The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists. Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. Most of the time however, it's more of a "here, take these indefinitely".

It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".

Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).

They allow me to function. I've gone through various dosages of various types to find the ones that work best for me, but they have never stopped working. They also allowed me to stick with CBT therapy, and after 20 years my therapist told me I didn't need him anymore ("Call if that changes").

Your second paragraph reveals a biased motive behind your opinion.

I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?

Agree. But sometimes there is no "root cause", the brain is still a mystery. If you had been depressed even when you knew there was nothing to worry about, you would see it differently, because then you deduce that the black cloud is produced within.

Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.

If you view a world at a certain angle there is always something to worry about: 1. World in not perfect, it doesn't confirm to how we want it to be (and could not even in theory given that different people want it to be different) 2. The future cannot be predicted with 100% accuracy so even if all is perfect today you can worry that it will turn bad in the future.

When looking at the same reality one persons sees the situation as OK and another as a an endless and hopeless disaster it is hard to tell who is right. A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.

This is the "people with anxiety should just stop being worried" attitude that failed to help for centuries. Whether or not you believe SSRI's are clinically effective, denying the existence of mental health disorders is not helping.

No, anxiety and depression aren't simply a matter of perspective.

My point is that it's hard if not possible to objectively tell if the situation you are in is good or bad. And I'm not trying to deny anything.

So your point is explicitly off-topic to the subject matter (read the title above). Gotcha.

> A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.

Or because of a legitimate chemical imbalance or some other cognitive issue they can’t control alone. Right?

> "There is no convincing evidence that depression is caused by serotonin abnormalities"

- https://www.psychologytoday.com/us/blog/insight-therapy/2022...

and

> "the etiology of depression is incredibly complex, the narrative that it is caused by a simple “chemical imbalance” persists in lay settings. We sought to understand where people are exposed to this explanation"

- https://pmc.ncbi.nlm.nih.gov/articles/PMC11752450/

and

> "Onset of depression more complex than a brain chemical imbalance. It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals."

- https://www.health.harvard.edu/mind-and-mood/what-causes-dep...

and

> "Analysis: Depression is probably not caused by a chemical imbalance in the brain – new study"

- https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...

(These are not thoroughly checked articles, they're the first few search results; however claims that depression is caused by a chemical imbalance ought to be able to show where that idea originated, how the imbalance is measured in patients, where that hypothesis is supported by evidence, why antidepressents don't fix depression in half of patients, and several more suspicious things).

I didn’t say it was simply that. You’re twisting my words and these studies to discount all of behavioral health.

Yes you did. No I'm not.

(I've written paragraphs and paragraphs thinking through some of my views in this thread. You wrote three words naming a thing which doesn't seem to exist. If you want more engagement, engage more. What words am I twisting? Where did you say it was anything more detailed than that? What behaviour that people "can't control alone" are you talking about?)

I did not and I am telling you I do not believe that it is that simple. You do not need to waste time arguing against your incorrect interpretation of my comment. If you need me to say I could have phrased it better, sure, I could have phrased it better. But I am now telling you exactly what I mean and think so we don’t need to do this song and dance.

For emphasis: I do not think it is simply/exclusively “chemical imbalance.”

But why do you think it is at all "chemical imbalance" when that doesn't seem to be an actual thing? What evidence convinced you? What measurements were taken on a human brain to diagnose the imbalance?

We can nitpick terminology all day but at the end of the day for you to assert that this is purely about perspective is patently absurd and I’m not going to let you distract from that fact. There are medical realities that impact people. There are external factors. There’s more to depression then recalibrating “how bad things actually are.”

That's incredibly reductive. I'm sure some people's depression can boil down to a matter of perspective, but it's naive to extrapolate that to everyone with depression.

I'm incredibly optimistic and am content with my position in life. My default state is being mindful of the present and I don't think about things too far into the future. I very rarely ever feel stressed out over things in life.

However, none of that changes the fact that I feel completely empty and find no joy in things. Interests are nearly non-existent, emotions dialed to 1, and the only thing I'm motivated to do is lay in bed staring at the ceiling... unless I'm on sertraline.

Admittedly that's just anecdotal, but I worked in a clinical neuroscience lab researching treatments for severe treatment-resistant depression (read: people who tried so many options including CBT that they even tried electroshock therapy). The only thing that helped those subjects was a regimen of personalized neuroimaging-guided transcranial magnetic stimulation for 10 minutes every hour for 10 hours every day for a week. Even then, it wasn't permanent. Some saw improvement for months, others only weeks.

For some people, it's not just a matter of "perspective".

> I feel completely empty and find no joy in things.

Maybe the idea that we should find joy and feel full is wrong?

We are on a random planet circling a random star in an unfathomable Universe.

STOP looking for meaning and you are liberated. The quest for meaning by itself might be exhausting and makes you feel depressed.

Who said I'm looking for meaning? I'm not.

It's not as liberating as you might think. A joyless existence is either suffering or nothingness. A life without meaning, either internal or external, is one where nothing is meaningful with no motivation thus one of crippling catatonia til death.

All I can say is just that it doesn't feel good and if you can't feel good about anything, your calculus of your life inevitably leads to the conclusion that existence isn't worth it.

There is only one cure/hack for Nihilism or similar...

Go somewhere where you need to work physically you az off to afford daily food. You will be so exhausted eventually that: 1 you will not have any energy left for thoughts. 2 If you have any energy left, you will give it to angriness which will lead to other circumstances which are none related to find the meaning of life.

Ignorance may lead to happiness and friends :)

I think a lot of people are conflating depression with "bad thoughts". That's just one possible symptom, usually as a result of a combination of both anxiety and depression.

I didn't have anxiety, just depression. I rarely thought. I existed on autopilot. I was physically exhausted on a daily basis as a division 1 athlete in college. Often went days without eating either because I simply forgot to eat or forgot to make time for it between classes and training. Didn't change anything.

I think something people are forgetting is that motivation is either driving you toward something you want or driving you away from things you specifically don't want. A complete lack of motivation means I wasn't motivated to do anything to get something, but also I wasn't motivated to anything to avoid something either. I wasn't motivated to eat to avoid hunger pangs. I wasn't motivated to quit my sport to avoid routine physical exhaustion. Instead, my empty autopilot existence just freely acted on the expectations of those around me as a proxy for motivation.

Interesting reply thanks. I would say though, If I were programmed or a program or whatever you name it... I would realize the under statement:

If One can´t be happy with what One have now, One will never-ever be in any circumstances.

This is not your case certainly but is connected with the autopilot (meaning we don´t get to choose.

Yeah, most folk get the causation backwards. They think having meaning in life will pull you out of depression. It's the other way around. You have to get pulled out of depression to be able to find meaning in your life.

Realizing that some "chemical reactions" can change your destiny then further learning that when you want something, all the universe is bound to conspires in helping you to achieve it.

This one came out good :)

If its not just a matter of perspective and only medication can help, etc, then why do we call depression a "psychological" or "mental health" concern? Why isn't it just considered a neurological disease?

Depression is increasingly starting to be seen as a neurobiological disorder as we learn more.

In my own opinion, we need to stop viewing "mental health" as a separate class of conditions from general/physical health. A mental illness is a health/medical condition just like any other and shifting our views and diagnostic criteria in that direction would do a lot to remove the stigma associated with mental illness.

Someone with depression has a chronic illness, not a temporary "it's just in your head" condition.

Not sure what your point is, many mental health concerns are caused by neurological diseases.

In case of depression in particular, it appears to be a label given to a big bag of various issues you may have causing similar symptoms.

I'm not telling it's a matter of perspective, my point is that I see no objective metrics to tell apart if the situation is bad so it's one expected to be depressed and when the situation is good (so only medication / therapy would help). And it makes discussions around this topic harder.

Depression and pessimism are not the same thing.

Whether or not there’s a root cause is different than whether or not the doctor even bothered to look for a root cause in the first place.

Most, especially GP’s/primary care doctors will immediately prescribe without making sure you’re also going to see a therapist at least once.

They also hand them out as if there’s no withdrawal symptoms. And many doctors aren’t even aware that many people do have withdrawal symptoms. (Withdrawal symptoms being terrible “brain zaps” that make anxiety 10x worse when coming off)

No one is denying they’re useful. There are just a lot of doctors pushing these drugs as a fix all for everything, and a lot of patients who aren’t informed and aren’t getting good advice from their primary doc

> Chemistry trumps psychology

To nitpick: The mind is applied biochemistry. Psychology intervenes in the chemistry, like many other activities do. The goal of that is to solve the root cause so that your future levels will be maintained at the right level, instead of just forcing the level by sourcing the respective chemicals externally.

A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.

Psychology can change neurochemistry but only in certain limited ways. Many people are on antidepressants long term because that's the only thing that works for them. Taking antidepressants is already stigmatized enough. People should just do what makes them feel best over the long run. Your rule of thumb does not trump hard-won personal experiences.

We don't really know how SSRIs work, but there's some evidence that it's through desensitizing serotonin receptors, not directly addressing the lack of serotonin. If so, "use it or lose it" doesn't apply; long-term adaptation is the point, and SOMETIMES does persist after quitting.

>A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.

There are ways to "hack it".

For example, ~6 months ago I started trt (testosterone replacement). It was the best decision health wise ever. I feel way better psychologically, first time in my life I managed to stick with cardio training for so long (before 3 months was the most). There are other benefits too.

So what about the "loose it" part? Well there is a hormone called HCG one can take a twice a week to trick one's balls into producing some natural testosterone. Its use prevents atrophy and infertility.

> Some cancerous tumors produce this hormone; therefore, elevated levels measured when the patient is not pregnant may lead to a diagnosis of cancer and, if high enough, of paraneoplastic syndromes. It is unknown however whether this production is a contributing cause or an effect of carcinogenesis.

Interesting.

