There seems to be an increasing number of non-academic articles, essays and books that are expressing the idea that the Serotonin hypothesis of depression is flawed. It seems like the drug industry just picked up this idea in the 70s and has been running with it (to the bank) ever since
Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that wears off over time - as your body adapts to the induced serotonin imbalance. The only answer from the medical profession? Increase the dose.
I saw this with my own mother. She went from being a mildly depressed retired housewife to suicidal within the space of 12 months. She started on low-dose SSRIs which seemed to work for a while before she regressed. Each time she started to feel depressed again she would be prescribed with an increased dosage. This pattern repeated until she was taking the maximum 'allowed' dosage, by this point she was delusional, paranoid and suffered terrifying, persecution-style hallucinations - perhaps not surprising seeing how much her brain chemistry must have been out of whack.
Sadly, I'm making these observations with hindsight, she took her own life in 2015. I wish I could share this article with my dad, if I knew it wouldn't break his heart. Both she and my father couldn't share with their children how gravely ill she was until it was too late. They both trusted their doctors implicitly. What they weren't prepared for was the fact that the theory that formed the basis of her treatment was, it seems, no more than guesswork supported only by publication bias, wishful thinking and greed.
Ironically, one of my first web development jobs, way back in 2000, was at a 'medical communications company' where I created an intranet site for GSK (IIRC) for use by their salespeople to shore up the claims of the effectiveness of Seroxat/Paxil and counter negative studies. So, I guess that makes me complicit in all this too.
The part about funding studies and throwing away the ones that don't say what they want about a drug is worse than described because a lot of the funding goes to graduate programs where the students have no choice but to find results favorable to the drug.
I have an ex-girlfriend that went into the PhD program for Neuroscience at a reputable university. Her entire degree and living stipend was paid for by a pharmaceutical company. The company "suggested" that her PhD research revolve around a drug that lowered aggressive tendencies.
The sloppiness of the study appalled me. I couldn't say that much because she and I were dating at the time, but it was absurd. There was no funding for getting a reasonable sample of people. So they went to a halfway house and brought in 30 males and 30 females. All criminals, all on probation or parole, all with serious histories of substance abuse, and most of the women were pregnant.
Almost all of the males dropped out for one reason or another. Many of the women did as well. I believe the final tally was 3 males and 13 women. All of whom tested positive for some assortment of drugs.
The sample size is obviously problematic here. What was possibly even worse was when I would go to the lab and watch this person sift through ECGs. The test itself that defined aggressiveness was totally ill-defined, and the neural response to the test was basically, "Well, let's just take a look at it. Okay, this one looks aggressive. That one doesn't."
It was a total shitshow. The end result? A published paper in a prestigious journal about how this drug reduces aggressiveness, a PhD, and FDA approval for the drug.
I hate to identify with conspiracy theorists, and all that. But I literally watched this process happen with a person I was dating for almost all of it.
When it comes to drugs, you really have to do your own research. Your doctor isn't going to do it for you. That's the double burn of healthcare in the U.S. Even when you have it, you can't really trust it. You have to pay for it, you have to know what's wrong with you, and you have to know what you need. And if it isn't a drug, then fuck off. You have to pay for it anyway.
People say, "Fuck you, that's one story that probably went badly. Science is self-sufficient and self-correcting. The plural of anecdote is not data." Fair enough on all points.
But there is a systematic and broken way of doing science in the medical industry. And doctors are not scientists and don't really get trained to know the difference between good and bad science.
I totally agree with this, and I will repeat a somewhat controversial view I hold:
Governments & business owners directly gain power & influence in the world via their citizens/workers productivity. The western attitude to "mental illness" is shaped VERY strongly by this - when you get "depressed" working an overly stressful job with no hope of anything better, it is better to convince the poor sap that its a problem with THEM rather than a problem with the world. Then give you some pills to make it better.
This dysfunctional culture will swallow up all your time, force you to work on things you fundamentally don't believe in, leave you isolated from people and then tell you its your fault for being depressed. We need to make the world stop dehumanizing us. Monkeys in cages get depressed.
