> "Mark Horowitz, an associate professor of psychiatry at Adelaide University and a co-author of the study,"
Austria - cold, has mountains, but not Adelaide University
Australia - hot, has kangaroos, and Adelaide University
Is the Grauniad returning to form?
Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully
Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Having a child forced me to fix my life, and I'm incredibly happy because of it.
SSRIs have been proven to be very effective against anxiety disorders, which in many ways mimic depression, but have different pathologies and causes.
Also, they saved me.
There have been some serious efforts made to reproduce the original groundbreaking results that showed how effective SSRIs were, without much success. Anecdotally, I know plenty of people who have benefited from them, so I would not say they are ineffective as a blanket statement. I do think it’s important to understand that nobody really knows how these drugs will impact any one individual, and it’s trial and error to find something that may help.
If you're a doctor, and if Prozac helps your patients, then it's obviously excellent. You should keep writing prescriptions.
If you're a scientist, you obviously want to distinguish between "real" drugs and drugs that help because people believe they should. So, you do these kinds of tests.
And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps? Maybe? I don't know. That's the weird part.
That's a very big ethical question in the medical field. Placebos _do_ help, but only if people believe they will. So is it ethical to lie to a patient and give them a placebo knowing it's likely to help?
Does "placebo" mean "no effect" to some people? Placebo absolutely has an effect. Testimonies like this are on the level of "vaccines caused autism" pseudoscience and the serotonin theory of depression isn't even taught any more. It belongs in the bin of crackpot treatments like chiropractic. There is zero chance Prozac would receive FDA approval today.
How is it different from the expected hormonal changes that an adolescent is expected to go through?
@dang it's hard to believe that I'm not being brigaded.
Of the recent downvoted comments, one was a complaint about moderation that anyone who has paid attention to dang's track record here over more than a decade knows is baseless. (And if you think the top comment on any thread is a bad one, you can always choose to be a helpful contributor to the community and email us to let us know).
Of the other two of your downvoted comments, none were downvoted by the same users.
The choice is yours to make an effort to observe the guidelines and be a positive contributor to HN, or alternatively to keep using HN for political/ideological battle and complain to the moderators when things don't go your way, but it's clear what others in the community want to see.
You're a ridiculous person.
> or alternatively to keep using HN for political/ideological battle
Which ones? The one about ML and programming languages? Or the one about asking a genuine question about an experience with childhood depression? Or the one observing that you and dang unevenly apply moderation rules? Or the one commenting about how you can't say the word for the literal definition of fascism on this site without getting downvoted? Or the one about dishwashers?
Where's my ideological battle?
You have no credibility. You unlike dang, don't do a good job. Go ahead and ban me or put me on a cool down to prove my point.
It's notable in this instance:
- You posted a series of comments about controversial topics, having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
- When a handful of your comments receive even a solitary downvote, you call in "the cops" (dang) to come to your aid, with a claim of "brigading";
- When we investigated and found that, no, there's no "brigading", some of those comments are not even net-downvoted anymore, and that any downvotes you're getting are to be expected given your combative style of commenting, you've responded with these incoherent attacks on moderation/moderators.
Whether we all agree that many of your flamewar-style comments really are, in fact, political/ideological, is not the point and seems to be a way for you to deflect from being held to account for your conduct.
What I'm saying to you is that people who care about making HN better have all kinds of ways of showing it, and it begins with making an effort to observe the guidelines, and it also involves engaging respectfully with other community members and the moderation system. We are always, always working to make HN better and our moderation approaches better, and we always welcome and engage with feedback, as dang has been doing with you in another subthread today. But we've both been doing this job long enough to sense when someone isn't really wanting to help make HN better at all.
Please.
> having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
What? Just because I have a different worldview than you, doesn't mean I am fighting for or am a brave combatant of anything. But it's extremely telling that you think that, and revealing about your own views. And furthermore troubling that you are a moderator here.
Maybe you should read up on the clustering phenomena wiki and understand your own personal biases a little more.
You don't know what my worldview is or what dang's worldview is and honestly I don't know what your worldview is and this is never relevant to how we moderate HN. We want HN to be a place where difficult topics can be discussed and all perspectives can be represented. That's what we optimise HN for, with the caveat that the guidelines foremost ask us all to "be kind" in comments. It's notable that you keep complaining about some kind of "bias" without being able to point to any evidence for your claims, and that all of your comments in this subthread ultimately resort to ad hominem. If there was any substance to your claims you would have presented it by now. The entire history of HN submissions and comments is available for anyone to download and analyse.
Let's be clear what's going on here: you've claimed to be a victim; you can't demonstrate exactly how you've been made a victim; when we investigate your claims, which we've taken time to do in good faith, we find that, no, there's no evidence for your claims of victimhood; when we tell you that, you respond with ad hominem attacks.
Please just observe the guidelines like everyone here is expected to do.
Your continued aggressive dismissal of milquetoast commentary against your moderation style is offensive.
Your characterization of my posts here as a warrior championing some cause is similarly offensive.
Your words, not mine:
> ... having established a history of participating on HN with this persona of being a brave combatant ...
How kind, and full of good faith.
You clearly feel something towards my worldview. Your language is charged, you have opinions directed at me. To be clear: I don't care about you at all. But I do find it amusing to watch such a visceral reaction to a general commentary, "the mods are biased, and shape the bias of this website."