Well, I don't think you'll be able to avoid testicle atrophy even if it minimizes it, but the important part is understanding the tradeoff. Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.

But it's your body, your life, your priorities and decision. I also wouldn't consider it a good decision health-wise to take steroids to get huge, but I have no problem with someone deciding that absurd bulk is their main goal in life and worth the tradeoff.

>Well, I don't think you'll be able to avoid testicle atrophy even if it minimizes it

I only take 250iu twice a week. 6 months in I can't see any atrophy. Some people take it every other day.

This hormone HCG is very interesting. In fact it is what many urine pregnancy tests test for. I wonder if I did a pregnancy test it would cone out positive :-)

But, the reason why I'm talking about it is to explain that it works the same as another hormone called LH produced by the pituary gland that regulates natural testosterone production by testes

So when one takes external testosterone the mechanism through which body shuts its production down is by shutting down this LH hormone.

By taking HCG ones testes are told to make testosterone. Not a lot of it, but it seems to be enough to prevent atrophy so far.

> Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.

For sure. Many of these effects are very positive. For example I was a little pre-diabetic, this has improved a lot (but one may argue via exercise - then again I manage to be consistent with the exercise thanks to psych. changes caused by the testosterone).

Another is these psychological changes. I feel more "stable". I never was really unstable, at least I never noticed, but it feels better. Like, whatever happens I can most likely solve it kind of feeling, even when things go wrong.

Finally about the shortening of lifespan. I think I offset this by exercising, but another factor is getting regular blood tests. The doc monitors things like hematocrit etc. I'm told to drink a lot more water, to measure blood pressure even though I never had high pressure etc to keep it in check.

I think most problems happen with people that do not realise their blood gets "too thick", they get high blood pressure, miss it for years and end up with circulatory system issues.

It is a tradeoff. Not everything is ideal. One negative side effect I did get is worse skin until I found a procedure to exfoliate/moisturise and so on. It's a bit of a pain in the arse as before I'd just have quick showers. Now it takes longer. But so far it is worth it.

>A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" -

Very basic and very often wrong rule, so take it with a grain of salt.

Insulin for example is the opposite. "lose it then use it" would be a general rule for type 2 diabetics where insulin resistance commonly due to weight gain is the primary problem. Losing the weight leads to better uptake and usage. For a type 1 "lose it then use it" you typically lose the ability to produce insulin to an an autoimmune disorder, then are stuck using insulin for the rest of your life.

The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up. Evolution, at grand scales, doesn't care if you survive as long as enough of your population survives and breeds. At the end of the day you might just be one of those people that was born broken and to work properly you need replacement parts/chemicals. A working medical system should be there to figure out which case is which.

> Insulin for example is the opposite.

You're describing entirely orthogonal issues. In case of insulin resistance, your natural production is running full blast with demand exceeding supply because the consumer stopped caring about the hormone. In case of autoimmune disease, the natural production was killed - you can neither use nor lose what is already dead, and even if some capacity was left it will either soon be killed or atrophy under external insulin, but it will not be mourned.

So no I would say it is exactly the same - "use it or lose it" - but that does not mean that there is never a reason to manually overrule your body's attempt at homeostasis through direct manipulation. It just means that there is a very significant consequence to the process.

> The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up.

As a somewhat sidenote, this is also why I dislike the idea of trying to classify people into "normal" and "divergent/atypical". In my eyes we're all normal people and an entirely normal aspect of being a human is that we all differ and have individually specific needs by virtue of being built by a trillion micro-meter sized workers, each with their own hand-copied version of the blueprint, only caring about the millimeter of you in their immediate vincinity and not really talking to any of the others.

The parent commenter describes seasonal Winter depression. If the problem was brain chemistry, wouldn't it be with them from birth until treatment? Who has Seasonal Type 1 Diabetes, or Seasonal Dwarfism, or Seasonal Missing-an-Eye-From-Birth? Depression generally isn't something children have from birth, it's something adults get temporarily.

A few HN submissions recently are in the style "thinking about doing the thing is not doing the thing. Planning the thing is not doing the thing. <etc etc>. Only doing the thing is doing the thing". Comparing a brain to a large software project with bugs hiding in it, in that vein giving the computer 11 hours of 'sleep' each night is not debugging the code; overclocking or undervolting the CPU is not debugging the code; installing the latest updates and patches is not debugging the code. 'knowing there is nothing to worry about' is not debugging the code. Only debugging the code is debugging the code. Reading a badly explained idea on an internet comment and dismissing it with a mocking "thanks I'm cured" isn't debugging the code. Saying "I've tried everything" isn't debugging the code.

A more specific example, if you are going on a rollercoaster and you are experiencing physical and mental symptoms of worry - nervous, anxious, angry at the person pushing you to ride, twitching and trying to back away, eyes looking around searching for an exit, coming up with excuses to do something else instead, nervous shaking, dread tightness in the chest, affected breathing, perspiring, gritted teeth, etc. etc. then washing over all that with "I know there is nothing to worry about so this must be a problem of brain chemistry" seems a clearly incorrect conclusion.

Such a person clearly has a worry. Quite likely one that's out of proportion (e.g. "rollercoasters kill thousands of people every day!"). Possibly one that's completely incorrect (e.g. "going more than 10mph makes people's insides fall out!"). Quite likely a less clear and less obvious one - which could be anything, e.g. they saw a documentary about a rollercoaster which behaded a child and that's their only thought about rollercoasters; they saw a show about fighter pilots pulling high-G maneouvres and passing out and think that will happen to them on a big rollercoaster; they see the rollercoaster track and support flexing and don't understand that a some flexibility doesn't mean weakness; they went to a theme park as a child and older children bullied them into riding a scary ride and they wet themselves and figuratively died of shame and buried the memory; they were pushed into learning to drive at 15 by their wicked stepfather and this is pattern matching to the same kind of experience; etc. etc.

Saying "there is nothing to worry about, rollercoasters are safe enough and you know it, so your brain chemistry must be broken" isn't debugging the problem. It isn't even explaining the problem. Why would broken brain chemistry particularly affect them at a theme park, or in Winter, and not the rest of the time? How was this broken chemistry identified and measured and quantified and that hypothesis proven?

Likewise, just because the parent poster has tried sleeping and exercising and taking Vitamin D, doesn't address that humans evolved in Africa, connected to oceans and trees and tribal living, and not commuting to a fluourescent lit beige box filled with strangers writing JavaScript while being bombarded with news items about wars and genocides and stories of how everyone else is having a wonderful Christmas, earning more money than you, with a cost of living crises always on their mind, etc.

> "Good enough chemistry enables cognitive treatments."

Drugs can force people to carry on with a life that's making them miserable when they have no other available options to find out why and fix it. That isn't evidence that "there is no root cause"(!). Any more than turning it off and on again can let you get on with your job, but that doesn't show there's no root cause for a program locking up.

> "then you deduce that the black cloud is produced within."

And you have a lifetime of your prior experiences affecting your mood. When you remember that your aunt hit you when you swore at the dinner table, or you saw someone slip on ice and fall over and break their wrist, or watever, every life learning experience is "the mood is produced within".

> If the problem was brain chemistry, wouldn't it be with them from birth until treatment

Ha, of course it can be! Our brain chemistry is not stable through our life! Many children are born with epilepsy, but some people develop it later in life. epilepsy, like all neurological disorders are nature AND nurture, genes AND the environment.

Using your roller coaster analogy, there very well may be genes that control; how much fear someone experiences when riding a roller coaster. The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if youa re too afraid to ride a roller coaster you should take xanax.

> "Our brain chemistry is not stable through our life!"

Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry". It's not like your stomach, liver, kidneys, <organs> suddenly stop working after you lose your job or your life partner and we say it's both inexplicable and because of a deficit of "body chemicals" and nod agreement with each other that "body chemistry isn't stable" through a lifetime.

These are just unsatisfyingly crappy non-explanations.

And quick attempts to assume that Doctors, Neuroscientists, Psychiatrists, Psychologists must have a better detailed knowledge of brain chemistry and I'm just falling for nonsense seems to find that they actually don't, and they don't agree that "brain chemistry" is a good explanation, and it can't be measured in a patient, and the idea isn't strongly supported by evidence, and even the mechanism of action of "drugs which correct brain chemistry" isn't agreed on, and when given to people to "correct brain chemistry" it often doesn't make the problem that was blamed on brain chemistry go away.

> "there very well may be genes that control; how much fear someone experiences when riding a roller coaster."

I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further. There probably are many genes which affect how much fat bodies store, or burn, or food cravings, or what constitutes hunger, or production of various leptins and grehlins and insulins and stomach acids, but that doesn't mean "I'm obese because of my genetics" is any kind of explanation at all. Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation. Downe's Syndrome is a good use for genetics as an explanation. "I have a macro-scale set of vaguely related behaviours, symptoms and body effects and no clear cause, it's my genetics" isn't.

Even if you have sequenced your genome, and have some specific gene that is associated with extra fat storage, genes can be turned on and off through a lifetime by behaviours and environment. Having a gene from birth doesn't mean it's being expressed and is therefore causing a specific problem, or that the problem can't go away and can't be fixed. ( https://www.cdc.gov/genomics-and-health/epigenetics/index.ht... )

> "The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if you are too afraid to ride a roller coaster you should take xanax."

I agree with this. Society likes assuming everyone is the same. Imagine if we collectively noticed that Adrenaline gives people "a burst of strength" and decided that daily exercise, individual strength training plans, gym visits, were all too much bother and that ageing adults were suffering from "an imbalance of Adrenaline" and when they struggle to carry their massive haul of groceries in from their car they should carry an auto-injector of Adrenaline to help their chemical deficiency.

> Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry".

