Comment by costcopizza | Hacker News Reader

Comment by costcopizza | Hacker News Reader

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The "chemical imbalance" theory has been losing steam for quite some time.

The British Psychological Society has issued this consensus statement: There is actually no evidence for the current view – and we agree with many senior psychiatrists in saying that – we do have an overwhelming amount of evidence that even severe psychiatric breakdown is actually the end result of a complex mix of social and psychological circumstances. People who have suffered things like bereavement, loss, discrimination, poverty, trauma, abuse, domestic violence, in other words things that have happened to you.

From my experience, and many others, we have a script running in the background of our minds. Nonstop. This script is brutal, telling us we're worthless, unable to do this, will always be alone, etc etc. It gets etched in our mind and we become it, and likely impacts all aspects of our brain chemistry. (Depressed patients are often deficient in many key areas Omega 3, Magnesium, Vitamin B, etc)

https://www.scientificamerican.com/article/is-depression-jus...

One thing, please, for anyone on this board, or anyone who intends to advise anyone about whether or not they should take medications:

Unless you are a doctor, you have no advice to give. Unless you are a doctor and have examined a patient, you have no advice to give except to that patient.

I don't care what good or bad experience you personally had with medication; people respond differently, and it does not qualify you to give advice to anyone about any drug they are considering taking.

I respectfully disagree. I would agree that someone-that-isn't-your-doctor shouldn't tell people what they should do, but hearing the personal experiences of numerous people that have taken certain medications or had certain therapies is invaluable. This is quite different than "regular" diseases and maladies. The drugs and therapies for psychological diseases aren't well understood and are very hit-and-miss. Like you said people respond differently, so hearing the experiences of multiple people can be just as, or much more valuable than your doctor's recommendation which may be based solely on a datasheet they read and maybe tried on a few patients. You may hear experiences of drugs that your doctor has never prescribed before or has never even heard of before. It's not uncommon for a psychiatrist to have certain go-to medications that they use almost exclusively. If those don't work for you, then getting advice from other patients can be a lifesaver.

The medication that helped me the most by far was not recommended to me by my doctor. I recommended it. And I found the medication through an ad in the lobby of the doctor's office plus I was considering that class of medication based on the experience of my mother. People rail on prescription medication advertising, but I might not be alive today if not for that ad. And that ad could have easily been a recommendation by a handful of random internet strangers (in fact I would trust the internet strangers more because it's less likely they have an agenda whereas the ad definitely has an agenda).

"...but hearing the personal experiences of numerous people that have taken certain medications or had certain therapies is invaluable..."

...in roughly the same way that the personal experiences of numerous people of psychic phenomena, UFOs, and the supernatural are invaluable. Or personal experiences of the safety of commercial aviation. Or that the sky is blue.

Anecdotes aren't data, data isn't always applicable, other people are frequently more concerned with themselves than helping you, and your mileage will vary.

> of numerous people of psychic phenomena, UFOs, and the supernatural are invaluable.

No, not at all. How would that be valuable? If psychic phenomena, UFOs and the supernatural were definitely real things that could help your difficult to solve problems, just not well understood and could vary in effect from person to person then they would be valuable. But they are not any of those things.

> Anecdotes aren't data

They definitely are.

> data isn't always applicable

Oh, certainly. 5 internet peoples say Drug Q helped with craziness syndrome even though that's an off-label use doesn't mean it will totally definitely work for you. But if you've tried everything else, 5 anecdotal experiences is far better than the 0 anecdotal experiences and zero studies of the zero other options you have.

> other people are frequently more concerned with themselves than helping you

How is this at all relevant? Maybe because a doctor gets kickbacks for prescribing a drug and so prescribes that drug despite it not being likely to help much? But that's just a good reason not to rely solely on your doctor. Nobody is more concerned about you than you. Doctors can have ulterior motives and can be working with out of date information especially when it comes to off-label uses of drugs. Common off-label uses became common because of anecdotes. And sometimes those anecdotes spurred the company making the drug to get it approved for that use. This isn't at all like UFOs.

> your mileage will vary

I am well aware of that. But some people are getting mileage out of it and the worst that could happen is I get no mileage just like am getting now (not right now, but before I found the right meds).

