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Comment by matheusmoreira | Hacker News Reader

> You haven't even come up with a basic taxonomy of depression and you're already applying your theory.

We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence.

Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.

> In physics this would be blasphemous.

Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.

We don't fully understand depression. We don't even fully understand how some medications work. However, we have studies showing that by taking these medications patients improve and mortality decreases. That's enough to justify their use.

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> Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.

Those imperfect theories are applied today, and still work in lots of contexts. They are complete, but subsets. We can make predictions, given certain initial conditions, with accuracy as close to 100% as you require, the only issue is measurement. Comparing psychology to physics in this manner is pretty embarrassing, and shows a lack of understanding of physics.

Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.

> We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence. Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.

I didn't say they needed to have a 100% success rate. You just need to find the mechanism. I'd be happy with a 0.1% success rate if our determination of the mechanism implies that there is no cure once it reaches that stage.

Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.

edit: Don't drink alcohol to cure your depression. I suspect the mechanism is related to the gut flora. Alcohol kills the gut flora.

> Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.

Failures in nuclear reactors can have disastrous outcomes for a huge number of people. Is this comparable to the use of prescription drugs under medical supervision? A failure in these cases means the patient may experience adverse effects for no benefit, a risk inherent in any treatment.

> You just need to find the mechanism.

People are working on it. Meanwhile, we have make the best of what we know right now.

> Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.

Alcohol and depression aren't a good mix.

https://pubmed.ncbi.nlm.nih.gov/21382111/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799954/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712746/

> Alcohol and depression aren't a good mix.

Again my point, obviously I don't believe this to be true, but since it does have a positive success rate (there's no study which quantifies this, strangely enough, your studies are purely epidemiological, you'd have to take someone without ASD and then prescribe them ethanol at about 20% to actually study this) it would be negligent, as per your theory/ethics, to not prescribe this, and in fact it was prescribed in the past during prohibition [1]. Now, looking back this is obviously false.

> People are working on it. Meanwhile, we have make the best of what we know right now.

Great! The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.

I think you'll find the taxonomy of depression to be a subset of existing disease categories. The brain, gut, and nervous system are connected in a chaotic manner.

PS. I don't drink at all, zero alcohol. I agree that it's probably very much related to all existing depression categories, correlated positively.

[1] https://www.smithsonianmag.com/history/during-prohibition-yo...

I can find a better source if you want, I'd have to do some digging.

Finally, hopefully you have already read this:

https://www.sciencedirect.com/science/article/abs/pii/S01650...

Anyways, thanks for the discussion, I don't expect to convince you. Maybe you'll think twice, however.

> The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.

Absolutely. Healthy life style decreases the risk of depression and can help depressed patients. It's standard advice.

Prevention and treatment are different though. A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising. It makes sense to try and improve the symptoms prior to trying this.

> Prevention and treatment are different though.

There are different, but they are not mutually exclusive.

> A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising.

I had the same symptoms, I found that exercising and dieting was the only thing that gave me pleasure (other than alcohol or cannabis). During the thick of it I would do pull-ups by walking to the bar, knocking some out (if I had a RA flare-up then I would do planks), and then collapsing after my heart-rate went back down. The issue was that people kept telling me to keep eating carbohydrate, which was causing lots of inflammation (I had tons of visceral fat). I also found that direct sun exposure improved my symptoms a ton (I was talking a D3 supplement prior).

Maybe if we told people "We have no idea how to cure this--the only proven method is diet & exercise, and this often lead to an early death if you don't start now" it would work? Once I realized that myself, it was a huge kick in the ass. I was figuratively paralyzed because no one seemed to give me this most basic advice, and the only way to get to a psychologist where I live is to self-harm.

I know a cancer survivor who was told that, and she did it, at 65, and she was obese by a large margin with severe trauma from the chemo.

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