Ohhh, leg chemistry, good choice! You know that leg "chemistry" is control by neurotransmitter release, yes? So you must have never heard of Familial Periodic Paralysis then. Let me tell you what happens with that, because it happened to me while taking Seroquel. Familial Periodic Paralysis is also called Hyperkalemic periodic paralysis and is due to mutations in the gene that encodes the alpha-subunit of the skeletal muscle sodium channel (SCN4A).

https://www.ncbi.nlm.nih.gov/books/NBK1338/

"The paralytic attacks are characterized by decreased muscle tone (flaccidity) more marked proximally than distally with normal to decreased deep tendon reflexes. The episodes develop over minutes to hours and last several minutes to several days with spontaneous recovery.

Some individuals have only one episode in a lifetime; more commonly, crises occur repeatedly: daily, weekly, monthly, or less often. The major triggering factors are cessation of effort following strenuous exercise and carbohydrate-rich evening meals. "

Look at that! Their muscles stopped and stared working again!

And yes, this happened to me while taking seroquel because it lowered my potassium so much it affected my nervous system.

Any good psychiatrist will tell you that they have no idea what is going on. But that does not mean neurotransmitters cannot be changed and that they do not effect behavior.

> I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further.

As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?

>Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation.

I have my hair color, height, skin color, all the physical traits from my parents, so why do you think the brain is not physical as well? Or or adrenal system? The brain is effected by genetics, this is true as has been shown clearly as a risk for schizophrenia. I have no idea why people think our mood, which is dictated by our thoughts which are created and sensed by our brain, which is a physical organ, does not have anything to do with genetics and neurotransmitters.

and then you go on to talk about epigenetics, like that matters by genes don't? Do you know that genes control the epigentic response? Genes like DNMT1? So people with differences in DNMT1 will have different epigenetic responses?

> I agree with this. Society likes assuming everyone is the same.

So how are we different? nature AND nurture. Genes AND environment. I agree the solution to these problems are wrong, but your solution are just as bad as the ones your are prescribing.

Listen, there are times when our neurtranmitters are supposed to be different, like when we are in pain or when some one dies. But some people, like me, have these changes regardless of the situation and we can like them to other environmental factors like diet, sunlight, weather, etc.

I could tell you whey and why I think am so sensitive to the world but I doubt you would listen, because no one listens, because everyone knows.

You're replying as if I said that drugs can't change neurochemistry and can't change mood or behaviour, and genetics doesn't exist and can't explain anything. I wrote quite a lot because I wanted to make it pretty clear that I wasn't saying either of those things.

If your old fashioned TV glitches and you hit it and it works, that doesn't mean it had a percussive imbalance. If you sledgehammer your brain chemistry that can change your mood and behaviour, and that doesn't mean you had a chemical imbalance and need a sledgehammer every week forever. It's the lack of supported good explanation that I'm against, especially after becoming convinced that a lot (not all) depressions and anxieties are addressable with therapy - but not just any therapy with any technique, just like a TV problem can be traced to a bad solder joint or a loose wire or a warped chassis shorting out a wire, but not by just randomly poking wires and replacing components without any training or experience and saying "I tried everything so it must need hitting". Similarly, "genetics" can be a fine explanation which is why I edited Downes Syndrome into my comment, also blue eyes, Trisomy 21, Huntington's Disease, and many others.

> "As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?"

And how do you feel about these quotes I just found on Reddit: "I think my genetics are stopping me from losing weight. I am 25F 5'2 and 145lbs and I have been having the hardest time trying to lose 20 lbs; or "I hate my genetics. I'm lifting 5~6 days a week since october last year, what means almost 10 months of consistent training, but my measureaments and bodyshape still like shit" or "Are my genetics/health screwing me over or am I just shit? r/GuitarQuestions"

Do you think those uses of 'genetics' are good explanations, that the poster should be satisfied with? Explanations that have good predictive power and a clear model of finding other people with the same problem, and suggest what to do next to compensate? Or are they (as I grumble) bad explanations which don't have any predictive power because they don't specify any particular gene or its effects, in much the same way that saying "it's fate"?

> "your solution are just as bad as the ones your are prescribing."

My solution of fix the TV electronics is just as bad as "hit the TV and accept a bad explanation for how that helped"?

>humans evolved in Africa, connected to oceans and trees and tribal living

Human evolved to have no modern medicine, indoor heating or refrigerators.

Arguably specific chemical patterns don't emerge and persist on their own. Basic causality will indicate that something caused that pattern, whether it is a disorder or a traumatic event. Chemical processes are not random. Otherwise, carbon based life forms would have never lasted this long

The neurotransmitter model of mental illness is largely incorrect. It's much more complex than just "Depressives have less serotonin, therefore lets give a reuptake-inhibitor to keep serotonin in the brain".

The creator of the Serotonin hypothesis admitted it was wrong, and he shifted to melatonin's precursor later in his career. The challange with any research in this area is Serotonin and Melatonin both affect biological functions by gradient activity not lock and key receptor models. This pair is how plants and animals respond to seasonal changes which vary year to year. Serotonin is the warm and light lide melatonin is for cool and or dark.

My personal preference is to always suggest getting actual daylight on your retina for 20 min three times a week. Not through glasses, including eyeglasses, but can be through eyelids. That loads transferatin, as in transfer, this loads the enzyme that make serotonin. This then allows the body a better chance to make the intermediate between Serotionin and Melatonin, and is the one believed to help. But the patents have expired so it is like an orphan drug now.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3779905/

Explain the no glasses part to me? I read the study you linked but in there they used opaque glasses.

> Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.

It's not at all clear that chemistry is the root issue. The brain is a synaptic graph that does something. Some graphs can have weird paths that lead to pathologies (maybe bad feedback loops). Chemistry seems like fairly a blunt instrument for bludgeoning a "bad" graph into one that's "better".

Forced habits, like cognitive exercises from psychology, can sometimes rewire the graph by themselves because that's how the brain learns/adapts, but we still don't have a good grasp on how to do this truly effectively in many cases.

That said, the blunt instrument of chemistry can sometimes be useful, particularly if it enhances neuroplasticity, as I think psychedelic research is beginning to show.

Every time I have a yearly physical, my GP will ask if I have feelings of depression.

I know this road leads to SSRIs at the very least, so I always reply in the negative.

The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.

I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.

> I know this road leads to SSRIs at the very least, so I always reply in the negative.

Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.

To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.

N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).

She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".

I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.

Crazy. I hear such wild horror stories with doctors. I'd never return to a doctor like that, sorry you had that experience. Still, this feels like a case where the lesson is "get a new doctor" not "lie to one" but I understand that circumstances can make that a pain.

Likely the office was getting a kickback from the supplier for writing that prescription. This is shockingly common in the US. A straight cash payment is prohibited, but it's easy to work around that legally and provide equipment or "compensate" some other expense.

Agreed. A friend of mine is a primary care doctor, and it's remarkable how often people come in for depression and after examination and labs it turns out their depression is heavily influenced by other issues, especially low testosterone or hypothyroid. A lot more people have issues with these than most people realize. There have also been people he has seen who were reporting depression, often where nearly every anti-depressant had been tried, where getting treatment for ADHD massively improved their case and was life changing. As much as people like to hate on Adderall nowadays, for people with ADHD it is miraculous.

Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.

I am in that case, low testosterone and hashimoto (hypothyroid), ADHD and big Scolioses. Last weeks I am dealing with insomnias, and had to take pills to sleep and it seems my parasympathic system is in alert mode for years, stress, divorce, ex-kid and older kid, etc.. I stopped SSRI after 21 years for 5 months and its probably causing my insomnias, the brain was not used for missing serotonine and brain don't stop thinking, loop, alert mode.

I am doing several blood analysis with a functional doctor and lyme may be around or was in the body, and so many other things. I was thinking I had lucky gut, but seems negative..

I did get my Vit D up to 65 and I seems to be issues with ADH hormone since kid and probably that makes dehydration. It's a fucking nightmare..

I may only see a testosterone replacement as a solution maybe..

>often where nearly every anti-depressant had been tried, where getting treatment for ADHD

This is actually a somewhat difficult diagnosis to make, especially when diagnosing adult ADHD without the user documenting and bringing in a well defined log of their behavior (and possibly another person to point out things they don't know about themselves).

>ADHD is a highly heterogeneous disorder with a significant comorbidity rate.

Is thing that you read about in literature around it. And even more common than that is the comorbidity of all the above symptoms, that is ADHD and depression + more in autism.

There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.

YMMV for sure - I was on an SNRI (Cymbalta) for a few months as an attempt to eliminate nerve pain. It all but destroyed my ability to climax both during and for maybe 6 months after getting off of it.

The brain zaps were also hell if I was even like an hour later than usual to take it

Why do you think SNRIs wouldn't have sexual side effects? They still inhibit the reuptake of serotonin just like SSRIs. That's the part that causes (certain) sexual side effects.

You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:

1.) It's killing my libido 2.) It's too strong

For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.

And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!

Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.

Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.

All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.

> but rather that they're abused by psychiatrists

Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.

>Also, prevention.

Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.

Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.

> The last thing that your doctor wants is giving you pills so you go away

Except for all the doctors who do want just that.

> Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick"

While such patients exist, I don't believe they're a global majority, and the group of patients who want the exact opposite, more time rather than "quick", is the bigger out of the two.

Literally a few comments down from this one:

> N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to). She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".

> I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.

> like if we took sleeping pills every time we had trouble sleeping

Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.

Which knowing the side effects of Ambien is pretty bonkers.

I know zero people that have ever taken Ambien.

https://www.cdc.gov/nchs/products/databriefs/db462.htm

Seems like daily users would be less than 10%.

Yes, it is quite a statistical outlier for an entire family to be using it daily.

something weird is going on there, for sure.

you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.

after being prescribed Mirtazapine, then Trazadone I realized I don't think I've had restful sleep as long as I can remember. I need a sleep study done probably but until that the quality of life from taking something that has virtually no negative side effects for me is insane.

meanwhile people are like "just take magnesium or melatonin lol"

Nobody should take this as medical advice, but from my own experience, nothing has made a bigger difference in my sleep quality than supplementing with magnesium glycinate. I didn't even start taking it for that purpose - I was taking it for something else and quickly noticed that it made the quality of my sleep significantly better. The only side effect from it is that sometimes I have strange dreams (not nightmares or anything, just odd).

