Weird article. It tries very hard uo front to defend modern depression drugs until midway down, where the lede gets buried:
Research suggests antidepressants work only a bit better than placebos (dummy drugs people are told could be the real thing). There are debates among researchers about how significant this difference is.
And this bit has been known for a good deal longer than the more current news that the shakiness of the whole premise of brain chemical imbalance.
> The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision.
> Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”.
> (please note that “clinically insignificant” is very different from “statistically insignificant” aka “has a p-value less than 0.05.” Nearly everyone agrees antidepressants have a statistically significant effect – they do something. The dispute is over whether they have a clinically significant effect – the something they do is enough to make a real difference to real people)
I imagine depression is a multi-faceted problem and not singularly a chemical imbalance problem. On a holistic level it could also mean you’re spiritually broken and don’t have the right tools to navigate life and its many hurdles. People need the right tools to navigate life.
Everything in your brain is made up of chemicals though. Even if one’s depression is caused by external factors (as opposed to some kind of inherent or congenital chemical imbalance), modifying the chemical state of your brain can still possibly address the depression.
I’ve been on SSRIs for years — I’ve bounced back and forth on my view of depression. I think my brain is likely prone to respond to certain stressors in a depressive way, due to a combination of genetics and years of conditioning/“practice”. It seems possible to me that I could learn, via a combination of things like therapy and meditation, to notice and control my brain’s reaction to those stressors. But at the same time, “chemical interventions” like SSRIs have also seemed to help.
Musing some more while I'm here (a bunch of armchair psychology to follow):
Everything in your brain is chemicals, but beyond that, external influences can I think cause very deep, "low-level" changes in your brain, that end up feeling more like chemical imbalances than they do like being upset about some particular thing. Like, the thought "I'm sad my partner left me" is made of chemicals, but I think depression operates on a much lower level than that of conscious thoughts like those, even when induced by some external stressor.
When I pay attention to my own mood, I can sometimes notice specific things that trigger feelings of depression. Something stressful happens, I'm worried about something, etc., and I'll react by getting depressed. But the depression doesn't feel like it's tied to whatever just happened. I'm not sitting there being like "omg I'm so sad about X" -- I just feel depressed: I'm not getting much joy out of anything, nothing seems interesting or exciting, I'm not looking forward to anything, etc.
It's only when I force myself to take a step back and ask "what might have happened recently to cause me to feel depressed?" that I'll realize "ah yes, X just happened, that's probably why I'm feeling depressed right now". But even after that realization, the depression _still_ feels disconnected from the stressor. My conscious brain knows that the depression was probably caused by X, but my subjective experience of the depression is still disconnected from X.
I guess this is kind of analogous to waking up with back pain, wondering "what did I do to my back?", and realizing "ah yeah, it was X". Realizing what caused your back pain doesn't somehow alleviate the back pain -- the damage is already done. You can maybe try to do X more carefully in the future, but even that is no guarantee that X won't cause you back pain again.
I think we like to think that because our brain is where our consciousness and ego and thoughts are, that we can control it in a way we couldn't control other body parts, like our backs. And that we ought to be able to "will away" mental pain in a way we couldn't just "will away" back pain. But that's not always the case; the brain's just another organ.
This 100%. Framing mental health as a purely individual or chemical issue distracts from the societal/cultural level problems you're hinting at.
I've come to the conclusion that a lot of what we call the mental health epidemic is really just late capitalism being fundamentally unable to meet human needs of spirituality and emotional belonging.
There's nothing inherently wrong with capitalism as a means to an end in an economic sense, but as an ideology and identity (as is especially pervasive in the US), it's extremely toxic. Capitalism in this sense dehumanizes people, and rewards and encourages lack of empathy and sociopathy. We're taught that it's OK to let people be homeless, starve, and die preventable deaths from lack of healthcare because it's their fault for not being able to succeed in a system that is designed to profit off their failures. We're told we can't fix these because of insufficient means, but in actuality it's a question of prorities and not wanting to midly inconvenience wealthy people to share small portions of their wealth to support the society from which they extract their wealth.
Being in constant fear for your survival because your wages haven't increased in years while the cost of healthcare, food, housing and education keep increasing is disastrous for mental health, that shouldn't be surprising at all. If you're in that position you might be told that your employer can't afford to pay you enough to survive, when in actuality they likely still have healthy profits that are redistributed only to senior management and shareholders.