Unless you are a professional author, you have no message to communicate. Unless you are an author and have interviewed your reader, you have no idea how he or she will personally react to the words you write.

/s

The "get up and fix yourself" theory lost all its wheels long ago, though.

No, no, no, I'm not advocating for that at all.

Rather, trying to be the slightest bit aware of what the sewage of thoughts in your head consists of.

> trying to be the slightest bit aware of what the sewage of thoughts in your head consists of.

That's a pretty useful thing for a "normal" person as a preventative measure to reduce the probability of depression (although there's tons of biological causes including things about gut biome, overstressed immune system, etc., and it's not clear if this 'awareness' would help in those cases).

But to a person in the middle of depression, that's like asking them to fire up a debugger and inspect the issue, when their very problem is that their OS barely boots up and refuses to run any program whatsoever.

The first paragraph about the 'preventative' aspect might be what you had in mind, with the second para's content implicit in it, but I feel it's important to make it explicit given how widely misunderstood an illness depression is.

How do they explain the genetic factors that cause predisposition?

Just as the humans who eat too much sugar can more easily get type 2 diabetes, some humans who are exposed to 'X' can get mental diseases. (X is unknown or it varies). What if some humans are just more 'evolved' to live in the modern world than others?

10-12,000 years of living within dense populations, under despots, with periodic plagues, and in near constant war probably applies a lot of evolutionary selection pressures. Some of us whose ancestors were assimilated later probably have more genes that haven't been 'weeded out'.

I've read some research that human brain size has decreased over the last 100,000 years. The theory is that as humans began to become less independent, they had less need for certain types of brain functions. Since the brain is an extremely resource intensive organ, less brain means less energy requirements. So, humans quickly lose areas of the brain that are less necessary.

There are correlations between intelligence and depression. There are correlations between intelligence and sensory and spatial abilities. Maybe some of these things are related.

Wait, so are you saying it is or is not a chemical imbalance?

I think depression is a beast with many intersecting roads.

The chemical imbalance seems like it could be more the result of something than the root cause.

I'm just one person, but it really doesn't seem like that to me. There was no awful situation or experience that brought on my depression or continues to make me depressed. I call that situational depression. You aren't clinically depressed. You're just feeling really crappy because your situation is really crappy. Remove the crappy situation or improve it in some meaningful way and the depression goes away too. With clinical depression there is no trigger or "something" that makes you depressed. You could be in a great situation with nothing bad happening and you're still depressed.

Right now I'm in a situation that really weighs heavily on me. Yet I'm not depressed.

What you're referring to is, I believe, proximal causes and distal causes.

Distal causes in depression's case maybe stuff like sleep deprivation, overstressed immune system, gut biome issues, etc. (and possibly genetic elements, who knows!) with little known about how they cause it or how they interact/overlap with one another.

The immediate proximal cause is, of course, the "chemical imbalance", which is popsci speak for neurotransmitter issues (among possibly others), a higher level proximal cause might be a life event that somehow causes some 'critical mass threshold' leading a spiraling avalanche (though again, little is known at the biological level about why this is so, assuming it is so.)

Even if that is the case, if the root cause is just some triggering event, then the chemical imbalance can still remain even if the cause is no longer present.

It exists at a different level of abstraction. There might be a correlation, but there's no simple causation (or at least, not going in that direction).

Scott Alexander ('Slate Star Codex') wrote a very good post on how to think about the "chemical imbalance theory", where it's useful and where it's not. Here it is: http://slatestarcodex.com/2015/04/05/chemical-imbalance/

I also remember reading another article by someone in the field which explained it in terms of proximal and distal causes, which is basically about "different level[s] of abstraction" as tbrownaw in this thread puts it. Will link to it if I manage to find it.

Losing steam? You mean the theory was discredited because there isn't any proof whatsoever of it being true and we don't have the means currently to prove or disprove it (measuring said chemicals while the brain is alive). I'd say that's a little more than losing steam. That's on par with the anti global warming campaign as far as science goes. But it's a nice story (think fiction) so people like to keep regurgitating it, including psychiatrists and psychologists who all should know better.

But hey, it does sell a ton of drugs, so its primary purpose has been achieved.

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