Calling for a new approach to depression
theguardian.com
theguardian.com
Anecdotally, I have come to believe that SSRIs have a temporary mood-altering effect, possibly combined with a placebo effect that wears off over time - as your body adapts to the induced serotonin imbalance. The only answer from the medical profession? Increase the dose.
I saw this with my own mother. She went from being a mildly depressed retired housewife to suicidal within the space of 12 months. She started on low-dose SSRIs which seemed to work for a while before she regressed. Each time she started to feel depressed again she would be prescribed with an increased dosage. This pattern repeated until she was taking the maximum 'allowed' dosage, by this point she was delusional, paranoid and suffered terrifying, persecution-style hallucinations - perhaps not surprising seeing how much her brain chemistry must have been out of whack.
Sadly, I'm making these observations with hindsight, she took her own life in 2015. I wish I could share this article with my dad, if I knew it wouldn't break his heart. Both she and my father couldn't share with their children how gravely ill she was until it was too late. They both trusted their doctors implicitly. What they weren't prepared for was the fact that the theory that formed the basis of her treatment was, it seems, no more than guesswork supported only by publication bias, wishful thinking and greed.
Ironically, one of my first web development jobs, way back in 2000, was at a 'medical communications company' where I created an intranet site for GSK (IIRC) for use by their salespeople to shore up the claims of the effectiveness of Seroxat/Paxil and counter negative studies. So, I guess that makes me complicit in all this too.
Zoloft for example [1]:
> An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.
[1]https://www.drugs.com/sfx/zoloft-side-effects.html
On a personal note, I am very sorry for your loss.
I'd also like to say, to anyone reading this who is entertaining thoughts of self-harm or suicide: Please, please reach out for help. In my mother's case her suffering was almost certainly compounded by an irrational shame and self-imposed stigma. I'm just an armchair critic, if you are taking medication and you feel like it is helping - it is. If it isn't helping, please talk to your healthcare professionals about alternative treatment - there are always other options that don't involve hurting those who love you
Cannabis is on Schedule 1. Which, IIRC means zero beneficial medical use (think heroin, cocaine).
See the recent article with pictures of the "marijuana" that the government gives to researchers.
And with Sessions as the AG, I don't think the situation is changing soon.
Depression is probably a bad fit for Cannabis. Within the space of drugs that are used recreationally, Ketamine is (was?) the big hope.
While my scepticism of 'alternative' medicine, magical thinking and general woo-woo is as strong as ever, my experiences of the last couple of years have really shaken the former certainty I used to express in the rigour of science-based medicine. I still believe in the method, but the execution seems to leave a lot to be desired. Not entirely unrelated, I'm reminded why I became disillusioned with my biochem undergrad studies - specifically the labwork. We were repeatedly told to ignore results that didn't produce the 'correct' result and were even docked marks for effectively honest reporting. Although I'm sure it was mostly crappy technique that was to blame.
Thanks for your kind words
Maybe science and medicine have much yet to learn or are being led astray by current theories.
I am sorry for your loss. My own mother has a severe hack and cough from a life of smoking. I know I’ll miss her deeply when she leaves me someday. I can’t fathom how painful that must be.
Sorry for your loss.
As they're being tested on people with depression who have a higher chance to kill themselves, it's almost an inevitability that's going to show up as a side-effect, as unfortunately some of the trial people will kill themselves.
I'm trying to saying it's not necessarily causation that's it listed as a side-effect.
I’ve never seen a single study that shows altnernative efficacies in the same person, but it happened to me. Just one data point though.
No, that makes the salespeople, and your bosses at that communications company, complicit. We're just as neutral and tool-like as the computers we program.
You can extend that to any point of the chain, salespeople can be considered as just neutral and tool like as programmers and the blame shifted up ad infinitum.
While I don't think that he was complicit in this case (maybe the thought that what he was doing could have bad repercussions never went through his head, I don't know...), if you know that you're writing a program that will be used to calculate a way to kill the biggest number of people in a terrorist attack, would you still claim that you're not complicit because your boss that is paying you are the one complicit?