Everyone should check with their doctor, but it's an inexpensive supplement and the effects (if any) show up pretty quickly, so IMO it's worth a shot.

I have sleep apnea. Get the study done ASAP. It's a home test, non-invasive. Will change your life if you have it.

Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.

> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.

I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.

I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”

> but rather that they're abused by psychiatrists

Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.

The tl;dr is that our understanding of the brain and mood disorders kind of sucks.

The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.

>people want easy fixes that do not require any change in habits

Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.

The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.

Its easy to say anything. Doing the correct thing is not always easy. I think your last statement is woefully outdated. The current zeitgeist is lack of agency. Its like collectively many of us have shifted from an internal to an external locus of control. This is due to a variety of reasons, a big one of which is the internet empowering people to make themselves feel insignificant due to unhealthy scale. I'd write a book if I continued, but that's the just of it, I suppose.

The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.

> The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo.

^ citation needed

What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?

I believe that is indeed what they meant. The perception of being given a remedy is very powerful indeed, especially for issues ultimately linked to the mind.

That placebos can work should not be seen as undermining the severity or pain of the depression, but rather underline the power of tricking the mind into improvement.

Two papers that might be of interest to people regarding this topic would be Kirsch 2014 and Cipriani 2018.

And yes, agreed with argwhat.

> The hate is (among other points) because they are only arguably, marginally, better than placebo

Only true for some. Inarguably, well-proven false for others.

Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.

> it's more of a "here, take these indefinitely"

And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"

Yeah some people pop a melatonin every night before bed

> I have the impression that's exactly what people do in the USA?

It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.

I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.

Luckily, sertraline was an almost instant cure.

I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.

The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?

I'm not an expert so maybe someone else can clarify further, but in relation to sleep medications I've heard that they should not be used for more than two weeks, or they can permanently fuck up your sleep cycle.

They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.

At least that's how it was a while ago. Maybe the situation has improved.

I used ambien for sleep and provigil for mindfullness (the go/no go packets) during long deployments in the military and it took me years to get back to anything normal after leaving the Army. These are very powerful medications.

> At least that's how it was a while ago. Maybe the situation has improved.

Fortunately it has. Orexin antagonists don't cause dependency and provide high-quality ("natural") sleep.

Bit off-topic, but melatonin taken at right doses appears to work very well. (commonly prescribed doses are 10-30x too much and likely cause tolerance). See the post https://slatestarcodex.com/2018/07/10/melatonin-much-more-th...

I’ve heard this before that common doses are unnecessarily high but why is that? Patents?

Rather, lack of. Melatonin is over-the-counter, generic, badly understood by the people taking it and dosed according to personal preference which means marketing it is all abouy big numbers. Bigger number on package = more sales.

They’re considered dietary supplements and not medicine, so they’re not meaningfully regulated in the way meds are.

> why is that

Why buy 1mg pill when you can buy 100mg pill?

Even funnier is that often 0.25mg or 0.5mg is closer to the correct dose, and those sizes tend to be hard to find.

There actually is a condition that calls for extremely high (100mg+ doses), but it is a very rare thing, no one should ever consider that much without instruction from a doctor. But you'll find it right next to the normal <=5mg doses without any explanation.

The Natrol liquid isn't usually too hard to track down. They advertise it as 1 mg or 2.5 mg, but it's the same stuff, the bottle just direct you to take 4 or 10 mL respectively.

So 1ml (20 drops) would yeild an average dose of .25mg in that form.

The help aiding sleep is only one function for melatonin. The reason for higher suggested doses is due to its anti-oxident function. From personal experience melatonin needs to be paired with vitamin e to really clear out over night. I take vitamin e as I get into bed right before I take a melatonin sublingual. Another benefit of melatonin is that it upregulates our insulin receptors.

"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"

Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.

> The hate on antidepressants is not because they're not effective,

But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.

The "hate" on antidepressants is mostly from a place of "The kids are taking pills for things that aren't diseases and just need to get out more" and other stupid takes about how "back in my day we didn't have this much mental illness", which is why the hate is maintained even for things like ADHD medications which are so thoroughly proven scientifically that they are one of the best proven treatments humans have access to for any disease.

Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.

The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.

We just don't really have much in terms of better treatments because we know so damn little about depression.

The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.

Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.

Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".

>The "hate" is not based in science

The lingering roots of Calvinism in the US cause us all kinds of problems.

"You were born broken because god made you that way, don't make yourself better, and hurry up and die" permeates huge parts of our culture. It's why lots of other cultures look at us and what we do with relative confusion.

Yeah in Holland too. I deeply despise our Calvinist roots. It's so depressing.

"Imagine if we took insulin every time our pancreas failed to properly process sugar."

Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).

> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.

I wish people would stop saying this.

Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.

If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.

And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.

No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).

I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.

(I also added a small dose of Buspar to help with the sexual side-effects.)

If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.

For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.

I was diagnosed a while back with a chronic neurological disorder. One that has a heavy effect on my mood and can conversely be triggered by my mood. The underlying cause is scientifically proven to be physiological. I lack a specific neurotransmitter due to inactive cells in my hypothalamus.

For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).

While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.

I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.

The easiest way to deal with horrible trauma is to prevent said trauma in the next generation.

What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.

And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.

I don't know, people really suck.

> I just realised I have the impression that's exactly what people do in the USA?

How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.

We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.

Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.

It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.

It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.

For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.

Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.

Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.

I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.

> I’m just always astonished at “have you tried not being depressed?”

There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"

It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.

Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.

>in the US I think because of our hyper individualist culture.

Calvinism.

There's been a number of papers written about how pervasive Calvinistic ideas are in the medical community. This tracks with the New England area of the US pumped out the most doctors while medicine was 'growing up', and protestant christianity was the most common form there. When you view the creation of the US medical system with that view many of our screwed up systems make sense. A lack of willpower is a failure of man to be in touch with god, and not a problem a doctor should solve.

That was my experience with ADHD. In retrospect, I clearly struggled with it my entire life, with it starting to cause problems around middle school age. I started getting treatment a couple years ago and it was like someone flipped a light switch. Wait, this is what it's like for everyone else? They can just decide to start doing a necessary thing before it becomes a crisis?!

In before "of course things are easier when you're taking stimulants!", which is another dumb thing I hear too often. I feel basically nothing from taking Adderall, and not in the least stimulated or more alert or more awake or anything. I can just concentrate on boring things afterward.

What is that they say, if you have ADHD then ADHD medication doesn't act like a stimulant in the same way it affects non ADHD people.

It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.

With that said, does anywhere have enough specialists to cover as many sessions as would be needed for as many people would seem to need it?

yep and it works too.

I've been off and on them for years, usually my doctors seem to prefer if I'm off them and indeed treat them more as short term "stabilizers" so that my brain has a bit more space to deal with things.

This has been true across two countries (Scotland, Hong Kong) and multiple doctors, with a third country's (China) doctor suggesting I try out sleeping tablets for a few weeks - and only giving me a very limited supply of them - to try out instead.

I wonder if the "here take these" is a predominantly American phenomenon due to the weird incentives around health care costs (I'm being genuine here - maybe it's predominant in other countries too, I honestly don't know!)

“God, I see what you’re doing for others, and I want that for me.”

I had a very similar experience, except it killed my libido, so I chose to endure the suffering of Winter rather than live with emotional numbness.

Still, I strongly recommend it for people flirting with the abyss. It was life-changing for me while I was raising an autistic 2yo during the pandemic.

> I had a very similar experience, except it killed my libido

Did you, as well as the other people seconding this, have any libido left in the first place? I got on Sertraline because I was depressed, and it actually brought my libido back, by virtue of just bringing me back to a better emotional baseline.

All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.

> All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.

Wouldn't a "NOOP" be the opposite of a "Nope"?

Sorry for the pedantry, but this forum seems an appropriate place for this.

That's the point, killing an inexistent libido is a no-op

Ah, thanks for explaining!

I have switched to lamotrigin, it helps to balance mood as I had bad mood in months with less sunshine. Lamotrigin is not an antidepressant, previously it was used for epilepsy stabilisation but now it is prescribed for mood swings. (This is not a medical advice.)

It is still prescribed for epilepsy. I am actually hoping for some medication stories if anyone/someone they know has ADHD and epilepsy. It's for a juvenile, but your stories can be for any age. Or pointers to any resources about the combo.

Villazodone was created partly to address that. Once I switched to that, I had no libido-related issues again.

I have no experience about antidepressants myself so please excuse my stupid question.

When I hear people say "it killed my libido" I always think about the fact that hyper-sexuality can be a trauma response, and if your body is healing the hyper-sexuality is most likely also reduced.

It's like when you have a disease and then read the side effects of a medication and notice that a lot of the side effects are basically also something that can happen when your overall condition is improving but still some people report them as adverse effects and then these are added as side effects to the package label.

For example you take antibiotics but bacteria can have toxins in their body, and when the bacteria disintegrate you get more sick from the released toxins. It's called the Herxheimer effect: https://en.wikipedia.org/wiki/Jarisch%E2%80%93Herxheimer_rea...

When I started methyl-B12 supplementation I also had inflammation in sinuses for weeks but it was just from my immune system starting up again and being able to attack long-standing inflammation. Someone else would've put "fever", "headache" and "stuffed nose" onto the side effects medication label of methyl-B12.

Stupid question - why do you keep suggesting that having a libido equals hypersexuality?

Is this your trauma speaking, or do you automatically associate any sexual needs with a pathology?

You've done it twice in this thread alone.