Your worldview is irrelevant to this discussion. This place’s entire worth is built on the fact that a broad range of worldviews and discussion styles is represented, and our moderation philosophy is intended to allow everyone’s worldview to be fairly represented.
We're responding to your claims only because if there is any basis to them we want to know so we can address any issues and reform the way we operate. We’re actively working to do that continually. But it’s increasingly clear that none of your claims hold up to any scrutiny and every additional comment just generates more noise and still no signal.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool.
Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%.
Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced.
Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par.
SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful.
SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
I later learned that CBT can have that effect on people with ADHD, so I attribute that to being a possible explanation.
I still do therapy, but honestly, I think it's a waste of time and money. I predominantly do it for cathartic purposes and so other people/professionals will stop recommending it.
> terrible the withdrawal symptoms are when stopping
I tried one when I was in my early 20s too. I swore I would never take one again. Withdrawals weren't my issue really. It was the clarity I gained after getting off. I realized how awful I was to people around me. I had such blunted emotions, that I basically became devoid of empathy. I also learned that I needed high levels of anxiety to function, which the medication took away from me.
I think I had a somewhat similar experience: before antidepressants, I was practically non-verbal; later, I had the typical brain fog/emotional blunting -- still unable to communicate with the therapist; after adjusting to meds, by the time that I can put the problem into a coherent sentence, I can usually fix it anyway, so what is the therapist for? Is it really just rubber duck debugging, where the duck has a medical degree?
One thing I wasn't able to figure out was ADHD -- I didn't really believe I had it, as my psychiatrist was sure it's not the problem -- everything was explained with depression/anxiety/geniune lack of motivation. Now that I finally have a prescription for stims, seems like it was the other way around: most of the time I would have a feedback loop where my typical fuckups would trigger a downward spiral, and it's almost not a thing anymore; being able to get shit done is just generally such a pleasant experience!
TLDR My depression also wasn't a "true depression" in a sense, but you still need to fix some underlying issue, which is much easier when your thoughts are not all "I'm a failure" shaped
There is a great Bojack Horseman episode in which Diane struggles with the idea of taking antidepressants for similar reasons.
If it’s depression, that’s closer to allergies, chronic inflammation or a broken bone healed wrong than vomiting after food poisoning.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
Someone else in the thread's testifying with personal experience that there were significant withdrawl symptoms after only a few months: https://news.ycombinator.com/item?id=45999622#46008522
Are they lying, or are you misrepresenting something?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
Noticing it is very different from being depressed about it.
> What does "normal" even mean in this context? Are we talking about something measurable?
Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
Person A isn't depressed because he can't travel and buy nice cars. He's depressed and he can't travel and buy nice cars. He's mistakenly coupling the two.
Another tell for these kinds of things: Ever know someone chronically depressed who blames it on X? Then somehow, X is resolved. There may be a temporary improvement, and they go back to being depressed again, only they now blame it on Y? Somehow Y gets resolved and some months later they're blaming it on Z.
Everyone has problems. Including those who are not depressed. Fixing X, Y, Z, AA, AB, and whatever else is not going to take care of the depression.
On the flip side, people who do not suffer from depression make the same mistake: They claim they are not depressed because they "choose" not to let the problems get to them. Self serving beliefs!
These two words are semantically the same in your context. Unhappy = depressed. Unless you can define something measurable, and if you did in the comment above I can't find it.
I suspect there is something measurable, but I don't see very much attempt at discerning what that is. And without it, this conversation is pointless.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
Check out one of the modern black box warnings of fluoxetine (Prozac) that only addresses a subset of side-effects, suicide in children and young adults: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set...
Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
> Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics,
Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence.
https://robertwhitakerbooks.com/psychiatry-under-the-influen...
I've written for the Mad in America Foundation's webzine. My latest piece was titled Theodoric of Arizona: State-Sanctioned Pharma-Based Pseudo-Doctor: https://www.madinamerica.com/2024/07/theodoric-arizona/
This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.
> I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene [...]
Have you tried any anti-serotonin interventions? (chatbot in comment link below)
Mirtazapene is a "tetracyclic antidepressant". I think the development of antidepressants went MAOI -> Tricyclic -> tetracyclic -> SSRI. My chatbot transcript said the SSRI's are marginal drugs, but "SSRIs are much safer in overdose" than the earlier drugs.
My understanding is that the MAOIs were reasonably-effective at bringing people out of an acute depression, but they interacted with high-tyramine foods (fine cheese, etc) to cause high blood pressure. Reversible MAOIs are less problematic than the non-reversible ones. Methylene Blue [MB] is the most ubiquitous of the reversible MAOIs. I felt a definite warming effect with my first MB microdose (a fraction of a milligram), but I've never noticed anything from larger doses.
My comments on this thread might be helpful: https://news.ycombinator.com/item?id=46000812
https://osf.io/preprints/psyarxiv/wk4et_v3
Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
I can be persuaded, though. Can you show research?