If you don't know what are the uses of the program, I think that you can claim that, but if you know, definitely you're being complicit, even if you're being paid or working under orders (and not under duress).
I would also gladly write a program used to calculate a way to kill the biggest number of terrorists in a missile strike, and that has much less potential to be illegal (thus monumentally costly, and thus wholly counterproductive ... but again that's the businesspeople's concern).
And your argument is dangerous, by ignoring the ultimate authority+responsibility of any company's leadership and investors.
There is also a very steep scale of diminishing complicity. Is the accountant that works at the electric company which provides electricity to the office building where the sketchy sales guys plot to sell their unhealthy products also complicit (assuming he knows what goes on there)?
People aren't tools. No person is a tool, period. That's the point of my original reply. You can't excuse atrocities by saying people are tools and therefore not responsible for their actions. You also can't excuse atrocities by claiming people were just following orders. People are moral agents except in very extreme circumstances (such as lack of mental capacity, which the law does deal with). Programmers that helped big pharma ruin thousands upon thousands of lives are most certainly partially responsible for their immoral actions (working for big pharma) just like the Nazis who ran the concentration camps were partially responsible for the Holocaust. Hannah Arendt tackles this subject in "Eichmann in Jerusalem: A Report on the Banality of Evil."
1) I see depression as the relevant neurological area of the brain learning to get too good at paying attention to negativity. (Overfitting to associating things with bad feelings, outcomes etc)
2) serotonin is a key chemical in the process of learning which I model as changing the way we associate emotions with situations, things etc.
3) by taking ssri's you provide the brain with an excess of serotonin which increases the capacity to learn new emotional associations provided you are exposed to those situations and positive feelings / outcomes.
In this way, I believe (based only on my own reading and more as a thought aid than anything else) that treating the checmical aspect of depression is only viable if you treat the environmental aspect simultaneously.
So just taking ssri's won't work. You need a good, safe, supportive environment to learn to be positive in again.
From my perspective this all seems to be caused by the lifestyle she lives and her immediate surroundings - she's like under constant pressure to behave the way the rest of the ppl expect from her and she cares too much about what other ppl think about her. Another cause which I think is quite relevant is that she doesn't have much friends or hobbies of her on own so she's too dependent on my father who mostly cares for himself.
I'm trying to talk to my larger family about this problem but most of the time they just dismiss my claims about her not having a good life, cause they don't want to make more of a drama by talking to my father to change his habits - they see it like everything is ok and the problem is with my mother who is just mentally ill. This is escalating as I'm slowly getting more and more reluctant to even talk to my farther, sister and the rest of the people who don't see this as a problem. I'm even thinking of translating articles like this so they can read this and possibly understand that's not everything is about drugs. Any ideas of what can I do are welcome as this is the source of my depression and anxiety for quite some time.
Light is anti-stress. Sounds like your mother would benefit from supplemental light (UV/red/etc) when the sun goes away for the winter. Enough UV, but not too much...
Edit: fixed a word
CoQ10 gives you some extra energy. If you are in the US, buy the brand that's USP (IIRC) certified.
When I started taking my current medication, it was due to a massive breakdown which left me an uncontrollable sobbing mess on the floor. I was totally incapacitated. I started taking the SNRI (along with Diazepam/Valium for immediate effect), and after about 10 days, I became massively suicidal; It was just through sheer willpower, and the knowledge of upsetting people who cared about me that prevented me from doing anything about it. After about 3 weeks or so, those daily feelings dissipated, and I started feeling more 'normal'. Well people said it was 'normal' - for me, I just feel odd.
I live with the 'altered' version of me, knowing it's not really who I am. Coming to terms with just that, is the hardest part of being in this state.
My dose is really high, and I have no intention of increasing it. I also committed (properly) to therapy, and that helped immensely. I constantly consider getting my dose lowered, with the aim to be totally off the drugs, but in reality, I know that will never happen.