I didn't read their comment as insinuating libido is 1:1 to hyper-sexuality. I read it as: "consider if you have a libido, and depression, you may also be hyper sexually."

The situation is PersonA has determined they need an anti-depressant. So one thing is 'wrong.' It stands to reason that they may be using sex as a painkilling mechanism. After all, sex feels great. When the anti-depressant kicks in, the body may determine it doesn't have to use that painkilling method anymore, hence, the decreased libido. It doesn't mean having a libido is bad, it means that the person potentially was overdriving it.

Thanks for reframing it. That's what I was trying to say.

I'm not whom you asked. But it's a resonable association for some cases.

But I understand that it would have been better to ask and not associate because it's a fraction of the cases.

If I told you that I often have a fire in my fireplace, it would be incredibly strange if you suggested that pyromania can be a trauma response.

Either OP is confused about what libido means, or has some kind of heavy shame around sexuality.

Yeah, I agree with your sentiment.

Sex is awesome and liberating! Should be anything but shamed.

That is not what this was. You have been firing your fireplace, now you put on a sweater and you suddenly don't want to fire so much. Maybe that's not bad, but a return to normal. That was the proposition. Is it true, who knows. Case by case question.

> except it killed my libido

Similar experience. Apparently pretty much ubiquitous with SSRIs

i'm sorry this happened to you, this was of the reasons i held off trying them for so long. ubiquitous indeed, also on this front I got lucky...

please people, take my post for what it is: anecdotal evidence. SSRIs can basically give you any possible side effect, including destroying your libido.

Stupid question: Did it really kill your libido or just reduced/removed the hyper-sexuality which could very well be a coping mechanism for past trauma?

I don't relate at all to the latter part of your question, so be process of elimination it must be the former :)

Libido can be supplemented with Wellbutrin. Works great, even better than before.

Speaking from personal experience, people react to different SSRIs differently. I took a popular one that had significant side effects without a whole lot of benefit, and so I stopped it and didn't try anything else for 10 years. Then I spoke to a psychiatric nurse practitioner who suggested trying several others until we found something that worked for me. I had (incorrectly) assumed that if you had e.g. sexual side effects from one SSRI, that you'd have them for all. That is not the case.

I spent $300 on high lumen output light bulbs. 28 200W equivalent LED bulbs and 2 LED corn bulbs. Just a TON of light. Depending on severity either run it all day (late January and February tend to be the worst months), but even 10 minutes in the morning helps substantially. Just a lot of light. You can get hung up on high CRI and full spectrum but just do it badly first, then if it works worry about perfecting the setup. I just kept buying more bulbs and as I bought, I felt better and better.

Edit: this was the blog that gave me the idea, it comes up on hacker news a lot. https://www.benkuhn.net/lux/

SSRIs saved my life. No exaggeration. They might be overprescribed, only effective is some individuals, and they certainly have their share of side effects, but they're still the gold standard treatment for clinical depression and anxiety.

I still think you should have tried eating a banana first.

Same for me with buproprion. Night and day difference. Made me wonder how different my life would be if I had been diagnosed appropriately when I was a kid.

As someone who tried citalopram escitalopram and sertraline, along with venlaflaxine and fluvoximine, I would suggest doing a pharmacological test for psychiatric medications.

I am an intermediate metabolized for the first three and the ones I was on most long. It did not suit me and made my orgasms go from ‘wtf’ to ‘that’s it?’ And they are still not normal 2 years after discontinuation.

I am still depressed and anxious to the point of serious consideration of these medicines to save myself, but you can save yourself the experimentation by doing a simple test and avoiding those medicines.

Anxiety depression panic attacks are something I wish more people studied along with sexual health.

look my other comment for niacin

That’s B3 for nerve and dna repair if I understand correctly.

I notice a difference after eating non vegetarian food but since I also have IBS, my absorption can be a hit or miss.

A very balanced and nutrient rich diet with good sleep and exercise is the start to mental health recovery. People often forget how important all this is.

for ibs: no coffee, milk (any milk), vegetable oils, wheats, soy, or anything from USA :D and no sugar or alco then slippery elm and probiotics, d-vitamin + c-vitamin. fasting, intermediate is also helpful. add berries and yes, beef meat and lots of greens. with strict diet ibs goes better.

If a drug has an 1% chance of 100% effect, it will look pretty weak in those studies.

IMO it's pretty clear that depression is a symptom of many independent issues, so it's really lame that we don't have a more accurate way of diagnosing it.

The goal is to tackle it in every way. The medicines are supposed to be supportive and not the solution. More often than not people treat it as a solution.

Thats why they are eventually tapered and discontinued once you are able to be on your own.

I experienced this but ended up getting off of them after developing some back/hip issues but I didn’t think it was related, it wasn’t until I quit the citalopram that my shoulders were suddenly relaxed and the hip “looseness” or constant need to be adjusted back into place went away, like everything tightened back up, it is really strange, then I looked up how SSRIs can impact this and even bone healing, decided I couldn’t risk my body falling apart.

If it is SAD have you tried bright daylight balanced lighting?

Yeah, I have an extremely bright lamp designed to tread SAD that I sit, or well used to sit, in front of every morning. Daylight responsive led strip in my home office. And a pair of glasses with blue LEDs for on the go. It did... 10%? of what citalopram eventually did for me.

Thanks for the reply. Does the citalopram completely obviate the need for the extra lighting or do you find there is still a benefit to having the daylight lighting too?

I've stopped caring for my various lamps. I turn on the bright panel out of habit while working at my desk... but I don't feel "drawn" to it as before. I'd, for example, set my phone to the highest brightness in a dark room to motivate myself to get out of bed, or at least get to the light switch. Now I don't care, I just get up.

And I can look at the dark world outside the kitchen windows in the morning and not feel oppressed. It's just a lack of light, no menacing presence.

Have you tried more light? Like, a lot more light? Like, getting a light meter and aiming for 10-20,000 lux in your room? This blog was a good start for me.

https://www.benkuhn.net/lux/

Yah. Measuring the effects of these drugs with a single effect size number is ridiculous. They work exceptionally well for some people (myself included). It seems as well that SSRIs work much more reliably on anxiety disorders than on depression.

Getting on them can be a ball ache (or entirely painless; escitalopram was easy on and easy off, Wellbutrin was a nightmare to get on, but also easy off), but entirely worth a shot for anyone symptomatic.

If you spend a lot of time among some folks or talk a lot to LLMs, you are guaranteed to pick up manners, manners of speech, ways of thinking, behaviors (where applicable) ...

Me and my brother just can't stop mixing English and German when we talk to each other. But we don't or barely do it when we talk to others.

When I learned about code, logic, math, I started talking and thinking in different ways and from different and towards different perspectives.

The more I read, which I haven't done in a long long while, the more massive and vast the info I pack into a few sentences becomes.

The more I draw or play the guitar or work on game mechanics and story design or dialogues, the more annoying my speech and manners become but to my environment, that also means that I become "more" social and actually somewhat likeable and bearable.

You smell like Non-evidence based arrogance. I was always surrounded by people who smelled like that. But they are good little copypasta soldiers who follow trends and mutually assure that they don't go completely off the rails. But if one does, they leave him on his real or imaginary battlefield. Nobody wants to evolve anymore. It hurts some people just a little too much, I guess. They'd rather poison others and have their code deleted before getting to live a second life. I hope I could get you on edge a little. I'm just fucking around. But you will probably think something the likes of ... "there's always some truth to it when ..."

It does not, at all. Forming that judgment because of “Enter X” is ridiculous. I recognize my friend Claude in disguise all the time on HN and this is not one of those cases.

The OP just writes well. Also an llm is unlikely to write "thru"

See, I'm all for calling out LLM spam, but because of people like you who have a terrible calibration and make false accusations against obviously human generated messages, I get all manners of people criticising me for pointing out things I know for sure are actually LLM-generated. You really think "Enter citalopram" as a singular instance you point out weights this more towards LLM-generated than "thru" and "reheated cat shit", among the entire tone of the message, weights it towards human-generated? Your heuristics are wildly miscalibrated.

Your sense of smell is not something to write home about.

Yes only I wrote it while taking a shit. Sorry man.

A kinda strained endeavor, I must say. It's not bad but the SSRI side effects make continuous hydration obviously important. A small price to pay.

How would you prove that?

They don't, hence the suspicion instead of a definite assertion. And suspicions are easy, because what are the consequences if it's false? None.

Anyway your comment smells AI generated, I can tell from some of the pixels and seeing quite a few shoops in my time.

I don't need to "prove it", because all I have to do is link this:

https://arxiv.org/abs/2409.01754

https://arxiv.org/abs/2508.01491

https://aclanthology.org/2025.acl-short.47/

https://arxiv.org/abs/2506.06166

https://en.wikipedia.org/wiki/Wikipedia:Signs_of_AI_writing

https://osf.io/preprints/psyarxiv/wzveh_v1

https://arxiv.org/abs/2506.08872

https://aclanthology.org/2025.findings-acl.987/

https://aclanthology.org/2025.coling-main.426/

https://aclanthology.org/2025.iwsds-1.37/

https://www.medrxiv.org/content/10.1101/2024.05.14.24307373v...

https://journals.sagepub.com/doi/full/10.1177/21522715251379...

https://arxiv.org/abs/2506.21817

Either they used an LLM to write part of it, or the linguistic mind virus infected them and now they speak a little bit like an LLM.

Relevant excerpt from your own wiki guideline:

"Do not rely too much on your own judgment. [...] if you are an expert user of LLMs and you tag 10 pages as being AI-generated, you've probably falsely accused one editor."

Never accuse people of LLM writing based on short comments, your false positive rate is invariably going to be way too high to be acceptable given the very limited material.

It's just not worth it: Even if you correctly accuse 9/10 times, you are being toxic to that false positive case for basically no gain.