- If you look at highly religious areas like the bible belt, they are often linked to worse mental health outcomes for those who don't the religious worldview such as queer people https://www.thetrevorproject.org/research-briefs/lgbtq-youth... https://pmc.ncbi.nlm.nih.gov/articles/PMC8724198 https://pmc.ncbi.nlm.nih.gov/articles/PMC10752621
- That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too.
https://childrenshealthcare.org/victims https://pmc.ncbi.nlm.nih.gov/articles/PMC7545013 https://pubmed.ncbi.nlm.nih.gov/9521945/
- Having religious parents is often associated with conditions like anxiety or depression
https://pmc.ncbi.nlm.nih.gov/articles/PMC10719686
- Struggles of a religious nature causing mental health issues all the way up to suicidal ideation
https://www.sciencedirect.com/science/article/pii/S266691532... https://pmc.ncbi.nlm.nih.gov/articles/PMC4776639 https://www.researchgate.net/publication/371293385_SUICIDE_A...
The first 3 links you’ve provided discuss mental health as it relates to geography, not religion. To be sure, religion is associated with those geographic areas, but so are numerous other factors like race, income, etc etc.
The next links are closer to target, they talk about religious objections to medical treatments and the adverse affects upon kids. Nobody should deny this is a real problem, but fortunately it is a very small problem. ( One of the studies found only 172 fatalities over 20 years, and even estimated 10% of the kids may have died anyway.). So I’ll grant that is a real problem, but not one that affects many people. With luck, perhaps it will get better over time.
The next study is interesting, but again very limited. It has 6k subjects, but these are only with religious mothers and only in the UK. This study cites prior study that concluded “ an individual's religiosity is consistently, positively related to their own mental health in US samples”.
The next study associated suicidal tendencies with a very narrow aspect of religion, and even then self reported: “We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data.”
The next study does not seem to help your argument. It deals with religious beliefs in cancer patients and says “Higher levels of religiosity and spirituality are associated with reduced risk of suicidality and suicidal behaviors [29–31], including in advanced cancer patients “
The final link is just a case study about a single suicidal pastor. It concludes with a paragraph that says “Although there are studies showing that religious people are less prone to suicide…”
So I can’t say all that changes the findings of the many studies that conclude religion is good for mental health.
Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
I say this as someone who is extremely fit. I've worked out religiously since high school. While exercise is integral to me feeling somewhat normal and provides a short-term boost, that is just not how it works for everyone. Some of us have 'broken brains' that cardio can't fix.
Exercise manages my baseline, but sertraline is what helped me finally bridge the gap. It allowed me to regulate my emotions and anxiety in a way that no amount of exercise ever did. And the introspection from being on it helped me make lifelong changes.
To be honest, fearmongering from folks online is what stopped me from taking it sooner, but I wish I had. It was fairly life-changing.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
This is horrifying.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
The knowledge is out there. Yes there are a ton of bogus papers and a ton of bad research. Not everyone got the critical knowledge to figure this out but I also don't think this is only reserved to the "experts". They are also subject to groupthink and other political pressure to think a specific way.
At the end of the day, do your best own research and work with your "expert" to agree on a solution.
Pushing back on people reading paper is an anti-intellectual take (to use the same wording as another poster below).
There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curiosity--knock yourself out. But don't undergo treatment without working with an actual expert! I'm not an expert on orbital mechanics, but I have played KSP and have formed various opinions about it. But nobody should be listening to me for advice on how to launch a rocket.
We need gatekeeping for a reason, especially in the medical field which is rife with miracle cures, snake oil, herbal remedies, detoxes, homeopathy, and other forms of quackery.
Believing my "research" is better than my specialist's education is a path back to the dark ages.
Doing your research should not be in competition with your specialist's education. It should be complementary as yet another source of information.
I'm not saying experts are wrong but I also don't think they are particularly always right. They are human and they have strong groupthink. They will agree and disagree with some takes based on their personal or political beliefs.
If you get rid of the scare quotes, you can spend 10x or 100x as long as your doctor when researching something specific enough. That has many advantages, even without the training.
> is a path back to the dark ages.
This is quippy but doesn't actually make sense.
Yes, experts are wrong all the time, they have the disability of being human, but this seems like an extremely anti-intellectual take.
You seem to think that the educated class got a monopoly on knowledge on that field, yet after that claim to know that experts are wrong all the time. The anti-intellectual take is to give up on trying to understand as much as you can in a field because you don't have the right credentials to do so. Yes, medical papers are not that complicated to read.
That doesn't make you more competent than your doctor. But it probably makes you a better advocate for yourself than your doctor is.
My point is: Don't discount yourself reading papers and doing your own research. Then work with your "credentialed experts" to come to an agreement. Don't ever think that the "experts" got your best interest at heart.
That said, I have a tough time believing that spending an hour on Sci-Hub makes you better at diagnosis, yourself or otherwise, than someone who spent a decade being educated with decades of practicing. Thinking that you know better than trained experts because you have an understanding of the very beginning of a field is overwhelmingly tempting but is generally not based in reality. Usually the people who have actually been trained in the field know more about the field than a random person who read a few papers that they thought were "comparatively relatively simple".
I read papers all the time, usually formal methods, but sometimes other fields like medicine, and I will sometimes leave the medical paper thinking that it's "easier" than what I study, but I think that's just Dunning Kruger. I know more about formal methods, so I know a lot more about what I don't know, and thus I feel like it's harder. I don't know a ton about medicine, and since I don't know what I don't know it can feel like I know everything, and I have to fight this urge.
By all means, read about research in whatever ailment you have, I'm not really trying to discourage that, but I feel like dismissing experts in the field is almost the definition of "anti-intellectualism". If you find a study that you think is promising, bring it to your doctor. Hell, bring it to a dozen doctors, multiple opinions isn't a bad thing.
