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Comment by tecleandor | Hacker News Reader

For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing.

The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects).

I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Probably it's not because of the serotonin. They have weirdly different effects depending on the person. But there's something going on that we still don't understand. Both because we don't understand the whole mechanism of depression, nor WTF the SSRIs and SNRIs are doing in our mind and body.

At least in my humble opinion.

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I completely agree. I believe we have no idea how these drugs work at the moment.

For one, serotonin receptors are _everywhere_, notably the gut, which also has a strong relationship with emotional state. And as you point out, they don't just affect serotonin. Given we have a whole bunch of drugs that attempt to be serotonin selective, but where each one affects different people in different ways, it seems likely to me that the non-serotonin effects are likely significant.

Plus, what's the reason so many of us are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause? Why would a huge chunk of the population have a imbalance of brain chemicals?

Ultimately I suspect my GAD/OCD is probably environmental, but environmental in a way that I can't easily identify or fix. Maybe it's the unnatural desk job oriented lifestyle I have, or maybe it's plastics in my blood, processed foods, lack of religion, social media or something else. Or maybe the neurotransmitters just sometimes need a kick up the arse to get them back into proper functioning.

All I really know is sertraline helps me live a normal life, and for that I'm thankful.

> Why would a huge chunk of the population have a imbalance of brain chemicals?

That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc.

Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office robot who's able to work without getting too stressed out or distracted by other things.

I suspect that I wouldn't need the meds if I had a different job. Which feels weird, because it sounds like I'm trying to fit into an environment, instead of being in an environment which fits me, if that makes sense. Then again, maybe everyone has to do that and it's just my biased perspective that I'm the one who's not made for it.

Which sucks, because I love IT, also as a hobby.

The easiest examples for that: Sometimes I do an IT project at home, maybe build a PC, configure a homelab, try out Stable Diffusion or edit videos from time to time. If I do these things at home I can easily sit in front of the computer for 5+ hours and loose track of time, but I don't seem to be able to be as focused for IT projects at work if I'm unmedicated. Unless they really interest me.

I believe the same thing. In fact, I believe people with ADD have a natural advantage in pre-modern settings. We are built to run long distances, outsmart prey, and forage. A distraction isn’t a distraction on that environment, it’s awareness and quickly thinking through possibilities and avenues of success.

If anything it is more of an attention surplus than an attention deficit.

This is a point that Dr. Richard Barkley, one of the major researchers in ADHD in the last few decades, has stated slightly differently. In a sort of jest, he mentions that [ADD] should be called “intention deficit disorder” as there is plenty of attention to be given to things, sufferers just lack a lot intentionality behind their actions. This ultimately manifests as an executive disfunction which prevents this slice of the population from subconsciously knowing how to prioritize or assess the importance/value/urgency of stimuli.

> I believe people with ADD have a natural advantage in pre-modern settings

Totally, yeah. I can't prove it of course, but I've noticed countless of times that I seem to be extremely more aware of my surroundings than my friends etc. I hear and see more compared to them, which has positive and negative sides.

Same here, man. It’s for the reason you described in your first paragraph. Working in a soul sucking corporate office space is so painful for certain personality types.

For me at least, I’ve always thought it would be cool to be a delivery driver or someone who’s out and about everyday moving around… but I stuck with IT because it makes astronomically more money.

So sitting at a desk all day will require me be medicated because my baseline preference is to be up and moving, working with my hands, talking to people, etc.

I think a lot of people with ADHD that’s severe enough to require medication are just people who don’t do work that truly fits their personality.

Which if we’re being honest, sitting at a desk all day is not natural. I never needed Adderall when I was working in a warehouse in college, or when I was a city guide that was supposed to walk around downtown and greet people.

tl;dr Unnatural lifestyles require unnatural supplements.

As your sibling post pointed out I think our adhd was a benefit in preindustrial times, or at least in preagricultural times.

And a desk job with a fun coding project to do (fun coding usually doesn't pay as well) was fine for years. Hyperfocus was nothing but upside except for having to do taxes or do he occasional tedious task.

But when you get too good at your domain, and you have 10 unrelated coding projects, even if they are all fun, adhd is no longer your friend. #include wife and kids and doctors appointments and birthday parties and ... Adderall helps now. I need to turn off my hyper adaptation quite often now.

By will alone I set my mind in motion, but I need amphetamines to slow it. It is like we were born as mentat and instead need drugs for everything except that.

Hear, hear. There's a lot of us in this same boat. These asocial, sedentary IT jobs + hectic lifestyles are out of sync with our biology and psychology.

I didn't know it at the time, but I was in the same situation for years. I started doing blue collar work at mine sites and oil/gas pads. For me, it's a good fit. And the people are real.

>Why would a huge chunk of the population have a imbalance of brain chemicals?

Because they are all members of a society whose food production is controlled by 2 or 3 mega-corporations, who also, incidentally, have an interest in selling pharmaceutical products to make people feel better about their lives ..

That's quite a huge accusation, do you have any evidence to back that up at all?

Cause if I understand the implication correctly, you're basically saying that the 2-3 megacorps who control food production (which is already far from true, IMO) are literally poisoning people to cause them to need antidepressants.

Are pharmaceuticals food?

https://www.theguardian.com/environment/ng-interactive/2021/...

Americans eat the most hyper-processed food on the planet. They're also over-prescribed with anti-depressant pharmaceuticals. Causation/Correlation? You decide: move outside the scope of Bayer's and Monsanto's reach, and see for yourself how less depressed you feel on a daily basis after a few months of real food ..