I had disk issues in my lumbar spine that caused nearly unbearable pain and terrible quality of life. Tried everything: PT, OTC painkillers, epidurals, massage, nothing worked. Was prescribed pragabalin and duloxotine. Duloxotine is an SNRI that also treats nerve pain. That combination helped some but I was sleeping 11+ hours per day and generally felt like my head was in a complete fog, was pretty much useless with work. I had been trying to avoid surgery but finally had 2 procedures in 2024 that helped immensely. Weaning off those 2 drugs was no fun: sweating constantly, anxious, headaches for about 2 weeks. Extremely happy I went the surgery route and stopped those meds. I can't imagine living day to day feeling like that.

Duloxetine was indeed a beast to get off of. It got so bad that I would open the capsules and count the number of beads to taper as slowly as possible. It was hell

Tangent… but for sweaty feet, try a ski boot dryer!

You can get them for $50… they dry out my shoes which makes them last a lot longer before they get so smelly I have to throw them away. Plus, who doesn’t like warm shoes in the morning?

That, and there are some creams called Sweat Block or whatever you can rub on your feet which reduce sweating. Those work as well.

Also try wearing merino wool socks. It seems counterintuitive to put wool on your sweaty feet, but they're quite comfortable and they help you avoid that "clammy feet" feeling when you are sweating in cotton socks. They also don't develop odor the way that cotton does.

You can also 3D print them: https://www.printables.com/model/194340-60mm-radial-fan-boot...

Imaging the number of people that this comment could inspire to get on SSRIs lol

I'm not saying it's a bad.

But I'm also saying there are no magic pills...!

They've been losing ground to placebo in more recent research.

Plus, most of the more serious side effects take a lot more time to manifest than the typical length any given patient remained in the older clinical trials that secured FDA approval and grounded the official manufacturer literature.

I am glad we have these tools, but I suspect they are vastly overused, and patients not well informed.

I’m glad to hear that. Another frame is that your depression turned out to be “math hard” rather than bodybuilding hard [0]. Your disciplined, methodical approaches were steady applications of effort, whereas what you actually needed was easy to implement but hard to envision.

[0] https://www.alexcrompton.com/blog/2017/05/26/hard-is-not-def...

How do you know it was the SSRI?

To cherry-pick a quote from a review of SSRI studies:

>the magnitude of symptom reduction was about 40% with antidepressants and about 30% with placebo.

That tells me that antidepressants have some effectiveness, but placebos work shockingly well. You can give someone a sugar pill with no medical properties whatsoever, and a good portion of people will recover, likely crediting the pill for their recovery.

Hi, author of the blog post here! Thank you for sharing your experience with antidepressants, I'm really glad it worked for you & made your life better.

I did mention the following at the end of the "antidepressants" section, but reading your comment convinced me to move it further up. The intro now reads:

> The "standardised effect size" of antidepressants on depression, vs placebo, is around 0.4. (On average; some people respond much better or much worse.)

Also, I wasn't expecting my article to do well on Hacker News; thank you everyone for the comments & critiques! I'll edit the blog post as I go along, to refine it in response to your comments.

My personerino let me be ridiculous and fawn a bit, and tell you that you're one of my internet heroes.

Don't take it as criticism, more of a personal take on figuring out what antidepressants do for me. Furthermore, since posting that parent comment I've converted my vit. D dose to IUs and I realised i'm only taking 800 IUs daily. So a thank you for clueing me in on that, and who knows what happens if I up that. Maybe you were right all along and all i DID need was a heroic dose of vitamin D. (... thats what she said)

Aw, thank you for your kind words! I hope the extra D helps! ^_^

Thank you for the blog post! I live in New England and always had the winter blues, always just assumed it was because of the weather but never acted on it.

About a week ago, there was a reddit post claiming it's actually geographically impossible for anyone where I live to produce enough Vitamin D naturally from the sun alone, due to the shorter days and lower angles throughout the day. I had no idea.

Thank you! I relate; I live in Montréal, close to New England, with similar climate. The current UV Index for Montréal is... 0. And the current UV Index for Boston is... 0.6. (1.6 later today)

I can't find a rigorous academic source right now, but the top web results all say we need at least UV Index 3 for our skin to be able to make enough Vitamin D. I guess summer may work for us, in the Montreal/New England area, but other than that, yeah, you and I will need to get Vitamin D from diet and/or supplements. And fish is expensive, so supplements it is.

> I won the SSRI lottery I guess,

From reading internet comments you’d think so, but your experience is more typical than anything.

Depression is deceptively common. As a consequence, SSRI use over a lifetime is also more common than most would assume. Any drug will come with negative side effects for some portion of its users. Multiply that by the high number of people who have ever taken an SSRI and it starts to become obvious why there are so many Internet anecdotes about SSRIs not working.

Meanwhile, most people who take SSRIs successfully aren’t going around and advertising the fact that they’re on psychiatric medications. There is less stigma now than there was in the past, but it’s still not something most people like to broadcast to the world. For patients on long term SSRIs in stable states, the SSRI is just a routine thing they take in the background and don’t really think about. There’s no reason for it to come up in conversation.

To add to this discussion as someone who had above experience this winter, after (literally) years of mood fluctuations, fatigue and brain fog.

I have started taking SSRI after a harder-than-usual body collapse, and after no matter what I did my mood hasn't improved for a month. Regular running, meditating, writing, crafting, coding etc were my antidote to my mood swings but this time it didn't work. Started taking SSRI and continue doing all this things, and I was reborn.

My therapist said that a big chunk of why i am feeling better is also because I kept doing things that are good for me. That she sees with a lot of her patients that they think a pill will magically change the situation. It doesn't work on itself, you need to show up and do things that release serotonin in your body.

But seriously, unbelievable, years of frustration and friction in my life disappeared and I have never felt better.

Why were you getting body collapses?

> Depression is deceptively common

I didn't even know I had it, but when I was diagnosed, my psychiatrist was very concerned and made a point of encouraging me to keep in touch, making sure I worked through things and engaged with the problem. I initially thought something like "I'm fine, just a little down here and there, I wonder if this person is inventing work for themselves?"

Same with anxiety. I would have told you something like "I'm not an anxious person at all. I don't even know what that's like, though I can sympathize with people who suffer with it". As it turned out, I was suffering pretty severe anxiety. In retrospect it's as clear as day, but at the time it was just... The way life was.

The thing is, all of my assessments remarked that I demonstrated relatively high self awareness and openness. My experience being diagnosed with ADHD and depression made me seriously concerned for people who 1) can't afford this process and support, and 2) will just continue to grind like I was, living half-dead without knowing it can be any other way.

I suspect there are a ton of these people—I think I notice them quite often—and I was arguably accidentally pulled from that stupor and would likely still be there, unaware, if it weren't for a chance encounter that caused me to think slightly differently about the possibility of having ADHD.

Same I am in outstanding physical health and my diet / exercise is excellent. Taking Lexipro has made a massive improvement on my emotional bandwidth. I take vitamin D / fish oil and bits of other supplements. At least for me no question this medication even at a 10mg dose has made a major positive impact.

Bessel van der Kolk also mentions in his excellent book "The Body keeps the Score" that the effect of antidepressants is correlated with the source of the depression. If the depression is a comorbidity from early childhood trauma then antidepressants are limited due to trauma-related reshaping of how the brain is organized. Cases like yours or those that a related to traumatic experiences as an adult are more the result of a shallow neurochemical imbalance which antidepressants are able to impact beneficially.

>> "The Body Keeps The Score"

Such a great book. Highly recommended.

I'm guessing you can afford spending $300 on light therapy glasses.

Disclaimer: I'm not a doctor, but saw 4 seasons of dr. House. Moreover, few hours of Huberman Lab on sleep and light and most importantly, this episode of Additude Mag Podcast on curing SAD and ADHD day-rhytm shifting with light glasses: https://www.youtube.com/watch?v=fu4mLgkNc6I

What happens in the seasonal affective disorder season is the sunlight pattern diverges from 6-18 that we evolved with. Without daily reminder of getting enough sun (or sun-like) light at the 6 o'clock⁰, your body clock will drift.

It can start by feeling groggy instead of refreshed in the morning, even if you've slept enough. And can escalate into loosing the will to do anything or even live.

No wonder. You're still an animal. You need to be fed, put to bed, etc. at a specific time. If you try to make your body sleep during the day, and eat and work during what body expects to be night, you won't really sleep and won't really live/work. Enough of not really sleeping and not really living - you mess up your body, your gut biome, your hormonal balance and your brain chemistry. You kind of should get depressed when you do it.

You can steer your body clock with light. Most of us do it, by exposing ourselves to strong (strong enough it won't matter if it includes blue wavelength or not).

But you can do it consciously (and in a way good for you) by putting on light therapy glasses (I'm using Lumiere 3¹, and they are not the only ones, find your own) at 6⁰ everyday, or right after you wake up if you're trying to readjust your rhythm. Or if you have time and want to save $200, use a stationary lamp and just sit in front of it doing nothing. I don't have the time. When readjusting, small doses of melatonin (0.5mg) 1h before sleep will accelerate body clock shift.

But don't listen to me, if you have SAD, you should really listen to that ADHD experts episode.

I feel for you, struggling with that stuff for a long time. Vit D, fish oil (lot of). All lights at home set to reduce intensity after 18. Strict going to bed routine. Still sleep poorly once in a while, but can do things in winter again. Hope it will help :)

0: choose whatever suits you. With small doses of melatonin and discipline in using light glasses you can even flip day and night. Just stay consistent, good farmer always feeds his cows at the same time.

1: at the time of buying ( fall '25 ) they were cheapest and best overall in norway. Solid build, ok battery, can have them on during yoga using attached rubbers and kind of can have them over glasses. Mine are very large and have blue light filter, but I manage 20min without eyeglasses. Medical certificate. Few leds, holo strip, battery and some plastic - my inner Scrooge says it's not worth $285, but everything else was worse and more expensive.

