, mental or otherwise. But many people within the field and especially outside of it treat the pharmaceuticals that alleviate symptoms as the cure. Also, many people prescribed these medications never meet with a psychiatrist in a meaningful way. It's not infrequent that an educator recommend that a parent get medication for their child, for example.

So, yes, of course there are bad actors, but this is pretty important. It's the kind of research that has been sometimes difficult to fund and difficult to get published because of the immense influence of the pharmaceutical industry on the field.

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That study seems very compelling and very well done. A long study with a very large population.

I think the conclusion is that many, but not all, of mental health diagnoses, are mistreated with these drugs. I think this is a very good thing to have discovered. Everyone owes Tom Cruise a big apology.

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I could say no sensible psychiatrist has believed in this theory for decades now, and I'd be telling the truth, but I am quite sure there are still hacks out there saying things like this. It masks the uncomfortable truth that psychopharmacology is an extremely blunt instrument and none of the disorders we treat are "diseases" in the sense that, say, tuberculosis is a disease. That does not at all mean that there are not strong biological factors involved amenable to intervention but it is very well accepted that even very clearly serious things like schizophrenia are...well, not a thing, as such, or at least one would need to talk about schizophrenias to be remotely accurate.

With all this uncertainty, we're left in a tricky spot. When I describe this issue to patients the metaphor I use is to describe the brain as a desktop computer. We can tell it is acting up because of what it is outputting on the monitor but the only way we can adjust the output is by throwing rocks at it. We have learned over time that if we throw certain shaped rocks at certain parts of the case just so, we often can make certain changes in the output happen. But explanations are not going to be forthcoming anytime soon and if some other kind of output happens instead it's hard to know where the point of failure was.

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