I just don't like the general "don't trust experts" thing that seems to be flying around certain circles now.
I'm not saying you issued such a dismissal, but the comment that started this thread did so.
The excuse from my doctor? "I didn't know!"
Then he should cite the papers, point out the research, etc. Rather than dismissing the entire discipline and all its practitioners with a wave of the "common-sense mental illness isn't real" wand.
It's so common it's a trope. "Antidepressants don't work" says the scientists testing antidepressants on things they're not supposed to work on.
Studies repeated with just major depression all conclude antidepressants are better than a placebo.
Click through the article to the study and you'll find they did not limit their study to must major
By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
So should I not have done my own research?
With that said, the first few search results for the query were from the journal Nature, the NIH, and Harvard university. Hardly the loony or malicious caricature that you attempt to paint.
The average medical professional is worst-placed to judge the veracity of any studies they find than the average engineer or mathematician who's done a solid statistics and probability course. Medical students are assessed on their ability to memorise and regurgitate facts, not on their ability to conduct statistical analysis.
The caveat you cite applies to basically any and all internet (or even media) consumption, and is therefore a non-argument.
I will say if you search for "chemical imbalance debunked" as discussed, the first result for me is a paper that also says dyslexia cannot be proved to be a disorder. Which just from vibes feels really conspiratorial, even without making comments on the veracity of the academic paper.
There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong.
If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect.
[0] See, for example, https://www.science.org/content/blog-post/trkb-bdnf-and-depr...
It most certainly has not been debunked and mind altering chemicals most certainly do work.
SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar.
This is close minded dogma no better a religion.
(I have many first-hand and second-hand experiences.)
Pretty weird the article we're commenting on about Prozac being no better than placebo for children is just now coming out when it was already approved for use in children, then.
If this guy has a non chemical cure, I'm all for it. In fact I'm actively researching children psychologists to stave off the meds as much as we can, the problem is that 99% of psychologists are quacks, so choosing them is tough.
‘Highlights
• Antidepressant withdrawal can be severe and protracted.
• It produces characteristic physical and emotional symptoms.
• All symptoms were more severe after stopping than before starting antidepressants.
• We identified the 15 most discriminatory withdrawal symptoms in our sample.
• Withdrawal did not differ between people with physical or mental health diagnoses.’
‘Warning: Suicidality and Antidepressant Drugs
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for Major Depressive Disorder (MDD) and other psychiatric disorders’
Read the package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/01...
The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.
> This is one of the most shocking things I have ever read.
Good grief. I hope you're exaggerating for effect.
Are you disturbed by that claim? That's what you're raising your hand to.
Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).
Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.
What are the long-term effects of suicide?
A 7-year-old kid doesn't understand what suicide really means. Putting them on something that encourages a behavior that they don't understand and has completely catastrophic results isn't a risk I would take with my children.
The subject was specifically about long term brain chemistry changes.
People committing suicide after taking it, while incredibly sad, is completely unrelated.
Lower bone mineral density, increased risk of fractures, osteoporosis
Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)
extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)
emotional blunting / apathy
slowed thinking, brain fog
increased risk of gastrointestinal bleeding
QT prolongation
On the other hand, I watched family members take these drugs, and their lives seem somehow dulled-- filled with banal tragedy, like staying in a bad marriage, or not being particularly interested in their grandchildren. I have a theory that the drugs make palatable that which otherwise wouldn't be, hence they stay in the bad marriage, the bad job, and they watch their bad TV and eat their bad food and everything is fine. I've also seen one of them go off the drugs, and for a couple months they were a much more vibrant person. I saw them express joy. I feel a low grade rage toward the industry that I've been deprived of this version of them. I do entertain the possibility that I'm imagining it all. Maybe things really would have been worse without the drugs. But I am glad no one ever insisted, or even strongly advocated I take them myself.
A large part of me dislikes being on any sort of medication long-term, and think most people have the same dislike. I have gone off of Prozac a few times and always found that I gradually became frustrated and depressed again, and as you said the reason for the dislike is ineffable, so I chose to go back on. I'm fortunate to have a life with no bad marriage, no bad job, and very little trauma at all, which is also unfortunate since it means despite years of therapy and introspection and travel and hobbies and other varied experiences I've never been able to find any cause for the depression and therefore no way to fix it, other than medication. It makes me think of Captain Picard: "It is possible to commit no mistakes and still lose. That is not a weakness; that is life."
Yeah, I did that too, then I took some and I was less goddamn depressed aftwards.
Medication does not remove the need for therapy. If they are stuck in a bad situation and do not have the tools to come out of it, then in therapy they can learn about the tools and techniques.
Medication avoids having that particular day where everything hits rock bottom and the only solution seems to be suicide.
For some people just therapy is not sufficient but need also medication.
Psychiatric illness is something where many people have misunderstandings. Since many people go through depressive episodes, they feel that their experience is the same as others who are facing chronic depression. And since it is not physically visible, it is also hard to empathize with.
No one says you can come out of heart disease or diabetes by just bearing it bravely. Somehow for psychiatric illness people assume that it is something that can be braved out.
'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Departments of Justice and Health and Human Services’ Health Care Fraud Enforcement Action Team (HEAT) announced today. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.
[..]