Final word: Nestlé.

Is there anywhere outside their reach that doesn't involve giving up all the other benefits of the industrial revolution? I'm not a Luddite, I like labor saving devices andblife saving procedures, and even some medicines.

You assume a lot of competence on the part of these large actors to collude and conspire at the macro level.

Let’s assume, for sake of argument, the conclusion of your assertion is true in that we are being poisoned and offered medication to mitigate the effects of said poison. This is more likely the effects of independent actors acting upon their respective self-interests.

Food companies try to drive costs down to sell cheaper products at the same price, which may end up having poor health consequences by virtue of untested substances having mass exposure. Pharmaceutical companies respond to market forces by developing drugs they can get funding for, which usually ends up being ailments that a lot of people have. There are way more efficient ways for them to team up and make money, this is just a side-effect of large institutions acting in self-interest.

> what‘s the reason so many of use are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause?

Because modernity hasn’t been an unmitigated success. In the pursuit of abundance, we’ve made all sorts of trade offs that we are now realizing have had unintended consequences to mental and physical health. Every leap forward has felt like progress but has underlying negatives. The world has trade offs!

The move from agrarian to industry to service/knowledge based economies, as an example, has produced countless benefits, but as another commenter mentioned: sitting at a desk certainly isn’t as healthy as moving in the fields. Being in big urban environments to facilitate the new economy has produced amazing culture and a more inclusive community, but at the cost of tight-knit lifelong social networks, noise and air pollution, crime, etc.

I’m not saying yesteryear was better - I’m pointing out the trade offs that were made and how we are now recognizing some of the costs. Perhaps the pendulum needs to swing back to some degree to ease these costs if we as a society aren’t happy with the price paid. There is a return policy!

Mental illness is not a byproduct of modern society, its study and treatment is. Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed. That's like saying schizophrenia didn't exist in antiquity, people were just attacked by actual demons and everyone else was "normal".

>Mental illness is not a byproduct of modern society, ...

I didn't state that it is solely caused by modern society.

> Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed.

Source? Or is this just a theory like mine?

"Mental illness is not a byproduct of modern society, its study and treatment is. "

If you have data on the incidence of depression in hunter gatherer societies we can compare to modern societies feel free to share it.

"Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed."

So in your mind the functioning of a society has no impact on the rate of mental health problems?

Exactly this and I have suspected for years now there is a huge gut connection. I am not saying it is the only cause (or even the sole cause) but I do believe for a lot of people it is exacerbating the issue significantly. The gut also has tons of opioid receptors and there are some scholars who now consider the spinal cord to be a serious part of the brain - and the spinal cord directly branches out in very large nerves all over the gut.

I personally notice a large positive change in my mental health when my gut is functioning properly and I am eating the right fermented foods. I do not take SSRI's and have not been diagnosed with major depression. I also find it hard to believe that it is a coincidence that as a species we have been eating and making fermented food for so long and so suddenly discontinued its use in a widespread way and are now seeing increases in many types of disease. Although lack of exercise may very well also be a huge contributing factor.

Depression, OCD, GAD, ADHD and most other neurological issues stem from complex feedback loops and deficiency in neurotransmitter systems.

They're labels applied to symptoms, not causes.

Like any complex system with feedback loops, sometimes intervention in the loop causes it to rebalance.

Sometimes the loop break is an intervention in serotonin, sometimes dopamine, sometimes GABA.

There is never a silver bullet. But there are bullets that make life manageable enough to break cyclic issues.

> The "depression is lack of serotonin" theories seem to have less and less base every day

But that is not true.

The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems.

The problem with medication is that it treats the symptom (lack of serotonin) rather than the underlying problem (how did we get there in the first place?) Kinda like telling somebody to loose weight by restricting their diet before first understanding what caused them to gain fat in the first place. Is your diet composed of garbage? Why is it, is it because you can only cook garbage? Is it because you can't cook and only buy garbage? Is it because you sit whole day and don't exercise? Is it because you are getting depressed and make it up with food?

The treatment should address the causes of the problem and not just the symptom.

This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it is so? Maybe it’s because this person’s favorite breakfast is a bacon-maple donut which they habitually consume 5 days per week. What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

We’ve optimized our efforts on treating symptoms and not causes. Drugs that survive regulatory scrutiny and are profitable tend to be those that treat symptoms of chronic illnesses. If you can prove that someone’s LDL goes down and they will buy it for the rest of their life, that’s a drug that will survive. They don’t have a miracle cure for this because they are withholding anything, there is just no incentive to research it and if there was, there is no good way to prove that drug X will cure non-visible condition Y without good, measurable data.

I think part of the reason is that there is lots of money in treating acute symptoms with medication while there isn't much in having serious talks with patients to try to debug their lifestyle problems that might be causing their health problems and then educate them on what and why they should be doing it.

I also think people naturally tend towards easy and fast solutions even if those solutions are known not to work. This self imposed blissful ignorance is what causes people to keep buying weight loss supplements or go on diets even though both are known not to work while we know that for 99% of people there is a simple solution -- reduce stress, learn to like to eat healthy and exercise daily.

> What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

Realistically this is what most people want. I spent years watching people choose to go on medications rather than make simple lifestyle choices. Habits are powerful.

It’s not possible to treat the cause when a patient wants the easiest solution. So yea, we have a bunch of medication‘s that treat symptoms. Causes are sometimes impossible to know, the body is complex enough that we don’t even understand how some medications work at all.

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