My psychiatrist said that "first time depression usually results in a re-occurrence 40% of the time, second time depression is 60%, and if it hits a third time, that's you done - you will always be this.'
I have an ex-girlfriend that went into the PhD program for Neuroscience at a reputable university. Her entire degree and living stipend was paid for by a pharmaceutical company. The company "suggested" that her PhD research revolve around a drug that lowered aggressive tendencies.
The sloppiness of the study appalled me. I couldn't say that much because she and I were dating at the time, but it was absurd. There was no funding for getting a reasonable sample of people. So they went to a halfway house and brought in 30 males and 30 females. All criminals, all on probation or parole, all with serious histories of substance abuse, and most of the women were pregnant.
Almost all of the males dropped out for one reason or another. Many of the women did as well. I believe the final tally was 3 males and 13 women. All of whom tested positive for some assortment of drugs.
The sample size is obviously problematic here. What was possibly even worse was when I would go to the lab and watch this person sift through ECGs. The test itself that defined aggressiveness was totally ill-defined, and the neural response to the test was basically, "Well, let's just take a look at it. Okay, this one looks aggressive. That one doesn't."
It was a total shitshow. The end result? A published paper in a prestigious journal about how this drug reduces aggressiveness, a PhD, and FDA approval for the drug.
I hate to identify with conspiracy theorists, and all that. But I literally watched this process happen with a person I was dating for almost all of it.
When it comes to drugs, you really have to do your own research. Your doctor isn't going to do it for you. That's the double burn of healthcare in the U.S. Even when you have it, you can't really trust it. You have to pay for it, you have to know what's wrong with you, and you have to know what you need. And if it isn't a drug, then fuck off. You have to pay for it anyway.
People say, "Fuck you, that's one story that probably went badly. Science is self-sufficient and self-correcting. The plural of anecdote is not data." Fair enough on all points.
But there is a systematic and broken way of doing science in the medical industry. And doctors are not scientists and don't really get trained to know the difference between good and bad science.
Governments & business owners directly gain power & influence in the world via their citizens/workers productivity. The western attitude to "mental illness" is shaped VERY strongly by this - when you get "depressed" working an overly stressful job with no hope of anything better, it is better to convince the poor sap that its a problem with THEM rather than a problem with the world. Then give you some pills to make it better.
This dysfunctional culture will swallow up all your time, force you to work on things you fundamentally don't believe in, leave you isolated from people and then tell you its your fault for being depressed. We need to make the world stop dehumanizing us. Monkeys in cages get depressed.
When 5% of people are depressed, maybe its fair to say they should seek treatment on their own. When 30%, 40%, 50% of people are depressed.... its time to adapt the world to fit peoples well-being instead of the other way around..
Don't be afraid of medication if other techniques fail. My life was ostensibly fine, with a good job, friends, and family. I had a chemical issue, which is solved to this day with Lexapro. I consider it a drug that saved my life.
But you said in a previous comment "I was working 35 hours a week at a startup and studying two difficult subjects at my university (computer science and Latin) while maintaining an active social life. I kept pushing myself harder and harder, and essentially collapsed".
I think most people would burn out with that amount of stress.
I've edited my original comment slightly.
Reimbursement for psychotherapy has been getting squeezed in the last several years. Reimbursement for psychotherapy is generally based on time: i.e. $x for a 30 minute session, $y for a 90, etc. Reimbursement for "medication management", i.e. prescribing drugs, is not based on time, but generally is a fixed amount. So the more prescriptions you write, the more money you make. Psychiatrists therefore focus on meds rather than therapy, as the reimbursement rates for therapy can't support a practice. Many psychiatrists don't take insurance at all bc they don't want to be "medication mills", so they charge $200-600+ per hour for therapy and only rich clients can pay. Psychologists and other licensed therapists can't prescribe meds, so they do therapy, but often make less than $60-70k a year. People don't want to go into psychology / psychiatry because of the stress of dealing with suffering people without having the tools to help them, and then getting paid relatively little (compared to other health care professionals)
This results in much of depression and other mental health being treated in primary care. PCPs aren't trained that well in treating mental health beyond what pharma sales reps tell them, so they wrote an rx and call it a day. 70% of patients don't respond to the first trial of antidepressants, but PCPs don't really know how to handle this
always wondered how the drug industry managed to coerce a whole professional group into being so malignous to society.