When 5% of people are depressed, maybe its fair to say they should seek treatment on their own. When 30%, 40%, 50% of people are depressed.... its time to adapt the world to fit peoples well-being instead of the other way around..
Years of strict exercise, diet, meditation, breathing techniques, various forms of therapy, and numerous self-help books did not cure my anxiety and depression. 2 weeks after starting a low-dose (10mg / day) of Lexapro made me feel better than I had in 10 years.
Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is solved to this day with Lexapro. I consider it a drug that saved my life.
One of the biggest reasons that antidepressant meds are the go-to treatment for depression in the US is reimbursement. This reason is a cause of another important problem with mental healthcare in the US: shortage of mental health providers
Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $y for a 90, etc. Reimbursement for "medication management", i.e. prescribing drugs, is not based on time, but generally is a fixed amount. So the more prescriptions you write, the more money you make. Psychiatrists therefore focus on meds rather than therapy, as the reimbursement rates for therapy can't support a practice. Many psychiatrists don't take insurance at all bc they don't want to be "medication mills", so they charge $200-600+ per hour for therapy and only rich clients can pay. Psychologists and other licensed therapists can't prescribe meds, so they do therapy, but often make less than $60-70k a year. People don't want to go into psychology / psychiatry because of the stress of dealing with suffering people without having the tools to help them, and then getting paid relatively little (compared to other health care professionals)
This results in much of depression and other mental health being treated in primary care. PCPs aren't trained that well in treating mental health beyond what pharma sales reps tell them, so they wrote an rx and call it a day. 70% of patients don't respond to the first trial of antidepressants, but PCPs don't really know how to handle this
Dismissing the scientific trials as flawed by cherry picking and then choosing an anecdotal cow to make a point seems ironic to me. The only thing I can get from this is that we may not have the whole picture regarding depression and focusing only on medication is the wrong thing. But as far as I know from people battling with this is that even in my country the doctors strongly recommend lifestyle changes and hours of therapy with a psychologist for long term success
Quite apart from the generally pseudo-scientific content, there is a big part of missing context in this: the author's background. Johann Hari was first found to have plagiarised large amounts of his published work over many years, and then to have used sockpuppet accounts to make negative (and libellous) edits to the Wikipedia pages of his critics. This is his first major publication since his disgrace. Is it really that surprising that somebody whose career was left in ruins is likely to identify hating ones job as a cause of depression?
> 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it.
In my opinion this should be a national emergency on par with something like the opioid crisis (a symptom of this). We're a nation of depressed, drugged up zombies sleepwalking to our unfulfilling office jobs everyday to pay off our student loan / mortgage debt (yes I know not everyone is in that situation, but even if only 10% are that's 30 million people).
I've been depressed, and I'll tell you this straight up. If a doctor gave me a cow instead of the pills, I would have been way better off... ignoring all the actual problems the cow solved for the rice farmer in the article, just the honesty of the doctors recognizing the real issue in the right spirit would have made me laugh, and prolly "cure" me, at least for a little while.
"And that’s when, after two more years studying civil servants, he discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed."
I wonder how this research squares up with the so-called Executive Monkey experiment, which found that it was actually the monkey with more control that had more stress.
Suggest alternate title: Many people are depressed because they lack control over their work.
I'm surprised to see this as "new" because there has been work published since the late 60's  and widely known since the early 90's  showing that depression is often no more and no less than "having depressing thoughts". That is, if you can persuade the person to believe that they don't have a good reason to be depressed, they stop showing signs of depression.
> We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most...
This (emphasized) is what I think is causing my increasing anxiety and depression. I look around at people, talking loudly, showing off, taking selfies, buying expensive crap they don't need from expensive shops, etc. I try to puzzle out why they're so happy, they all seem so superficial, and I can't understand why they don't feel miserable about the people less fortunate than them who live right next door, the people serving them, who are all struggling to just get by and by all measures increasingly failing. I really want to live in a more equal society that takes care of all citizens.