The United States alleges that AstraZeneca illegally marketed Seroquel for uses never approved by the FDA. Specifically, between January 2001 through December 2006, AstraZeneca promoted Seroquel to psychiatrists and other physicians for certain uses that were not approved by the FDA as safe and effective (including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness). These unapproved uses were not medically accepted indications for which the United States and the state Medicaid programs provided coverage for Seroquel.
According to the settlement agreement, AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.
[..]
The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.
"Illegal acts by pharmaceutical companies and false claims against Medicare and Medicaid can put the public health at risk, corrupt medical decisions by health care providers, and take billions of dollars directly out of taxpayers’ pockets," said Attorney General Eric Holder. "This Administration is committed to recovering taxpayer money lost to health care fraud, whether it’s by bringing cases against common criminals operating out of vacant storefronts or executives at some of the nation’s biggest companies."
The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute. '
The takeaway is that anytime a physician prescribes you a drug, at the very least you have to check that there hasn't been a gigantic fine levied against the drug maker for illegally tricking your doctor into prescribing it to you.
It's horrible that A-Z would illegally market drugs for off-label uses -- I would not disagree for a minute with your reasoning! -- but we retain this "escape hatch" because it is important to patient health
without the off-label "escape hatch," we would not have, for example, the glp-1 class of anti-obesity drugs, or, buproprion for smoking cessation, the most effective drug ever found in its area.
We needed doctors working firsthand with patients, and building "anecdotal" (i.e. case-based) evidence to learn things that really matter on a population level
Common side effects of long-term SSRI use in adults include weight gain, emotional numbing, loss of libido, and sexual dysfunction. It seems to me that anyone taking SSRIs when their brain is still developing would be more likely to have these side effects, and to have them persist after ceasing use.
It's anecdotal, but I know some people who were prescribed SSRIs during puberty. It's not possible to know how they would have turned out if they hadn't taken these drugs, but as adults I pity them. Their lack of sex drive causes relationship problems, which is especially sad since they do want children. They're starting to get older, so I doubt it'll ever happen.
1. https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
The clinicians I've interacted with have always warned me of the possible side-effects of psychotropic medications, and said they should be notify immediately if the side-effects appear. I believe this is at least standard procedure, if not legally required?
I do have a low libido. Can't say whether or not that's due to Prozac, but regardless it hasn't negatively affected my life, probably because it was low before I met my wife. If someone enters a relationship while their libido is at one level and then during the relationship it changes considerably then I can certainly see how that could be a major challenge. That's an important thing to weigh when evaluating medication.
You are asking for evidence that does not exist because nobody has done good studies on it. That's too high of a bar. There are many drugs and life interventions that we don't have studies on regarding children, but that doesn't mean those things are safe for children. To use an example so ridiculous that we can both agree on it: There are no studies showing long term effects of fentanyl on children. Yet if some parent managed to get a fentanyl prescription for their kid, I think we would both be concerned.
Obviously I'm not implying that giving a child Prozac is as harmful as fentanyl. I'm saying that your line of reasoning proves too much. If someone did get their kid on a dangerous drug, and defended their decision by pointing out that there are no studies on children showing its long term harm, there is nothing you can say to that parent that others in this thread haven't already said to you. That should give you pause.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
It’s also impossible to to talk about idk Columbus, slavery, Great Britain, or the founding of America (and like ya know, the treatment of native Americans) without ascribing some blame to the people responsible…who were by and large “white”. We also talk about how any judgement based on skin, appearance, gender, ethnicity, or religion, is flat out wrong.
Could it be that we think it's healthy because we can just give meds to the kids that it affects?
How would someone even have the ability to say "it's healthy" - I'm struggling to think how it comes about. I think it's healthy for my kids to cry about a worm dying in the garden, but anything less than "anxiety about a dying planet"...
Put it another way: climate change messaging IS totally about anxiety and putting human as the cause, so we can (as adults) change our habits and save the planet. Could it be too much for kids though?
(so in this particular situation, maybe highschool / early adult)
I only felt motivated to annoy my parents to recycle more. Since the effects were not directly in front of me a strong emotional reaction didn't occur.
Perhaps there are children who already have anxiety and latch onto climate change and other problems.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
It sounds like you made a wise decision given your personal and family history and your son is benefiting. Kudos.
I wish there were a way to shortcut this process for society so that so many people didn't need to either go through a similar experience personally to have such an epiphany, or worse, never have it at all. (Speaking not only about medication for kids, but other polarizing issues as well.)
You said elsewhere that there were "no known long-term side effects". Aside from that not being universally true for any drug I've ever personally researched, no side effect is more long-term than suicide.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
Do you think that there is a way to treat the underlying cause and not the symptoms?
I was on medication during that period and it complemented my practice, provided a stable base to apply meditation and other recovery protocols.
We can say certain behaviors, experiences, illnesses and some genetic identifiers can trigger the conditions, but not the underlying cause. We can say things like some therapy and medication can help with the illness, but not the cause.
Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
Yeah, I feel like it's fair to describe the cognitive behavioral model. We're not necessarily looking for the cause of these thoughts and beliefs, tho they may come up, we're simply going to challenge them at face value and reinterpret the situation.
Have some empathy.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
I trust a cohort of scientists significantly more than anonymous strangers online, and you should too.
NONE of the current theories being experimented with on patients have a concrete, proven scientific basis with some such as the decades-long SSRI scam have actively harmed patients and created physical dependence/addiction and actively causing harm to patients and their families (eg, SSRI-induced suicides).