Learning about the concept of internalized capitalism was a game changer for me. Once you decouple your self-worth from your perceived productivity for the economy/society (aka your value to wealthy elites), it's a lot easier for you to accept yourself and stop blaming yourself for something that's totally outside your control that you perceive to be as a personal failure.
I definitely think there are broad societal trends contributing a lot to mental health issues, but I'm less convinced it's capitalism exactly (depending on what you mean by "capitalism" of course[0]). Two societal trends that seem significant to me and my own depression are a) emphasis on individualism over community, and b) rejection of religion.
I once went down the rabbit hole of anti-antidepressant “science research” (due to some internet argument), and what I got from it is that a) research papers often have “comments” in the form of other scientists answering them. The bad ones I read were answered in a very enlightening way! b) studies showing no or little effect may have bad methodology.
One prominent error is that the often used Hamilton test is only an ordinal value, its value should not be used to quantify improvement. The other thing I saw (and have some anecdotal experience agreeing with it) is that around half of the patients react very well to anti-depressants, while the other half doesn’t. It may be misdiagnoses in the latter’s case (or as someone mentioned in the comments, there might be another illness subtype under depression which has a different underlying cause), but I assume the bad name of anti-depressants come from the large number of people in the second group.
It's anecdotal, but anti-depressants certainly had a positive effect on my depression. However, a large component of my depression was caused by a co-existing anxiety disorder.
I often feel the anti-depressants cured some kind of physical imbalance that led to my anxiety disorder, and thus the ensuing 'curative' notions of anti-depressants might not be directly attributable to any physiological aspect of my depression, but the cause of a large component of my depression...an anxiety disorder.
Anxiety and depression have a close relationship and both represent a chemical imbalance in the brain. When you have an issue like this to the point of disorder, it's unlikely to be the only problem. Psychiatric labels like PTSD, GAD, OCD, BPD, serve to categorize the behavioural manifestation of the imbalance.
I don't claim to have a cure for depression. However, meditation has been a significant help in balancing my emotions and achieving calm. I am convinced poor diet and sleep hygiene are major contributors to mood disorders. Work on those in tandem with practicing meditation. If that doesn't work for you after a few weeks, the medication will still be available.
Sigh, why does HN keep picking these editorialized articles up? I honestly expect the community to flag this as clickbait.
We have new evidence that invalidates our previous hypotheses, so we adjust course and keep going. “We all” didn’t believe a “myth about depression.” We believed that scientific findings combined with some relevant studies, experiments and feedback loops would yield a step in the right direction. We accept that the scientific method isn’t infallible.
I don’t understand what people are after. The further along we get in our exploration the more hypotheses we’ll invalidate. Which is to be expected. I would rather be outraged at ignorance than outraged at new knowledge that contradicts the old.
I have been diagnosed with Major Depressive Disorder.
I have been struggling with depression for 35+ years.
I have attempted to kill myself. [Yes I failed at that too! =)]
I thought about (and planned) killing myself several times a day.
I have had 6+ Psychiatrists.
I have tried EVERY drug available.
Electric Shock Therapy was going to be next, but I have avoided it.
The best drugs only work for 6'ish months for me.
Then my doctor offered an experimental Ketamine treatment.
I've had 3 rounds of treatment over the last 6 years.
I didn't obsess about killing myself any longer.
It's almost like I forgot to dwell on it.
I still have some bad days, but my bad days now are better then my best days used to be. So that's an improvement.
I'm very happy you found something that works for you. What method of ketamine treatment have you been taking? I just stopped after 2 months of troches, which didn't seem to bring significant, if any, benefit.
Interestingly, I found myself abnormally susceptible to the psychedelic effects. When taking ketamine orally, the expectation is that most of the medicine is absorbed while you hold the troch in your mouth for 30+ minutes. After a lot of experimentation, I found that I barely absorb any medicine through my mouth, but once I swallow it I absorb it very rapidly. This made it difficult to control the delivery speed, and likely hindered my treatment.