I just spent $300 on LED light bulbs. Especially if you have an older house the sockets are all wired up for incandescents so you can just split the socket and run 7 bulbs per socket, I have 30 light bulbs, including two 200W corn bulbs and the rest are “100-200W equivalent”

Re "citalopram" and "SSRI lottery I guess"...in fact, citalopram is not a true SSRI and in fact no SSRI is only an SSRI as they also on, at increasing doses, many other neurotransmitters like norepinephprine and Muscarinic acetylcholine receptors.

However, citalopram specifically has a big effect on the histaminegma the sigma-1 receptor. I will focus on the sigma-1 receptor:

https://www.sciencedirect.com/science/article/pii/S134786131...

Never heard of it? Yeah, don't be ashamed, it is the biggest secret in depression. In fact they are finding that many "SSRIs" are sigma-1 agonists, even prozac.

https://www.frontiersin.org/files/Articles/1691987/fnins-19-...

It tunrs out that Sigma receptors modulate glutamatergic dysfunction in depression, and glutamate, being excitatory, well, you can. make your assumptions from there.

https://www.frontiersin.org/journals/neuroscience/articles/1...

It seems the main function of the Sigma-1 receptor is Calcium release. And calcium ion channels are one of the most studies ion channels in mood disorders. By increasing calcium release you increase neuronal activity, hence, the uplifted mood.

It is too bad that the sigma-1 receptor is just starting to be studied and there is limited evidence of how omega-3 and Vitamin D effect it. But I do know that Vitamin D has a huge effect on SLC6A4 (SERT).

https://www.nature.com/articles/s41598-020-79388-7

I have Schizoaffective Disorder Bipolar Type (disabled) and have been on no less than 14 types of meds. I knwo how they work better than my psychiatrists, which I why I no longer take them. I also know my genetics which gave me clues to what is happening in my body. Now I eat a mostly seafood diet and my needs for meds has mostly vanished. I am still an odd old fellow, but at least I am not ranting in the streets or trying to kill myself anymore.

Meds saved my life, but a diet high in Omega 3, D, and a bunch of other things has removed so much suffering from my life, more than any medication has.

(Also, if you want to get into the weeds of depression, you might wat to look at ATP and depression https://onlinelibrary.wiley.com/doi/full/10.1111/cns.14536)

have u ever tried niacin?

Yes. Made me manic. You know we make niacin in our own bodies, from tryptophan, down the kynurenine pathway. Sine many of the enzymes that are in this pathway need B6 and B2, being low in these may lower endogenous niacin in the body.

https://www.researchgate.net/publication/353319033/figure/fi...

Many people I know, when tested, were low in B6. That is more important to me than niacin.

For others who want to try this, taking too much B6 is associated with nerve damage - https://en.wikipedia.org/wiki/Megavitamin-B6_syndrome

From your link: "The common supplemental form of vitamin B6, pyridoxine, is similar to pyridine, which can be neurotoxic."

Vitamin B6 in p5p form is cheap and widely available alternative.

The things that keep me away from SSRIs are the potential for addiction and not being able to take psychedelics.

I had a friend on SSRIs not tell us they were on them when they hit a DMT vape pen at a party years ago and they got serotonin syndrome. Had I known I would have warned them not to.

It's more "dependency" than "addiction". No one's waking up jones-ing for another hit of their SSRI. Dependency works well because some people are dependent on it like I am dependent on glasses/contacts.

Yeah, that's fair, there's not really a loss of control so dependency is probably the better term. Still, if you go off of them I've seen people get rocked with physical symptoms. I really try to avoid anything that would have such an affect on me physically.

Whatever the word, getting off of them is not fun. It took 6 months after getting of Paxil to stop feeling like I was being dropped down an elevator shaft at random times day and night.

> This just goes to show that for me, they're extremely effective.

I am not so convinced. Perhaps your case was simpler, but people can feel chronic depression. They may take some drugs to modify that, but what if the external factors won't change? You can see this issue for some people who have a disease that only gets progressively worse. I think we can not unify all this as "dislike on antidepressants" as a one-size-fits-all formula.

I had pretty much the same reaction after two days of taking it.

Took a while longer to get the dose right so that my anxiety also mostly disappeared, but the difference in quality of life it made for me is hard to put into words.

Have you tried SAD lamp light therapy? But not those lamps you get on amazon or other marketed SAD lamps, those are a scam. Just buy a 2 floodlights that are pretty powerful, say 100 watt each. Works like a charm. 15-30 mins a day its all it takes

As someone that falls on the side of “depression is real and antidepressants can help” it is very clear that there are people in this thread that need to hold their tongues because they know not of what they speak. (Not you OP)

There are some forms of depression that you cannot think or act your way out of. If you haven’t experienced that, I promise that you do not understand what it is like. You cannot really understand unless you have experienced it. Your opinion on it is irrelevant, and frequently offensive.

The same is true for people that say that antidepressants are mostly placebo. They are not. When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Yes, I understand that other therapies are also effective, and that some people are non-responsive to some drugs.

Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.

> The same is true for people that say that antidepressants are mostly placebo. They are not.

In fairness, anti-depressants are a lot of drugs. The article gives a list. 23 of them seemed to be better than placebo, 19 of them were much less clear.

> When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Placebos can also save people's lives.

I was incapable of the compassion you're talking about until I had a bad shroom trip and felt some horrible, hard-to-describe anxiety the next morning. It was some of the worst hours of my life until my serotonin system rebalanced itself.

I'm not saying it's the same thing as depression or regular anxiety, but it gave me tremendous perspective on how bad these conditions can be and you just don't have the ability to "shake it off" when things are unbalanced.

Maybe that's how my wife feels when she's off the meds. Shit. Now imagine having a douchebag by your side second-guessing your pain. Never again.

> Maybe that’s how my wife feels

The good thing is it isn’t necessary to know how someone else feels to have compassion.:)

It’s enough to accept you don’t understand the other person‘s thought process and stop trying to tell them what they are thinking. You don’t need to fix things, you just need to listen and not make them justify or explain themselves to you.

Doing nothing is better than doing the wrong thing.

This comes from my own personal experience. I can’t relate to people on an emotional level. Every relationship is processed with deliberate, logical action. If I love a friend, I need to figure out what would change their internal state so they can experience that love.

From the outside, this looks like I can relate on an emotional level.

Precisely. That's what I took from the experience as well. If that's so hard and I had no idea about it until now, maybe there are other things that I don't know, and some that I will never learn, and I should tread lightly.

Lexapro saved my life

Lexapro made me feel like I was randomly being dropped down an elevator shaft for 6 months after I stopped taking it. I’m glad it worked for you, and am not minimizing that, but these medications have a side effects profile a mile long and should be a therapy of last resort in my opinion.

The problem with antidepressants are that while we know, more or less, what they do, we don't know why they work for some and not for others. Escitalopram (Lexapro) was a vast improvement for me over Citalopram. Then it plateaued and a year later, left me anhedonic. Tried an SNRI that would give me brain zaps every day a few hours before my next dose and it was horrendous to quit using. It also messed with my ability to meditate for a long while. Basically, I could put myself in a mental state that would trigger the same kind of painful brain zaps that withdrawal from the SNRI caused.

They have a half life and you cannot stop taking them cold turkey without these symptoms, your psychiatrist should help you ween off of it slowly.

At the time I was unemployed and didn’t have a car, not much the psychiatrist could do about my “dirt pooritis” symptoms.

I can't go so far as to say it saved my life, but I'm part of that cohort of 10% of men who develop postpartum depression. Taking a small dosage of Lexapro had zero side effects for me and helped me deal with not just the anxiety and depression I was experiencing but also a lot of pre-existing anxious behavior that I didn't even realize was abnormal.

Huge quality of life improvement. 10/10 would medicate again.

A: The same is true for people that say that antidepressants are mostly placebo. They are not.

B: When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Are placebos unable to save lives?

Not claiming antidepressants are or are not mostly placebo, and don't mean to minimize the pain of depression in anyway. I just don't think whether or not they saved a person's life is an indication either way. The placebo effect is real, right? As in the subject actually gets better after taking it.

> Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.

This is the internet, friend. I wish you the best, but maybe don't put too much hope into that one. I think you'll have better luck cultivating the ability to be comfortable having your own beliefs while others have different (possibly wrong!) ones.

When you do this, you're just accusing people of having no real evaluative power about their own experience. It's pointless, and it's not really an opinion.

Placebo-controlled RCTs show that some people react well to antidepressants with major variation from person to person.

Maybe I wasn't being clear, since I didn't mean to accuse anyone of anything.

I'm not disputing that someone had the genuine experience of antidepressants saving their life. I'm asking if that precludes antidepressants acting as a placebo.

In other words both things can be true: antidepressants saved someone's life and antidepressants can act as placebo (even in the case where they saved someone's life). And notice I'm saying "can be true". I'm not saying they are true, cause I have no idea.

This is a logic question, not some kind of moral attack.

There are indeed some form of serious depression that are non-responsive to psychotherapy alone. Those are however not the norm. Dr. David D Burns, practising psychiatrist and author of the book Feeling Good: The New Mood Therapy has written a whole chapter in it on the appropriate use case and effectiveness of anti-depressants today. (If you are considering using anti-depressants, I urge everyone to get the latest revision of his book and read that chapter). He believes anti-depressant has its use during treatment but also shares studies that suggest modern psychotherapy, like Cognitive Therapy which he advocates, has now begun to surpass the effectiveness of anti-depressants in "curing" depression in the long-term.

A particular point he makes about depression in it is insightful: Although depression is conventionally viewed as a medical illness, research studies indicate that genetic influences appear to account for only about 16% of depression. For many individuals, life influences appear to be the most important causes.