Doctors then prescribe these new drugs perhaps needlessly (Vioxx?) or over generic ones.
Also in my experience counseling is only affordable to the wealthy or people in the criminal justice system (where it is already too late IMHO).
The simple fact, which you already mentioned, is that psychotherapy takes dozens of sessions with an expert to be effective. Cost of treatment is in the four digits, easily, while medication costs less than $10/week since most SSRIs are no longer protected by patents.
Psychotherapy and medication have almost identical effectiveness, making the latter the preferable first-line option in almost all cases.
6-12 sessions of CBT (NICE recommends 6-8 for mild to moderate depression) with a licensed clinical social worker would be comparable in cost to a year of generic SSRIs. However 55% of US counties don't even have a mental health professional (because payers stopped paying for it), so CBT isn't really an option for many
> beyond only the packs of pills we have been offered as often the sole item on the menu for the depressed and anxious
several times in that article, and it just doesn't ring true for me. Maybe the author is specifically talking about American psychiatry or maybe the people I know were just lucky, but all the people I know that have been to their GP about depression or anxiety (granted not a huge sample size) were offered CBT first and foremost and only one of them was prescribed medication at all in the end.
In my opinion this should be a national emergency on par with something like the opioid crisis (a symptom of this). We're a nation of depressed, drugged up zombies sleepwalking to our unfulfilling office jobs everyday to pay off our student loan / mortgage debt (yes I know not everyone is in that situation, but even if only 10% are that's 30 million people).
I obtained a prescription for an SSRI from a doctor, sat in the car outside the pharmacy for an hour staring at the prescription, then drove home. No way, fuck that those drugs. I've already wasted the better part of 10 years of my life to meth-amphetamine. I'm gonna work this out without drugs.
I am glad magnesium and vitamin D worked for you, but some people may need prescription medications from a psychiatrist.
I wonder how this research squares up with the so-called Executive Monkey experiment, which found that it was actually the monkey with more control that had more stress.[1]
[1] - https://en.wikipedia.org/wiki/Ulcers_in_Executive_Monkeys
>In an early version of the study, Brady placed monkeys in 'restraining chairs' and conditioned them to press a lever.[2] They were given electric shocks every 20 seconds unless they pressed the lever during the same time period. This study came to an abrupt halt when many of the monkeys died from perforated ulcers.
This (emphasized) is what I think is causing my increasing anxiety and depression. I look around at people, talking loudly, showing off, taking selfies, buying expensive crap they don't need from expensive shops, etc. I try to puzzle out why they're so happy, they all seem so superficial, and I can't understand why they don't feel miserable about the people less fortunate than them who live right next door, the people serving them, who are all struggling to just get by and by all measures increasingly failing. I really want to live in a more equal society that takes care of all citizens.
Anxiety is just another term for caring too much in some cases (This was mentioned here on HN last time I was reading similar discussion).
I think you are descibing empathy and selfishness, not anxiety.
Anxiety and empathy are probably somehow connected, but they are different things.
[1] https://en.wikipedia.org/wiki/Martin_Seligman [2] https://books.google.com/books?id=qreACUdDAc0C
It is a paradoxical issue though, because chemicals can indeed play a crucial role to overcoming depression.
But I digress.
In the same way, being in good physical shape, eating healthful foods, sleeping well every night, and not being stressed won't solve every medical problem. But a dependable and healthy body does solve some problems directly, and reduces most of the rest by orders of magnitude.
Every week there's a study that being poor causes a lot of damage to your body (on the DNA level IIRC).
However, _not all treatments work for everyone_. Certain SSRI's work for some and not others. This also holds for exercise.