I haven't been dealing with depression for anywhere near as long as you, but I do speak from experience about how terrible it is to not find anything that works. I've gone through ~13 of the most commonly prescribed drugs for depression, anxiety, and sleep, and none brought any relief. I've now tried and failed out of ketamine, which I was really hopeful for. Now I'm just back to sitting around trying to get _any_ doctor to actually see me and maybe get tested for various neurodivergent conditions.
Every treatment had slightly different results, but only 1 offered me any kind of significant moments.
The most commonly repeated imagery was usually geometric patterns (usually in a glowing neon, accompanied with an EDM auditory hallucination as well), and old-fashioned TV static.
I refer to these sessions as 'brain rewiring'.
The singular significant moment was a quiet nothingness. All the voices stopped. All the inner talk stopped. I can best describe it as:
cat BRAIN >/dev/null
It was incredible, and the only true inner peace I have ever felt.
SSRIs (lexapro) saved my life. 6 years of depression effectively gone in 2 weeks of starting. Literally night and day and I tried every non-medicinal intervention that you could imagine before taking the plunge.
I don’t care how it works but I will never stop taking it.
One of the episodes of the BBC's "Billion Dollar Deals" series talked about how the anti-depressants were pushed on to the masses by the drug companies, even to people who did not require it.
Readit News
Research suggests antidepressants work only a bit better than placebos (dummy drugs people are told could be the real thing). There are debates among researchers about how significant this difference is.
And this bit has been known for a good deal longer than the more current news that the shakiness of the whole premise of brain chemical imbalance.
> The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision.
> Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”.
> (please note that “clinically insignificant” is very different from “statistically insignificant” aka “has a p-value less than 0.05.” Nearly everyone agrees antidepressants have a statistically significant effect – they do something. The dispute is over whether they have a clinically significant effect – the something they do is enough to make a real difference to real people)
I’ve been on SSRIs for years — I’ve bounced back and forth on my view of depression. I think my brain is likely prone to respond to certain stressors in a depressive way, due to a combination of genetics and years of conditioning/“practice”. It seems possible to me that I could learn, via a combination of things like therapy and meditation, to notice and control my brain’s reaction to those stressors. But at the same time, “chemical interventions” like SSRIs have also seemed to help.
Everything in your brain is chemicals, but beyond that, external influences can I think cause very deep, "low-level" changes in your brain, that end up feeling more like chemical imbalances than they do like being upset about some particular thing. Like, the thought "I'm sad my partner left me" is made of chemicals, but I think depression operates on a much lower level than that of conscious thoughts like those, even when induced by some external stressor.
When I pay attention to my own mood, I can sometimes notice specific things that trigger feelings of depression. Something stressful happens, I'm worried about something, etc., and I'll react by getting depressed. But the depression doesn't feel like it's tied to whatever just happened. I'm not sitting there being like "omg I'm so sad about X" -- I just feel depressed: I'm not getting much joy out of anything, nothing seems interesting or exciting, I'm not looking forward to anything, etc.
It's only when I force myself to take a step back and ask "what might have happened recently to cause me to feel depressed?" that I'll realize "ah yes, X just happened, that's probably why I'm feeling depressed right now". But even after that realization, the depression _still_ feels disconnected from the stressor. My conscious brain knows that the depression was probably caused by X, but my subjective experience of the depression is still disconnected from X.
I guess this is kind of analogous to waking up with back pain, wondering "what did I do to my back?", and realizing "ah yeah, it was X". Realizing what caused your back pain doesn't somehow alleviate the back pain -- the damage is already done. You can maybe try to do X more carefully in the future, but even that is no guarantee that X won't cause you back pain again.
I think we like to think that because our brain is where our consciousness and ego and thoughts are, that we can control it in a way we couldn't control other body parts, like our backs. And that we ought to be able to "will away" mental pain in a way we couldn't just "will away" back pain. But that's not always the case; the brain's just another organ.
I've come to the conclusion that a lot of what we call the mental health epidemic is really just late capitalism being fundamentally unable to meet human needs of spirituality and emotional belonging.
There's nothing inherently wrong with capitalism as a means to an end in an economic sense, but as an ideology and identity (as is especially pervasive in the US), it's extremely toxic. Capitalism in this sense dehumanizes people, and rewards and encourages lack of empathy and sociopathy. We're taught that it's OK to let people be homeless, starve, and die preventable deaths from lack of healthcare because it's their fault for not being able to succeed in a system that is designed to profit off their failures. We're told we can't fix these because of insufficient means, but in actuality it's a question of prorities and not wanting to midly inconvenience wealthy people to share small portions of their wealth to support the society from which they extract their wealth.
