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Comment by johnward | Hacker News Reader

> Medication cures symptoms of depression but cannot fix the underlying problems causing it.

Sometimes those underlying conditions are brain chemistry though. The pills work for a lot of people. My Bi Polar depression doesn't seem to stem from any trauma or anything. I've done therapy and it did nothing. I've tried exercise, it helps for a short period. I tried diet, seems to help a little. If also tried about 15 different medications before a found a combination that keeps my mood fairly stable.

I almost killed myself before I found the right combination of meds. Meds work for some people we shouldn't be so quick to discourage it.

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There's a lot we don't undestand about mental illness, but I think the brain chemistry theory doesn't hold water anymore. Otherwise we would have been able to take a blood test and say - oh, your serotonin levels are out of wack.

I'm really happy you found a combination of meds that work for you, sounds like it was a long and rough road to get there. There's still things you can do to improve your condition beyond what the meds can do. I have some anecdotal evidence that the app helps people taking meds, but nothing conclusive yet.

Well, we don't know that we couldn't if we were able to easily take a blood test of the brain. I think there's two parts to the theory, the stricter interpretation that goes something like "depression is just the symptom of too little serotonin - which can be fixed by SSRIs" is quite weak. But the fact that brain chemistry affects mood, and in particular that increasing some chemicals can induce pleasant feelings is pretty robust - we have drugs like cocaine and heroin to thank for that insight. However translating that knowledge into meaningful treatments of depression is not straightforward as the body has a lot automatic control systems trying to keep things in balance.

So at one level we could claim that indeed depression is caused by "too low" serotonin/dopamine levels, as temporarily increasing them will take away the depression, but on the other hand this insight in itself doesn't provide us with a clear path for diagnosis and treatment, and it doesn't preclude that there's other things that's a root cause, such as thought patterns, neurological setup, etc.

That's a very thorough exploration of the topic, thanks. There definitely seems to be a two way street between chemistry and consciousness both affecting each other allowing us to tackle the problem of depression from both ends. I'm very excited about the result coming out of psychedelic research which seem to chemically trigger and stable improvement in thought patterns.

There's a difference between drugs "working" and drugs solving the problem.

One thing that I am cautious about is the biological guarantee that you will develop tolerance to the drug and will need ever more powerful drugs throughout your life to maintain the baseline of "ok".

I'm glad the medication helps, but it seems like exercise and diet (and other activities) are more sustainable in the long run even if they are not as dramatically effective.

Maybe it makes more sense to take medication on a short term basis to deal with crisis and focus on lifestyle changes for long term success.

I'm happy finding a mixture of medicine that seems to work for me and has been for a couple years now. It took me over 20 years to get to this point though. Most of this time was just me actually realizing a problem then taking a couple years to actually find a decent doctor.

The problem seems to be that we don't really understand enough about how to brain works and how these medication work with the brain. So many psych meds are like "we don't really know how this works, but we think it might do this".

I think that's why there so much trial and error with psych meds. Plus don't get me wrong, the wrong med can be devastating to certain people. I ended up in the ER a during my trials due to bad reactions.

I still try to exercise and watch my diet. I don't have any studies or anything but low carb seems to keep me more mentally stable.

Interesting to hear about low carbs, I've been moving in that direction because of family history of diabetes on both sides. I still eat some junk food with added sugar, I wonder if cutting out added sugar entirely would help.

The other thing that helps me the most is running, but sometimes I just fall out of the routine.

I agree with everything you wrote, especially about the way medications are dispensed. I did try a medication once and had a bad reaction, have not tried since then but I think about it often.

20 years is a long time to suffer.

Good to hear you got the right treatment. Bipolar famously doesn't respond to therapy, they're just going to keep being manic. People with schizophrenia aren't going to talk their delusions away, it will only feed the delusions. Drugs definitely have a purpose.

But the vast majority of people dealing with mental health issues are in the category of somewhat anxious or depressed with maybe a personality disorder thrown in. These are treatable with therapy, somewhat side effect free.

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