[1] https://www.ncbi.nlm.nih.gov/pubmed/26978184 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/
Low energy often comes with depression. So it's not easy as telling a depressed person to "do more exercises".
Depression is "invisible". I like to think that being depressed is like having a broken leg. You can't just get better by yourself, you need proper medical treatment.
Replace the broken leg with a generic bad back (non surgical) and it's not a bad equivalence.
Medical advice in many cases is to do things which hurt (exercise, stretching, lose weight) otherwise the back won't get better, but doing nothing will almost certainly lead to stagnation or a worsening of the condition. You can take pills which may reduce the pain, but those are not really a long term solution on their own.
I don't wish to diminish how hard it is (in either case, intentionally causing yourself discomfort is utterly exhausting in every way). It often is both possible and beneficial so be wary of writing off a school of thought entirely.
clearly there have been people helped by psychiatry, but clearly a lot of it has been debunked because, not a surprise, science is supposed to debunk itself and self-correct and iterate to better things.
so while in general it’s a losing proposition to say the field has no value, we need to separate the concept of science from specifics of how it’s practiced in particular cases. this is not a black and white issue. some drugs and practices and practitioners can be life saving while others are the opposite.
it would be interesting to know how right this article gets things for the claims it makes.
Thanks for writing this!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824975/
Not saying these meds don't work, they actually might work "too well" in some ways and that surveillance of and constant checking-in with patients is very important especially at the beginning and during periods after stopping treatment.
There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables.
There is also depression: the neurochemcial/neurophysiological disorder that has depression (sadness) as one of its symptoms.
It can be treated with various (miracle) drugs.
--
People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates.
Required viewing: a lecture on this topic by somebody who knows more about it that anybody else who is currently alive: https://youtu.be/NOAgplgTxfc
The modern miracle drugs that effectively treat and cure debilitating depression are not SSRI's. Whatever benefits SSRIs have are probably a result of their influence on neurosteroids:
>> Certain antidepressant drugs such as fluoxetine and fluvoxamine, which are generally thought to affect depression by acting as selective serotonin reuptake inhibitors (SSRIs), have also been found to normalize the levels of certain neurosteroids (which are frequently deficient in depressed patients) at doses that are inactive in affecting the reuptake of serotonin. This suggests that other actions involving neurosteroids may also be at play in the effectiveness of these drugs against depression [0]
[0] https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepre...
Other miracle drugs are also helpful for addressing the cause. Big Pharma doesn't care about cause/effect, they just want patients on maintenance treatments.
Depressed people usually have some sort of metabolic problem, caused by thyroid problems, inadequate diet, etc. Emotional stress is usually a major factor too.
> belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates.
Where do you belong? Are you a tireless advocate for the status quo?
In my experience, thyroid etc are the fist things tested for before suggesting depression. Do you have any kind of evidence for that argument ?
There is no evidence to suggest that Robert Sapolsky "knows more about it than anybody else who is currently alive". He has published four papers on depression, which are all highly speculative and do not involve novel primary research. The most recent of these papers was published 14 years ago. He is clearly an eminent neuroscientist, but he is by no means an expert in depression.
A cursory review of the linked lecture suggests that Sapolsky is making bold, weakly substantiated claims about the neurobiological basis of depression that would not be supported by the majority of people working in neuropsychology and psychopharmacology.
Your decision to link to this lecture is somewhat peculiar, given that it actually refutes your core claim. In Sapolsky's own words: "all of this knowledge winds up being effective for treating maybe 30, 40 percent of people... the vast majority of people, the antidepressant drugs don't do a whole lot" (timestamp 38:30).
https://doi.org/10.1002/14651858.CD007954 https://profiles.stanford.edu/robert-sapolsky?tab=publicatio...
Interesting thing about the author. He was a rising journalistic star in the UK. He'd won awards was regularly on TV and radio, until it was discovered he had been plagiarising others for a lot of his articles. It was also found that he had been editing wikipedia articles to attack people who critisised him. An interestingly tragic character.