Being in constant fear for your survival because your wages haven't increased in years while the cost of healthcare, food, housing and education keep increasing is disastrous for mental health, that shouldn't be surprising at all. If you're in that position you might be told that your employer can't afford to pay you enough to survive, when in actuality they likely still have healthy profits that are redistributed only to senior management and shareholders.
Learning about the concept of internalized capitalism was a game changer for me. Once you decouple your self-worth from your perceived productivity for the economy/society (aka your value to wealthy elites), it's a lot easier for you to accept yourself and stop blaming yourself for something that's totally outside your control that you perceive to be as a personal failure.
https://www.usatoday.com/story/life/health-wellness/2021/06/...
One prominent error is that the often used Hamilton test is only an ordinal value, its value should not be used to quantify improvement. The other thing I saw (and have some anecdotal experience agreeing with it) is that around half of the patients react very well to anti-depressants, while the other half doesn’t. It may be misdiagnoses in the latter’s case (or as someone mentioned in the comments, there might be another illness subtype under depression which has a different underlying cause), but I assume the bad name of anti-depressants come from the large number of people in the second group.
I often feel the anti-depressants cured some kind of physical imbalance that led to my anxiety disorder, and thus the ensuing 'curative' notions of anti-depressants might not be directly attributable to any physiological aspect of my depression, but the cause of a large component of my depression...an anxiety disorder.
I don't claim to have a cure for depression. However, meditation has been a significant help in balancing my emotions and achieving calm. I am convinced poor diet and sleep hygiene are major contributors to mood disorders. Work on those in tandem with practicing meditation. If that doesn't work for you after a few weeks, the medication will still be available.
We have new evidence that invalidates our previous hypotheses, so we adjust course and keep going. “We all” didn’t believe a “myth about depression.” We believed that scientific findings combined with some relevant studies, experiments and feedback loops would yield a step in the right direction. We accept that the scientific method isn’t infallible.
I don’t understand what people are after. The further along we get in our exploration the more hypotheses we’ll invalidate. Which is to be expected. I would rather be outraged at ignorance than outraged at new knowledge that contradicts the old.
I have been struggling with depression for 35+ years.
I have attempted to kill myself. [Yes I failed at that too! =)]
I thought about (and planned) killing myself several times a day.
I have had 6+ Psychiatrists.
I have tried EVERY drug available.
Electric Shock Therapy was going to be next, but I have avoided it.
The best drugs only work for 6'ish months for me.
Then my doctor offered an experimental Ketamine treatment. I've had 3 rounds of treatment over the last 6 years. I didn't obsess about killing myself any longer. It's almost like I forgot to dwell on it.
I still have some bad days, but my bad days now are better then my best days used to be. So that's an improvement.
Interestingly, I found myself abnormally susceptible to the psychedelic effects. When taking ketamine orally, the expectation is that most of the medicine is absorbed while you hold the troch in your mouth for 30+ minutes. After a lot of experimentation, I found that I barely absorb any medicine through my mouth, but once I swallow it I absorb it very rapidly. This made it difficult to control the delivery speed, and likely hindered my treatment.
I haven't been dealing with depression for anywhere near as long as you, but I do speak from experience about how terrible it is to not find anything that works. I've gone through ~13 of the most commonly prescribed drugs for depression, anxiety, and sleep, and none brought any relief. I've now tried and failed out of ketamine, which I was really hopeful for. Now I'm just back to sitting around trying to get _any_ doctor to actually see me and maybe get tested for various neurodivergent conditions.
Every treatment had slightly different results, but only 1 offered me any kind of significant moments.
The most commonly repeated imagery was usually geometric patterns (usually in a glowing neon, accompanied with an EDM auditory hallucination as well), and old-fashioned TV static.
I refer to these sessions as 'brain rewiring'.
The singular significant moment was a quiet nothingness. All the voices stopped. All the inner talk stopped. I can best describe it as:
cat BRAIN >/dev/null
It was incredible, and the only true inner peace I have ever felt.
We call that failing with great success :)
I don’t care how it works but I will never stop taking it.