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Comment by jrs95 | Hacker News Reader

Yup. Just to get rich selling pills that barely make a difference. As someone who’s probably had a prescription for every major anti-depressant, the only difference I never noticed from taking them is that my dick didn’t work.

Not saying that depression isn’t a serious issue and that it can just be “thought away” though. But the drugs are really only helpful to some people, and there’s not much evidence to substantiate that this is just a chemical problem. There may be a chemical element, but IMO this is being exaggerated for profit. Meanwhile we aren’t dealing with any of the underlying social problems that probably play a much larger part.

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I recently read the book "Lost Connections" by Johann Hari which covers this issue. In fact, it's a really a book about some deeper problems of Western society (where depression, anxiety, etc. has been on the rise for a long time), so the pharmaceutical pill-pushing and the fairly debunked "chemical imbalance" explanation of depression really just sets the backdrop of the story. He emphasizes - like you mention - social changes in modern Western societies as major causes of depression.

I really recommend the book. If you're not convinced or just want an audio version, then I recommend the episode of the Ezra Klein Show podcast where Johann Hari is a guest - that's what convinced me to read the book.

I’m curious, if depression doesn’t have some basis in chemical roots, then why is it often hereditary? Like other forms of mental illness which are chemical and hereditary, depression also exhibits these characteristics.

The current mainstream view is that depression is partly physical, so you're not wrong.

(edited for clarity) Some say that depression is a chemical imbalance, but this is not a mainstream view any longer (I think, although it's often mentioned in comments on the Internet), although treatment is still very much based on chemicals like SSRI drugs, which have very little proven effect, require constant upping of dosages to gain the small effect they provide, and also having several undesirable side-effects.

I did not equate the two.

I did not say you did, sorry if it seemed that way, but others further up this tread are indeed saying that.

It's entirely plausible that some people have hereditary character traits that make them less resilient to stress. They're not necessarily depressed because of their genes, but their genes make them more vulnerable to depression.

We observe a similar phenomenon with diseases like type 2 diabetes. People of south Asian origin have significantly higher risk of developing type 2 diabetes, even after controlling for diet and lifestyle factors. We have identified a cluster of genes that don't directly cause diabetes, but seem to increase the risk of developing the disease. You aren't doomed to develop diabetes if you have these genes, but you do need to be more careful about your diet and lifestyle.

https://www.nature.com/articles/ng.921

I am obliged to point out that Johann Hari has a distinctly chequered reputation. He lost his job as a columnist at The Independent in 2011 due to multiple substantiated allegations of plagiarism; it later transpired that he had vandalised the Wikipedia articles of journalists who had criticised his conduct.

https://en.wikipedia.org/wiki/Johann_Hari#2011_scandals

His book Lost Connections has been strongly criticised for misrepresenting the mainstream scientific position, cherry-picking data and making unreferenced and unsupported claims.

https://anotherangrywoman.com/2018/01/22/thinking-critically...

Thanks for your post, I was not aware of the controversy around Hari.

That said, I found his book "Chasing the Scream: the first and last days of the war on drugs" [1] an informative resource that in some places touches on this thread's topic.

[1] https://en.wikipedia.org/wiki/Chasing_the_Scream

The drugs can be really, really helpful to some people though. There is no doubt in my mind that Prozac saved my life 25 years ago.

Yep, my wife was on Zoloft for ~18 months after a pregnancy (postpartum depression), and it absolutely made a massive difference.

I first felt the genuine desire to seek out and socialize with strangers after a dose of kava. I now can’t take it as it conflicts with other medication. But before then and after then, I genuinely experience discomfort around all people.

> there’s not much evidence to substantiate that this is just a chemical problem

> we aren’t dealing with any of the underlying social problems that probably play a much larger part.

I assume your concern for evidence applies to your pet theory as well, are you able to share any?

It’s just my opinion based on personal experience, from my own struggles and those of people that I’ve known. It seems to make a lot of sense that we like the chemical imbalance narrative because it allows us as a society to wash our hands of this and pretend it has nothing to do with us.

While I don't directly agree with jrs95, the fact is that the pills just plain don't work a lot of the time. Google the medical term "treatment-resistant depression". The very first link says "Despite advances in the understanding of the psychopharmacology and biomarkers of major depression and the introduction of several novel classes of antidepressants, only 60%–70% of patients with depression respond to antidepressant therapy." (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/) Presumably, the odds were worse before.

Consider, too, that that probably doesn't even include those that develop tolerance effects afterward; with that, the numbers likely climb much closer to 50%-50% or worse.

Funny, I’ve known several people who clearly were depressed through physiology. Nothing to do with being able to “think it away”

Physiology and “chemical imbalance” aren’t exactly the same thing. Just because you’re physiologically predisposed to depression doesn’t mean that you can fix that by ingesting chemicals, which is usually what’s implied by that phrase.

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