You might like to read up on the short history of modern psychiatry. You'll find a great deal of mistakes, pseudoscience, and human rights atrocities.
It's largely a good thing that recent history looks hopelessly primitive and barbaric to us, because it means that we're making progress. Psychiatry still has a long way to come, but we need to be careful to not throw the baby out with the bathwater. Access to psychiatric care has a hugely positive impact on the overall disease burden; mediocre treatment is better than no treatment at all.
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
(B.S. in Biology and Psychology, studied neuroscience in school)
We know that placebo effect is incredibly important in the treatment of depression and other psychiatric disorders. We know that there are still huge areas of uncertainty and ignorance and that our best treatments just aren't very effective. If we publicly admitted those facts, then our already not-very-effective treatments would get less effective, because the placebo effect would diminish.
If we admit that psychiatry still has lots of glaring deficiencies, then a lot of people will end up getting sicker. If we don't admit it, then we might not invest enough in fixing those deficiencies. Nobody has a clear answer to this quandry.
Is it worth sacrificing some patients now for the benefit of patients in the future? Would admitting the deficiencies in psychiatry dissuade people from seeking treatments that are actually effective? Is it possible to maintain a public facade of effectiveness, while privately accepting that we don't know what the hell we're doing? Would that be ethical? Does the risk of believing your own bullshit outweigh the benefits to patients of getting a good placebo?
The author and his claims can be discredited if someone here can cite such a study.
- Assuming we can measure serotonin levels in humans, how do we determine whether someone's level is "low"? Does "low" mean "low compared to the average of non-depressed people"? Does it mean "low compared to the level the patient had before they became depressed" (if so, how would we know their baseline levels)? Levels of many chemicals (hormones, glucose, sodium, etc.) vary significantly between "normal" individuals.
[1] We can't talk to a rat to determine whether it's depressed. We can only observe certain aspects of its behavior, like appetite and activity levels, which we assume are proxies for depression, but could be due to unknown factors. We don't really know if rats have evolved to become depressed the way people do.
I also recall reading that SSRIs have been found to be more helpful against anxiety than depression.
1. Emotional state is like blood pressure. It's a continuously varying thing. There is no discrete depressive disease state, just an extreme end of a continuum.
2. Just like blood pressure, though, very high blood pressure (or low) represents an illness state, a potentially very serious one. The etiology is a different matter. It may be due to sociocultural processes, or existential threat, or genetics, or neurological insults, or all of the above, each in some measure.
3. When we talk about "depression," it's usually a shorthand for a broader set of problems, related to lack of well-being, malaise, despair, sadness, anxiety, fear, and so forth.
4. The particular cocktail of emotions for each person is different though.
5. The best meta-analytic evidence suggests that antidepressants work, but not nearly as well for people as we were led to believe, and there's huge publication biases. Some drugs might not work at all. Some drugs work for some people; those same drugs might not work for other people at all.
6. Serotonin per se probably has nothing to do with the effect of antidepressants.
7. Psychotherapy works as well or as poorly as drugs on average, with some of the same publication biases. This is considered against many different types of controls, including placebo controls and various types of behavioral controls. Being wait-listed is the worst intervention of all, though.
8. Different psychotherapies do not differ in efficacy on average. The superiority of cognitive-behavioral therapy, etc. is a myth. Different therapies might differ for particular individuals, though, and there are some basic ingredients that seem to be necessary for efficacious therapy. The effect of therapist dwarfs the type of therapy (that is, some therapists are really really good, and others are less good, and that is much more important to outcome than type of therapy per se).
9. The best outcomes are generally therapy and drugs in combination, and if one thing doesn't work, trying different things will often work eventually.
The recent history ("recent" being the last 30-40 years) of psychiatry and clinical psychology is dominated by economically and politically-driven reductionism and oversimplification, within the realms of therapy as well as pharmacology. A lot of these dynamics are driven by a desire to present as rigorously scientific, wrapping ones' selves in banners of other disciplines. The problem with this is behavioral science is its own thing; it resembles other disciplines in some ways, but not in others (much like every other domain of science).