I trust science, but I don't trust scientists any more than I trust any other human with their money, career, and reputation on the line. I trust the FDA and pharmaceutical company ethics even less (eg, Bayer knowingly selling HIV-infested drugs to hemophiliacs, saying Oxycotin is non-addictive, or the revolving door that allows non-working SSRIs to be released and marketed as working despite all evidence to the contrary).
50 years ago many people with mental illness would go undiagnosed. They would instead self-medicate through alcohol, illicit drugs, or risky behavior and die far too young after leading miserable lives.
50 years ago was 1975. It wasn’t the dark ages and the worst cases were already being moved to asylums for at least 150 years before that.
Suicide in particular is hard to hide any suicide rates are going up despite treatment. If mental illness rates are the same as 50 years ago and more people are getting effective treatment, we’d expect per capita rates to decrease.
Impoverished third world countries where people have nothing but problems almost universally have higher reported happiness and less suicide.
Severe mental health issues don’t just go away because you drink and if alcohol could suppress the problems, we’d never have made treatments to begin with.
In terms of “self medicating” with drugs, we’re hitting an all-time high (pun intended). Risky and self destructive behavior is also way up as evidence with our prison systems overflowing.
Nothing indicates to me that mental health is improving and everything seems to indicate it getting worse despite all the attempted interventions.
I agree with this.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
If my parents said this to me the moment I realized what I was on and that I had to deal with coming off of it late in life I would be beside myself.
I'd probably also look up the doctor that encouraged my parents to put their seven year old on SSRIs so I could warn friends.
These huge lists of side effects are haunting: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i... https://en.wikipedia.org/wiki/Fluoxetine
If my parents were like "uh well I had virtually no symptoms" I'd lose my mind!
Life sucks, I'm depressed all the time, kids are depressed all the time. There's material everywhere explaining a decline in general mental health. I'm happy and lucky that when my parents (or the one that was paying attention, who was certainly also depressed) noticed I was depressed or sad during a few events, some long lasting, they asked me about it, listened to me, and did their best to give me advice instead of giving up when I was seven and giving me drugs.
Remember when replying, this post has all been about myself, a victim of depression.
This decision was made collectively by me, my wife, our pediatrician, the child therapist, the psychiatrist, and for what it's worth also my son. We did extensive research. You may disagree with our decision, but please don't cast aspersions on how much we care.
Often, people react to the concept of a thing rather than the ground reality of life and its complexities of lived experience. Most people also extrapolate (in either direction) others' lived experiences based on their learnings, understandings, pasts and future ambitions. In this case especially, there's also added stigma around mental health, antidepressants and the locus of personal responsibility when it comes to mental health issues.
The _concept_ of a child on antidepressants suspends trust in parents, that's often assumed and unquestioned depending, depending on the child's age. Maybe close to 18yo? Supportive parents. 7yo? Horrible parents. I'd argue it also tends to suspend critical thinking and introduces an unshakeable bias, that a child of 7yo _never [ever]_ needs antidepressants. Why? What makes you say that? What's your evidence and reasoning?
If you feel so horrified by that, can you consider for a moment that the parents recognize the weight and gravity of this decision too? That they had to really think this through, pursue more thorough medical advice than usual, make a judgement call, and have to live through this decision throughout all their lives?
OP's response to multiple comments indicates that they did not make this decision lightly and without making sure that this was the better thing to do overall. I commend OP's openness and honesty in talking about it. It's certainly inspiring to see a parent care for their child's mental health, and not dismissing that to be "oh, the kid's just young and moody, they'll feel better tomorrow."
PS. We (as a society) are always learning more and newer things about mental health and treatments. It might look like we know a lot. Perhaps. But we also don't know so much!
I suppose the next step would be to upgrade from single-blind to double-blind, so that your mom won't know which month is the placebo month...
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
Glad to see you have your priorities straight! :p
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
Also I noticed... yoga, travel, art, those are still external. Even meditation can be if you approach it from a standpoint of like... one that is about forming your ego around it rather than being present... not sure if this makes sense. Like you can approach anything from a negative or place of wanting to 'fix' yourself, which ruins the experience imo. For me I would ruin things that were supposed to be fun because I would tell myself I should do this because it's good for me.
That being said, there are really low days still when I will feel absolutely nothing, I will think to myself... if this psychological pain is so intense, why should I keep going? I don't have answers for that. I genuinely just have to make it through the day. I understand that with the pressures of a family and kids, it's not one of those things where you can easily tap out, medication makes sense for that. I was just trying to share how I feel because honestly for me there isn't anyone in my life who I can relate with on this deep of a level... of these feelings, and it's really alienating in itself.
Pills, on the other hand, are easy to understand. This is not to say that they are a viable substitute in any way, but it does explain why so many prefer substance treatments.
Meaning in life is hard and personal. Some might have no idea where to start.
But I'd argue (somewhat pointlessly as I'm not going to change anything) -- This is the role that society, traditions, family, etc. has: "to bring people up" swimming in the same stream, given a purpose and meaning, etc.
For comparison I've barely traveled more than 1000kms. Never had a passport. Travel is not related.
> where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well.
Incorrect assumption; It's not the building and busy-ness. And the experience doing hobbies supports that. Nothing fills that "hole".
The feeling, the "hole" you're missing, is a combi-mix of purpose/meaning/larger-picture. I know it because I also had it. Many people try politics to fill their hole too, which also doesn't work: political parties are not big enough.
