“No convincing evidence” that depression is caused by low serotonin levels

I wonder how the popular understanding of these processes will evolve as more and more is discovered and understood.

My understanding of seretonin syndrome is that it's a serious life-threatening condition that can occasionally occur when people take too much MDMA.

> In conclusion, the anti-anxiety properties of SSRIs appear to be largely dependent on expectancy effects on dopamine signaling while SERT blockade is not sufficient for symptom remission.

Drug works, if you believe it does :)

https://www.nice.org.uk/guidance/ng222/chapter/Recommendatio...

It sometimes works, it's contraindicated for certain people, comes near the end of the list of things to try (wait to see if you get better and get some excercise/sleep/sunlight being low risk interventions for mild depression) and even when it is used and does work, starting/continuing antidepressants and other treatments is recommended.

It's just one more tool in an incomplete and inconsistent toolbox, not 1 weird trick your pharma company hates.

I know of one person who recently had some success with it, but they tried other things first.

Should they be doing both? I can't imagine shipping code that I don't know how it works, but it passes tests...

Otherwise, you'll get pseudoscience - just mix random chemicals and see how patient reacts, rinse and repeat until something works...

Or you can stick with something that has been already been scientifically studied and proven to be as effective as anti-depressants in curing depression - Cognitive Therapy. In fact, it even prevents relapses more than anti-depressants:

> Depression is one of the most prevalent and debilitating of the psychiatric disorders. Studies have shown that cognitive therapy is as efficacious as antidepressant medications at treating depression, and it seems to reduce the risk of relapse even after its discontinuation. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/

For those considering going to a CT therapist you can search for certified CT therapist from here: https://cares.beckinstitute.org/get-treatment/clinician-dire... (the Beck Institute was started by the founder of CT and is now run by his daughter who is also a professional in this field. Nowadays most therapist learn about CT during the education but only have the base knowledge of it and thus don't apply CT techniques properly during therapy, and remain ignorant of the advances in this field. Those who actually train and specialise in it are more effective.)

If a person is feeling sad, often, and without reason, and you tell them "Sorry, your brain is broken, you have depression, we will give you these pills to fix your brain chemistry." You have taken that person's autonomy away. They are now the victim of a disease.

I think the reality is that our society and civilization leads to a certain despair and sadness in many people, one that can be fixed by changing one's lifestyle, mindset, or overcoming challenges. This is not a disease, not a mental illness, not some health problem you cure with a pill. It's a spiritual dilemma that must be faced individually and overcome with effort and belief that one can change.

Essentially, I believe that by diagnosing people with "clinical depression" we are creating a self fulfilling prophecy and condemning them to a victim status that perpetuates their suffering.

There are some concerning departures from this with medical approvals based not on treatment, but biomarkers.

Without getting too political, two noteworthy recent examples come to mind. The first is abelacimab for alzheimer's, approved based on plaque, not disease progression.

The other is juvenile covid vaccines, approved based on antibody presence.

Again, it works

The article itself quotes one of the authors of the study, who is attending medical school in psychiatry, as starting that his training explicitly made this claim, that his textbooks make this claim, and that he himself was later passing it down to other students.

Other sources quoted by the news article are similar to your own claims. Overall, it sounds like there are camps in psychiatry that have indeed long abandoned this theory, but others who still hold onto it.

Furthermore, the meta analysis being talked about in the article does make the additional claim that SSRIs are perhaps not necessary for the treatment of depression. I don't believe they are right, but it's also misleading to suggest that theur research is entirely in line with psychiatric orthodoxy.

Let’s be clear though, I had an actual licensed psychiatrist say this to me last week. It’s not like people are getting this “pop-culture” information via blog articles…

You mean the TV commercials that played about 6 times per hour in the 00s explaining that depression is caused by a chemical imbalance ?

This for me doesn't seem logical. It could be that a long term imbalance makes you depressed, and reverting that imbalance takes time to affect the thought processes towards the positive. Only because the reaction is delayed, it doesn't mean it's not causal.

Read anything by Irving Kirsch.

He used The Freedom of Information Act to study All the antidepressants studies that were sent to the FDA by the pill pushers, Not just the cherry picked studies, but All.

He found they basically don't work better than Placebo.

Personally, I think the "Happy" drugs have been the biggest con job the American suffering have ever endured. At least we know opioids work--for awhile. Antidepesssnts just make Dr. Wealthy more wealthy.