What are your thoughts about about the relative efficacy of cardiovascular exercise compared to anti-depressants (not that they are mutually exclusive). Thanks.
Brian: You've got to think for yourselves, your all individuals.
Crowd: Yes we are all individuals.
It seems to me that medicine (and patients) seem to want a nice neat label to put on what is affecting them, then they can look up the label and fit it to a nice neat solution.
Unfortunately as you describe we are all individuals, especially when it comes to perception of feelings and experience and even those are not static, something as simple as a disturbed night sleep can dramatically impact somebodies mood. How the heck is medicine supposed to deal with all those variables and come up with a definitive "this works" when presented with a mental health issue.
Society expects simple solutions to problems. Dark -> turn on light. Broken leg -> apply traction, apply cast, prescribe pain killers. Patient depressed -> ????
Your average GP has about 15 minutes to provide a solution to the patient, how in that amount of time can they discover that:
the patient has recently had a messy break up,
haven't been sleeping or eating properly,
the cat was run over by the neighbour and
they have been working far too much.
Oh, and the patient would like to be prescribed a pill that will just fix it all.
Good luck with that.
Slight nitpick: CBT has a much larger and more reliable body of evidence than most other therapies. It's probably no more effective than other therapies, but it is very cost-effective, mainly because of the short duration of treatment. There is some evidence to suggest that self-guided or internet-delivered CBT may be as effective as traditional CBT delivered by a trained clinical psychologist, which would be a huge win in terms of cost and availability.
On a personal level, I'd recommend trying a wide range of psychotherapies if you can afford it. On a societal level, I endorse mass adoption of CBT. It's not necessarily the best therapy, but it's the easiest to deliver at scale. Access to treatment is the issue right now, especially in lower-income countries.
We need to be more careful in our language, the word depression has become overused, much like the drugs used to treat it.
If someone truly feels and believes they have a "wonderful" life, it would seem they are not suffering from crippling depression.
Though what I think you're trying to say is there are people who are depressed even though they seem to have all of their basic human needs being met.
Maybe having all those things actually isn't what leads people to feel grateful for being alive.
Some forms of depression are medical, people need to be aware of this. Thinking that everyone can be cured by running off and finding one's true self is incredibly dangerous. For some people, that is the solution, but for others, running away from their support network is the exact wrong thing to do.
All that said, soul crushing jobs are soul crushing. The modern world's insistence that we all have true purpose in life has not helped things any. A lot of people used to just be happy getting married, having kids, and seeing their kids do well. Now, we all want some sort of higher purpose (I'm guilty of this as well), which makes obtaining happiness really hard.
For the longest time, success was "at least a few of your kids survived". Since then, standards have been raised to a point that only a fraction of the population can meet the current bar.
P.S. Who said anything about running away from support networks? Listening to your needs I suspect might look like asking someone for help, or something along those lines. But that's just it, everyone's needs aren't the same.
The article, and popular mythos.
Leaving one's job, running off to explore one's true self. Society is full of stories of people fed up with everything so they leave behind all they know.
Heck sometimes it even works. But I'm countering the article's main thesis, which seems to be "depression is from having a crappy job" with the point that there are other causes as well.
An analogy I make sometimes is this. Have you ever been scared while watching a scary movie, or laughed at a comedy or teared up at a fictional drama? Even though your intellect knows the thing you are watching is an artificial event that never really happened, your emotional state and your physical state don't care what your intellectual understanding is.
Consider it like this: most qualities in humans fall into some sort of normal distribution. Some 1% of the population are the 1% with the least natural serotonin production. Genetics play a large role in that. Could that cause of depression not exist?
Now for the critique, the OP didn't really make it clear who's idea of a wonderful life it is. I also use the word secrect as a way to throw some shade, because the word secret implies the owners knowledge of the secret, which is not alway the case here, I should have just said "... has a secret."
The problem is that the pill often works regardless of why you feel like shit.
Could it possibly be that our idea of an "awesome life" is mistaken?