I'm not going to try to persuade you to change your life, I'm going to talk about what did it for me, and you (and others) can spectate and speculate, take and leave whatever you want. I'm sure I'll get flagged anyway.
My great realization is that nothing is set in stone, everything changes at all times, and humans have survived it.
> a debilitating feeling of lack of fulfillment, without any idea of what's missing.
A good way to start out is to start thinking about: what is your mission? What is your tribe in the world stage? are there messages or lessons from the ancestors of your tribe?
Shy away from getting over-scientific. Simple broad points. The universe is in constant change and chaos. But humans have survived for a long time. We have "lizard" brains that give us reactions, then we have learned / ingrained behavior on top of that, through all this time we've encoded "how to survive" in our brains and throughout our history; we are a storytelling species, so what stories do we have from history (note: not about history, but from history).
Realising stories, like fairytales,(ie: Rumpelstiltskin) etc - ARE old stories that ENCODE information as a way to pass knowledge from culture to culture. WHAT information is in there? what are they trying to tell us? This is the tribe of "humans" telling us something from the past, which is actually absurdly interesting and fulfilling to try and learn from.
Yes this is all "woo-woo" stuff, none of this is going to be a revelation to you. I'll probably look like a quack, but You can have a ponder about it, and realise that there's a big group that you're a part of, and there is a bit of a cosmic mission, and history plays out every day.
this won't give you purpose or fill the hole, but I think you might start to chip away at some different things in your life, (or you won't and I've just wasted 5 mins of your time, ¯\_(ツ)_/¯ who cares)
A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.
To be clear, Prozac is not a "feel-good" pill, it's a "gradually feel more stable" pill. It makes my lows less debilitatingly low and more manageable -- my lows are now largely logical responses to difficult events, as opposed to randomly happening for no reason at all. The effect is very gradual and subtle: you can't really evaluate it until after several weeks, and then the "evaluation" is a conversation about whether your affect has seemed generally more stable recently. An average person taking Prozac would probably notice no effect at all, good or bad. By contrast, a stimulant like Adderrall will have a noticeable effect on anyone within minutes.
My son never asked for Prozac or for a "feel-good" pill. My kids have heard of addiction before so we've talked about pills that do make you feel good and why they're dangerous, and also "dopamine drips" like brainrot on YouTube.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
But some people just are very prone to depression and need the extra help.
You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
And SSRIs are not very strong. They do have some nasty side effects especially sexually but this is not relevant at that age so that makes it even more suitable for kids than adults.
But these side-effects just need to be checked for (and the libido issue isn't relevant to under-teens anyway).
Of course you would say that after the Nth time. You are supposed to find out what causes the pain, not mask it.
If you have a headache, it's totally fine to take a painkiller. (If it happens on a regular basis, eg at least once a week, it can be a good idea to get those different pills from a neurologist, because the two main painkillers have bad side effects in the long run, but those different pills are just "masking" it in a different way)
What I am trying to say is that after the Nth time you would take the kid to the doctor to find out what causes the pain, instead of just giving them painkillers. It could easily be something treatable, or rather, curable.
There's also simply death. I didn't feel like mentioning it, but I think its worth pointing out that without treatment, death is a very real possibility.
I find this hard to believe. People in the past weren't depressed nearly as much, so whatever is causing it has to be environmental.
Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.
Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.
There are different severities - a small depressive episode, a multi-year dysthymia or mixed (manic + depressive) episode.
I've been managing OK without meds, but maybe simply depression wasn't as severe as that of other folk. It's still a mental illness.
However, the effectiveness of Mindfulness based stress reduction and acceptance & commitment therapy show that those who can distance themselves from their thoughts have developed "mental resilience"
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
Most of the "treatment" is apparently just telling people to stop feeling sad [0], or giving them drugs
[0] https://old.reddit.com/r/thanksimcured
but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.
Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.
I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.
If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.
Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?
Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
Not what the post you replied to was talking about.
> Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.
One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?
> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.
I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".
Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.
https://www.cambridge.org/core/journals/bjpsych-advances/art...
Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?
I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.
Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.
The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes.
Edit: Mark Horowitz is one of the authors of both studies.
Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects.
Source: https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html
[1]Number Need to Treat, that is, number of patients you need to treat to prevent one additional bad outcome
[2]Number Needed to Harm, that is, number of patients you need to treat to generate side effects so bad that someone halts treatment
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
See: the Sackler family
So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills.
The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society).
I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever: - A lot of outdoor time and exercise. - Take the time to build a community of friends that genuinely care for each other - Work on some projects that you feel help humanity and each other (or volunteer). - Build things you are proud of. Build a legacy
All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
Grandparent's report is hard to verify, not extraordinary.
These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.
Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.
Someone literally just told you this happened to them, and your reaction was "I don't believe you," followed by a confident statistic you apparently invented.
Do you think if one person in a million took a drug and had their emotional system altered, a siren would go off? That the TV would be interrupted by an all-seeing oracle declaring a medical anomaly?
If a rare side effect occurs, it looks exactly like this: scattered individuals complaining on the internet.
You're misapplying the Carl Sagan popularized aphorism "extraordinary claims require extraordinary evidence" and apparently think the meaning of an aphorism can be determined by looking up one of the keywords in the dictionary, rather than, say, the Wikipedia article on the aphorism itself.
