The serotonin theory of depression: a systematic review of the evidence (2022) | Hacker News Reader

The serotonin theory of depression: a systematic review of the evidence (2022)

nature.com

35 pointsdayve13 comments

No treatment of depression will be meaningful without acknowledging that this a "wastebasket" diagnosis, calling at least a half dozen disorders one name.

Practicing psychiatrists can determine which one or ones you have only by seeing what medications seem to help.

"To the man with SSRIs, every life issue looks like depression"

I mean, that's all psychiatrist do and can do, right? They aren't going to create a diet plan, work out plan, help you great goals, help you get your life together, etc.. They just offload that on others.

How many mental issues can be caused by physical aliments? Do they ever screen for those e.g. check thyroid levels, vitamin-D, etc.? (Not in my experience)

I honestly feel people would be better served going to a GP that actually looks at situations more holistically, then perhaps go take a visit to the pill-mill.

It is probably true that very many mental disorders, like other illnesses, would fall to improvements in exercise and diet. But often enough no progress on those is possible without some pharmaceutical relief first.

I wonder how much of that is due to societal demands. With work demands, commuting, household chores, errands, etc., I can clearly see how people struggle to find the time, energy, or desire to better their lives.

I'll admit, I should be better about my diet and exercise too. However, I am plagued with the same issues of lack of energy and motivation to better my life and I also have a "mental disorder" I was born with. I prefer to call it a 'societal incompatibility' or 'evolutionary maladaptation' -- much like an appendix which may have once served a more important purpose many moons ago, but tends to only cause issues in today's time.

Commentary by one of the authors https://twitter.com/markhoro/status/1549692299025813504?s=21...

The author of this paper has done something valuable, but the absolute rant in this twitter thread is frankly incredibly out there. They are dismissive of a purely chemical reason for depression. It quite simply must be due to a stressful event. Ok, so what? Does this mean it can be fixed without chemical intervention? Sometimes it cannot. How do they propose to fix it in those cases?

They are essentially advocating for a stance that the tools we have at our disposal today should not be as accepted, for the simple reason that they do not treat the exact correct thing. By this logic, we should not use chemo. It is short-sighted and really not of the level expected of someone doing any kind of research into psychiatric treatment.

I would disagree with the characterization of that Twitter thread as a rant. To me it seemed like a fairly reasonable and balanced distillation of conclusions that are suggested by the study. He didn't say that current antidepressants should never be used. He simply said we don't have evidence that a chemical approach to treating depression is the right approach.

I suspect it comes down to the difference between the two questions (a) Whether SSRI"s a/d meds work (b) Why/How they work.

Clearly these things help many people. But not everyone and may even be harmful in some cases. Why, now that we don't seem to have really high quality answers on.

While the conclusions make sense, it's weird that we have gotten to a point of meta-analysis of existing "systematic and meta analyses". How much further removed from the data can we go without the "error" accumulating and making any such meta analysis useless?

TLDR: This review suggests that the huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression. This is consistent with research on many other biological markers [21]. We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.

> Poverty, insecure work, sexism, racism, interpersonal conflict, etc all clearly associate with depression. The vast sums of money spent on looking for the chemical equation of low mood might be missing the forest for the trees

Finally. Finally finally finally. I had a therapist my first go-around tell me, when I asked if I should be on medication, that “sometimes people are depressed because their life just sucks, so let’s see if that’s the case before we consider a chemical intervention.” And he was right.

Ok but you can experience none of these life situations and still be depressed.

Yep. That's why my therapist said, “sometimes people are depressed because their life just sucks, so let’s see if that’s the case before we consider a chemical intervention.”

Notice two things about this statement:

"Sometimes." As in, not all the time.

"Before we consider.." As in, not ruling it out.

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