So I take antidepressants not to fix the issues, but to alleviate the symptoms so that I am able to take on the actual problems.
Why is that a problem, if you're not a Luddite or Puritan?
tl;dr: Many people diagnosed with depression are actually just sad because modern society is kinda lame.
(The article argues this point cogently, and I agree with it.)
[I slightly edited this because I think people thought I was saying that I think all depressed people are faking or something]
"Don't talk about what you don't know. Many people have real, chemical depression, and your comment that it's a product of life circumstances is not helpful".
I was always a but puzzled about the regularity with which that above formula appeared on HN. Sure, many entrepreneurs and especially developers lead lonely, stressful lives. I am a developer and entrepreneur myself!
But I also felt there is a sort of "groupthink" or "bullying" element to this, because there was hardly much substantive discussion about facts or statistics or science, in effect it was shaming the commenter into shutting up.
This bothers me. I like to see real fact based discussion when there is disagreement. Not just downvoting and vague assertions.
In this case I am sure you were downvoted by that exact same sentiment. Even if you had summarized the article, the content of the summary was enough to trigger the downvote.
1. How would we even know whether the person who posted the comment has no personal experience with depression? They may be agreeing with the author of the article because they've both had long experience with depression, and have both become skeptical about the mainstream views of it.
2. Just because someone has had personal experience with depression does not necessarily make them an authority on that topic.
Lots of people on HN express strong opinions about things that they're not personally experienced with: poverty, sexual harassment, etc. (not to mention tons of technical topics). If we stopped talking about everything we have no personal experience with, discussion on HN would dry up pretty quickly.
The problem with reading online discussions, /I think/, is that it's super easy to end up with a polluted perspective and bipolar esteem/locus of control: everything sucks, catastrophically so, I'm stupid, and it's all entirely my fault; even if it isn't, everyone is stupid & the world has conspired to ruin me.
So a description of patterns of thought, of pitfalls hidden as cultural ambitions - patterns socially or environmentally derived - are parsed into "so it's my fault? F___ off -- or it's the fault of society, well I bear that crushing realisation daily, thank you". Our highly individualistic culture poisons perfectly good advice for the people it might benefit, and/or adds to the weight many others can do without. Although "you can change your environment by changing your perception of it" is definitely sound, for so many peoples' valuations it's just another string in the bow of uselessness.
There are also, in my experience, two gates that must be open at the same time to allow for slow repair work, or larger positive changes. Unfortunately, they also depend on each other, and when things are truly awful neither are plausible. These are a) a surplus of willpower, no matter how little above the level required to minimally function, and b) a regular sleep pattern. Since depression reduces willpower dramatically, and we are very poor judges of what drains our willpower, the repair process can often feel like Sisyphean whackamole... But eventually, at least for me, I found little willpower exercises I could do every day. At one point, this was quite literally just attempting not to visit my 'stim' websites on first impulse. Eventually I'd still visit them. Didn't matter. That was it. Not even every day. Just every day I could was enough. Until I could do a little more.
It's kinda like the conversation where someone is trying to describe a problem with a piece of software or UI trope, and people chime in with unhelpful workarounds rather than addressing the issue itself.
substantive discussion about facts or statistics or science
Given the subjective nature of consciousness, dismissal of anecdotal responses as counterfactual or invalid is intensely alienating to the depressed subject.
Or, with slightly less woo-woo: is it any wonder so many of us feel hopeless when we are, collectively, shitting in the pool and force feeding each other hollow materialistic junk via brainwashing advertising.
Yeah, I'm gonna say it: this disease, this depression so many of us suffer, is a result of a sick society. But our hyper-individualistic culture blames the individual, then lets, no expects, that doctors prescribe them addictive drugs that don't work and are terrible to try to stop taking.
Seriously, what the hell are we doing? If I treated my dog like this I'd end up in court for animal cruelty.
You aren't yearning for a more antique society. You are romanticising the past.
The part you are looking for is being connected to a community, and there's many more ways to do that today than ever before.