We have lots of public data on SSRI usage (20+ million in the US alone each year) and discontinuation rates. The drugs themselves are decades old and have been through countless trials and studies, and of course there are databases like FAERS that track reports of adverse drug reactions.
Is your assertion that this is false? That in fact the typical SSRI patient is mentally/emotionally crippled by the drug? Doctors and public health agencies are hiding a public health catastrophe to sell genericized pills that cost tens of dollars a month?
Of course severe side effects can and do happen. Doesn’t mean every bad thing that happens to a person who happened to take SSRIs for a few days should be taken as a big cautionary tale.
I asked you how you determined "Millions more tried them... and then desisted from treatment without major lifelong mental alterations"?"
I took that to mean you were confident 0 out of several million people had lifelong alterations.
Any other interpretation of what you meant would suggest you are not responding to anything I wrote and simply writing non sequitors.
It seems to me you said something indefensible (0 out of 1 million people had permanent damage, there is no possibility you have data to show this) and are now trying to change the subject to something less insane (the typical patient has no permanent harm?)
Since PSSD wasn't recognized until 2019 I know you are full of hot air in suggesting if these drugs caused unusual problems we'd know about it by now:
https://www.psychologytoday.com/us/blog/side-effects/201906/...
I haven't taken any antidepressants since.
The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD".
I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ).
Around the same time there was Ritalin and maybe a few others came out.
The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids.
I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
Never again. I'm taking Pristiq now and that has been considerably better.
The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
"Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight."
https://www.va.gov/washington-dc-health-care/stories/combati...
"Consider adding some of these steps into your daily routine to improve your mood:"
"Spend time outside to get ample vitamin D ... Eat foods rich in vitamin D (salmon, eggs, tuna, etc.) Take vitamin D supplements"
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
But rather than fixing society, we will impose experimental drugs on kids. In some cases altering their lives irreversibily
It absolutely should be discussed and openly talked about
> we will impose experimental drugs on kids
What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
There isn't a choice if * Questing it is "morally wrong" as it's made out to be * It's the only solution.
What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
Children are experiencing everything growing at once. They have preferences, they have new experience, everything is very close to "the first time this has ever happened" and so, can be a very big deal for them, at the time.
¯\_(ツ)_/¯ internet arguments about parenting, experiences, assholes, having one, putting it in others faces, etc. The internet is just talking to a bunch of people who have different ideas. I wouldn't take it too seriously, over half of it is bots or socially inept people anyway
actually, "depression" or major depressive disorder is literally a mental illness, which has a genetic link. it is not a "lack of meaning or beauty" -- to suggest every depressed person who killed themselves had no "meaning" for life is deeply disrespectful to every parent, child, sibling, partner that killed themselves.
Hacker News really does attract a specific type of person...
If those children just had a temporary sadness then the placebo would appear to work?
shswkna•2mo ago
> They can also increase suicidal ideation.
A very close family member committed suicide, after Prozac dosage adjustments made his brain chemistry go haywire.
This happened 30 years ago, and it has been known to us that Prozac can cause this, since then.
The Guardians headline is way, way understating the real situation here.
carsoon•2mo ago
Medications almost always target symptoms and never address root causes.
shswkna•2mo ago
kittensmittens5•2mo ago
kittensmittens5•2mo ago
kayodelycaon•2mo ago
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
fragrom•2mo ago
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
doubled112•2mo ago
autumnstwilight•2mo ago
I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
hajile•2mo ago
Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.
pixelready•2mo ago
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
cornstalks•2mo ago
I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.
I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.
In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
hirvi74•2mo ago
Though, I am curious about the, "otherwise have very good lives" part.
Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.
As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The smart-ass in me can't help but suggest that maybe medication was your cow?
cornstalks•2mo ago
To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.
> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.
> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
*fist bump*
> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).
I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.
> The smart-ass in me can't help but suggest that maybe medication was your cow?
Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.
jrflowers•2mo ago
The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.
It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.
parineum•2mo ago
"Your community" isn't your doctor. This annecdote, to me, is cleariy an attempt to blame modernity for depression.
jrflowers•2mo ago
The doctor in the story exists in pretty recent history, which you would call modernity. If for some reason you’re using “modernity” as a way to say “systemic alienation of the individual” rather than “modernity” meaning “happening in the modern world” then yes, by your definition of that word, it is indeed a story about “modernity” being to blame for poor treatment for depression.
coffeecat•2mo ago
cornstalks•2mo ago
pronouncedjerry•2mo ago
wincy•2mo ago
Second - light. Lots of light, specifically in winter time. Like this https://www.benkuhn.net/lux/
I had a horrible time with school because as finals rolled around in the fall semester I’d get extremely depressed and anxious.
mrguyorama•2mo ago
For starters, everybody has a different utopia, so no matter how you change society it "won't work" for someone.
And depression isn't sadness.
nitwit005•2mo ago
squishington•2mo ago
tsimionescu•2mo ago
In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
Modified3019•2mo ago
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
jdietrich•2mo ago
>once I noticed it also affected my ability to experience color
A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.
https://pubmed.ncbi.nlm.nih.gov/34689697/
https://cdnsciencepub.com/doi/10.1503/jpn.200091
ekianjo•2mo ago
EasyMark•2mo ago
salemh•2mo ago
https://pubmed.ncbi.nlm.nih.gov/20616621/
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
EB66•2mo ago
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
slaymaker1907•2mo ago