It still seems many people believe there is strong scientific evidence to the "chemical imbalance" theory as an independent cause of depression, which is a myth.
It is a paradoxical issue though, because chemicals can indeed play a crucial role to overcoming depression.
Nevertheless, all the major emotions/moods one can feel: sadness, joy, laziness, vigour, fear, enthusiasm, anger, limerence etc are almost nothing but chemical conditions. If you feel panic or are angry at somebody - that doesn't necessarily mean you are in danger or that somebody is an asshole - that means you have elevated level of norepinephrine and/or low serotonin and/or something like that. Feeling lazy doesn't mean you have fallen to the sin of sloth but that you have low levels of thyroxine and/or dopamine and/or norepinephrine and/or serotonin and/or something else. That's a huge problem the majority of people don't understand this, just keeping this in mind makes the life a lot easier for you, your family and everybody around. Also it usually is enough to take something as natural, cheap and harmless as L-tryptophan (an essential amino-acid, the precursor to 5-HTP and serotonin, easily available as an over-the-counter supplement and found in many foods naturally) to fix the problem, SSRIs and benzodiazepines are not necessary in every case.
I am disenhearted by the apparent pseudo-scientific thinking in the comments on this article, and how it'll "be better if you just go workout and eat better", which might work for some people, but not for everyone. If there was a scientific study about changing life habits to stop depression, I'd bet that it would have the same amount of effectiveness or even less than SSRIs. I myself have been "miraculously" cured from depression by the most ridiculed profession in modern medicine, psychiatry, and with "poison" that was supposed to ruin my life and make me kill myself. Basically, aripiprazole and fluoxetine helped me, and help me live life, work and be happy. There was nothing wrong with my life until one day I tried to kill myself, and I was very resistant to treatment because of years of people's anecdotes how psychiatrists were crazy, were "out to get them" and "chemically lobotomize" them. This is bullshit, and we all know it, during my stay in a hospital I have seen many cases of teenagers who were "beyond repair" get "fixed" with medications, and would you look at that, 3-4 years on, they haven't regressed (I kept in contact). Neither have I. It's dangerous to spread conspiracy theories to impressionable and vulnerable minds, and you should think twice before dismissing the whole modern science of psychiatry, just because you fell that hippie life and smoking pot is the way to fix anyone's life. I don't care about the downvotes, but had to get this off my chest.
There are two things that both get called "depression". Like so many other confusing things, this all is the result of fuzzy language.
There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables.
There is also depression: the neurochemcial/neurophysiological disorder that has depression (sadness) as one of its symptoms.
It can be treated with various (miracle) drugs.
People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates.
Required viewing: a lecture on this topic by somebody who knows more about it that anybody else who is currently alive: https://youtu.be/NOAgplgTxfc
Thanks for changing the senseless title in the submission.
I'd like to think that medical professionals and academics in the mental health field have probably been thorough enough in their research to have looked at these finding over the years. I somehow doubt a person whose graduated in Social and Political Science and has no medical or scientific background might actually know what they're talking about in relation to this.
Interesting thing about the author. He was a rising journalistic star in the UK. He'd won awards was regularly on TV and radio, until it was discovered he had been plagiarising others for a lot of his articles. It was also found that he had been editing wikipedia articles to attack people who critisised him. An interestingly tragic character.
This explanation does not work for all types of depression. There are people who have wonderful lives, fulfilling jobs, happy families, who are still depressed.
We need to be more careful in our language, the word depression has become overused, much like the drugs used to treat it.
tl;dr: Depression is just sadness resulting from modern society being kinda lame.
(The article argues this point cogently, and I agree with it.)
Quote from article:
"Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”"
I have been saying this on HN and other forums for years.
Each time I get downvoted for how dare I suggest that it is other things in a person's life and that clinical "depression" is unscientific.
Most people would rather play victim i think
Is everything you think you know about headlines wrong?
Is depression caused primarily by clickbait?
Why did my comment get flagged? I assume this was a mistake, so reposting:
tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame.
(The article argues this point cogently, and I agree with it.)
[I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]