As a counterpoint, I experienced such severe negative symptoms after taking SSRIs that I had to be hospitalized for months. Medical treatment is not without its risks. I would always advise trying NPIs before drugs.

I don't in any way mean to discount adverse affects, or negative experiences. Those are just as valuable points. People should be aware of the risks when they take any pharmaceutical, and there are doctors who will happily prescribe these drugs without educating the patient or themselves about downsides and alternatives.

My point is that a lot of the commenters here are saying some variation of "have you tried being happier?" and "these drugs do nothing". Both of which are absurd to the point of offensiveness to people who have gone through it, in the same way that it would be absurd (and offensive) to claim that these drugs have no possible downsides and a negative reaction is placebo.

If only I knew what an NPI was.

Non pharmaceutical intevention

The placebo effect is a statistical reporting effect. Not a physical effect.

Somaticizers absolutely will change their behavior in response to a placebo.

Thank you for saying this, I wholeheartedly agree. Antidepressants have an excessively bad reputation.

I'm sure they have their problems too on occasion, but for me the decision to start taking Escitalopram was one of the best things I've ever done.

The side effects were totally negligible compared to the benefits.

I've stopped taking it a year ago or so and... it's basically cured me.

I'm not saying antidepressant are a literal pharmaceutical cure for depression, but in my case it simply put me in a position mentally to change habits and patterns of thinking in a sustainable way.

My only regret is not doing this 10 years earlier; the poor reputation contributed to that.

It takes a 10 min talk with a doctor to get antidepressants around here. Perhaps a test which looks like multiple choice score of symptoms with some weights.

I had an old gf receive two different drugs each with terrible side effects. To me it looked as poison.

I decided that I would rather hurt myself myself than fuck with my brain chemistry this way.

During the dark northern Winters I lack vitamin D (your doctor can measure this using a blood test). The symptoms are some physical issues and probably something that can be described as light depression which goes away if I remember to take the vitamins.

We are all different. Some people might need anti-depressants. I just need some vitamins.

I had a similar experience except instead of antidepressants it was when i started taking Adderall as an adult. A sense of peace and serenity in my mind that I had never felt before, it was almost overwhelming.

What dosage of Citalopram? 40 mg/day?

(Roughly equivalent to Lexapro 15mg/day; Saffron 30 mg/day if Crocin+Safranal properly standardized)

10 mg a day, down from 20 but that made me feel wired, like I ate a bunch of 9V batteries for breakfast. Big pupils, trouble sleeping, manic thoughts, the works.

I'm a small, generally sensitive guy so ymmv...

Thanks. Ever try Saffron extract standardized to crocin content (typically 2-3% crocin, dosed at 20-30 mg/day)?

One meta-analysis showed an antidepressant effect size around 1.2-1.6 , and unlike pharmaceutical antidepressants, saffron with standardized crocin has no well-documented or commonly reported withdrawal syndrome in clinical studies or reviews.

I had severe SAD to the point of having a mental break where I told my wife I was flying that very day to Miami to get away from the cold. I didn’t end up flying to Miami, which is likely why I’m still married…

So I ended up spending $300 on LED bulbs, both corn bulbs and 200W equivalent, bought some 7-Way splitters for my ceiling fan so it’s holding 28 light bulbs (people have joked I have a “biblically accurate ceiling fan” because it’s so bizarre looking, like a weird glowing biblical angel), and get about 10,000 lux in my home office now. As a bonus, I don’t have to run a space heater in my home office (since I only need it in winter, I’d have been using that electricity anyway via a space heater). Solved the issue completely for me.

sweet feet seems so random, maybe some serotonin receptors down there? are they noticeably sweety?

something's fucking my hydro balance. i've done my fair share of psychedelics, and i have to keep drinking water on shrooms too. i dont know, something highly idiomatic haha. i also sweat more in other places, but my feet are the moistest. right now i just change socks often, it's hardly a debilitating side effect...

Same story here, but different drugs. Every year Nov to Mar means no lapses whatsoever in diet, exercise, sleep, supplements, clutter, lighting otherwise the SAD will seep in and erode me. I tried udosing ADHD meds this year and suddenly subsistence is easy and I have gas left in the tank for worthwhile things.

I feel like I speedrun Maslow's hierarchy of needs.

No anhedonia so far this year and my creative output is at all-time high. Hope that helps someone get over their own biases about prescriptions.

Similar story here but for ADHD and Atomoxetine.

I finally went and got diagnosed at age 46 for what had been an childhood-onset issue in retrospect. All the signs were there: inability to start work until enough challenge or novelty or a state of crisis had come about, etc. When I spoke to friends about considering treatment, they said they thought of me as a hyperfocus kind of person. But they didn't see how many support systems I had put in place to function normally, how I saw others around me just doing things while I had to work myself up to start and then keep checking and double-checking for the silly inattentive mistakes I knew from experience I would keep making.

I've had a meditation practice for a long time and it has helped with anxiety but it hasn't really helped with getting started on tasks, especially those perceived as boring. I even had to psych myself up to sit down and start meditating, even though I knew I would enjoy it.

I didn't know until a year or two ago that non-stimulant medication existed to treat ADHD. I always thought it was only Adderall and the like, and I couldn't risk anything that would ramp my anxiety up, or take additional treatment for the anxiety with SSRIs because I have severe hemophilia and any additional risk of bleeding from SSRIs was an untenable proposition.

After sitting on the idea for some time and just hoping that I could fix it with more meditation, I finally decided to see a psychiatrist. The doctor suggested Atomoxetine, but said it doesn't work for most people and even then takes 3-4 weeks to take full effect. I started on the absurdly low dose of 10mg/day for the first month to be sure it wouldn't cause additional bleeds. By day 3 I could see a huge improvement in my working memory and ability to perform tasks. It gave me insomnia for a bit but I would wake up at 3 AM, sit down happily to work and write the best code I've written in years. I could not believe the difference it made. There were quite a few side effects initially but I was willing to put up with them because of how smoothly my brain was functioning. I became a nicer person to deal with. I felt this sense of possibility and freedom that I haven't felt since my 20s. My only regret is not having done this sooner.

So yeah, please don't avoid medication based on internet reading.

Similar. I was on stimulants as a kid and hated them as they did nothing but make me feel high then taper off leaving me exhausted. Nevermind the total loss of appetite. Later on as an adult I obtained adderall from a friend and experimented with it and it seemingly worked for a few days but it never stopped the intrusive thoughts or help with the anxiety. In fact all I did was chase a high with cup after cup of coffee when coming down. That put me off to meds for a long time.

More recently I was on a vacation where I took mushrooms and had a nice trip. Two days later at work I felt very relaxed driving in and sat at my desk BUT something was wrong, my head was dead quiet (the GP explained this exactly like I would.) So quiet that for a second I had a bit of panic as I thought something was wrong. Then something wonderful happened: I realized I was able to just do my work. There was no stress, no worry, no nothing. Just a calm quiet confidence to get the job done. Best day of my life.

After that I called a mental health center and connected with an ADHD specialist who has been working with me. I am also on Atomoxetine myself and while it has not brought me back to that zen head space it brings me close enough. My only gripe is at a higher dose it gives me sensations in my head. However, I learned that eating a proper breakfast helps a lot as I was taking it on a near empty stomach. Overall my life has been slowly improving and I feel more confident at work.

> So yeah, please don't avoid medication based on internet reading.

This - 100%

> I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.

Yes, you did. Had the same medication and got tremors and stiffness so bad I thought I had early-onset Parkinson. Could hardly unlock the door without dropping the keys five or six times. Fortunately, it ceased when I stopped the SSRI.

Same for me with Adderall.

I do wonder if being highly functional and feeling capable is normal though, like as a species it seems almost dysfunctional to happily plow through 8 hour workdays and bills and appointments and all the little bureaucracies we have to navigate. Sometimes a little voice screams "Run to the woods!" when I sit down and look at a long todo list for the day, but with Adderall I can generate some semblance of enjoyment from ticking off the boxes.

Granted our world is what it is, and we are mostly helpless to enact large changes. Finding some kind of peace with reality is probably better than bashing your head against why you don't fit into it well.

and then the effects wear of. You just feel "normal" or the same as before. I used to take ssri meds too. It was nice in the beginning. Stopping was a nightmare, I needed to taper down foe like half a year..

Do you take the citalopram year round, then?

This is my first year, doc told me to wait until at least march, April to start talking about tapering. I have zero symptoms in summer, so I'm inclined to get off them outside the darkest months... we'll see how bad the discontinuation syndrome hits.

Here's hoping it goes well, whichever path you take.

Thank you for your comment. I think that can help many people.

Similar story for me, but with Bupropion (Wellbutrin). None of the SSRIs/SNRIs worked for me, spent years trying different medications, Wellburtin was finally the one that worked, and oh man what a difference.

> Cold showers, ... no alcohol, strict sleeping rituals.

I feel like doing those three things would make me feel like reheated cat shit, regardless of the weather outside.

They do for me too. Alcohol gives me a huge downer the next day but the party itself is amazing so I just waste the day after with a pillow over my head.

And I hate strict rules and rituals, I love chaos. So that also gets me down. I often stay up till 6am (the parties I mentioned above only start at midnight)

So yah it might make some people better but for me the times I break it are the ones that are exceptionally good.

> I could cry with joy because I could finally understand emotionally why people like the Christmas season.

SSRIs are known to induce a

https://en.wikipedia.org/wiki/Mixed_affective_state

I seriously messed up my life early on by not being able to recognize the difference between being happy and manic.

One of those manic symptoms was often feeling like crying out of joy, and another was feeling way more cognitively capable that I was.

I described SSRIs like this:

When you're depressed, you're in a hole that's too deep to get out of.

The SSRI basically shovels stuff from the top of the hole to the bottom of the hole so your head is above ground level. You are still in the hole though and you need to climb out of it.

The side effects are suicidal ideation and brain zaps