My hope is most of these wonder drugs are sued into history, along with those mandatory doctor office visits.

Ask yourself this--why do Psychiatrists have the highest rate of suicide if these drugs work?

I'm glad we have residents whom picked an easy speciality upon graduation, but these drugs have such low efficy rates they should be illegal, or over the counter, with the exception of a few. Trazadone can be nasty. A bad reaction is cured by a needle to the middle part of the brain.

Most are easy on the body, but don't do anything besides make an Artist (Medicine is an art, and Psychiatrists are the milking to the bone.) wealthy.

God help our suffering Americans.

But they also see other patients showing measurable improvement, and trying different prescriptions until finding one that seem to have an effect is a common practice.

All in all, this is very murky situation, but drug prescription can still be effective and might be the only option for some patient for who other approaches didn't work.

So here's the interesting thing - there's evidence that 5-HT2a receptors are way too dense in people with depression. Antagonists obviously have a blocking effect, but increasing serotonin at the synapse counterintuitively has a similar effect - your body responds to it by paradoxically downregulating 5-HT2a receptors. Two totally opposite approaches with a similar outcome.

"Chemical imbalance" isn't actually taught as the root cause of depression. I suspect your psychologist might be overestimating their own knowledge of a different field (psychiatrist formally study these systems and medications, psychologists do not) and underestimating the amount of research being performed in this field.

Regardless, these drugs don't really work as "boosters" like commonly thought. It's better to think of them as modulators. In fact, in conditions like anxiety SSRIs are well-known to actually reduce serotonin transmission in certain areas of the brain. The research has diverged quite a bit from the simple marketing-material models that a lot of people have about these drugs.

The purpose of the drugs is to induce changes that result in positive downstream effects. It's not actually a contradiction that enhancing and inhibiting certain receptors could result in similar downstream effects. For example, a number of receptors in your brain will downregulate in response to both agonists and antagonists, even though they have opposite direct effects. Your psychologist's understanding of this topic is deeply flawed.

> 2. the drugs were tested inadequately across race, age, weight, sex.

SSRIs have been in widespread use since the 80s and tricyclics since the 50s. At this point, the idea that we haven't tested enough or that we haven't collected enough data is just a strawman argument proposed by people with impossibly high standards. I suspect no amount of testing would actually satisfy someone proposing this argument for drugs that have been studied for this long.

> 3. the drugs appear to be best applied for as brief time as possible but are routinely being prescribed for extended periods, and demand de-habituation and great care with withdrawal

It doesn't make sense to make blanket statements about "the drugs" when psychiatric drugs differ widely in this regard. Benzodiazepines should absolutely be prescribed for brief periods and this is reflected in their status as controlled substances and all of the prescribing literature. There are some doctors who ignore this advice and overprescribe, of course, but they are going counter to standard practice.

On the other hand, medications like SSRIs can actually take weeks or months to reach full effect and many patients unnecessarily relapse by quitting them early.

I'd be cautious of taking advice from anyone who makes blanket statements about "the drugs". This is bordering on uninformed anti-psychiatry.

> 4. almost all successful uses of the drugs are accompanied by CBT and like processes

The most successful uses of SSRIs are accompanied by therapy. However, we have plenty of studies where SSRIs are prescribed without any accompanying therapy and a positive result is still seen. If you're suggesting that the therapy is actually doing 100% of the work, that's easily disproven by the studies that test all combination (placebo, therapy alone, SSRI alone, therapy + SSRI).

I'd recommend getting your psychiatry advice from actual psychiatrists. The number of misunderstandings and mistruths in what you've relayed here is quite high.

It is also notable that the author has had plagiarism issues and other questionable behaviors in the past: https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism_and_fab...

Can you elaborate on who these people are? You're casting a wide net here.

My partner works in mental health. The reality I've observed is mental health is incredibly challenging. Much of it is highly situational and requires hours and hours of extremely time consuming, labor intensive therapy to even begin creating a meaningful treatment plan. If mental health had unlimited time, many providers would love to be able to provide this level of care.

In practice, medications are a highly cost-effective means of improving people's mental health. They can increase people's baseline significantly with therapy (time and cost) focusing on rounding out the rough parts. Many patients are not interested in the therapy component if they can get "80%" better with some medication.

IMO, this is why we're seeing such a boom in "pill mill" mental health startups. A large portion of the affected population is content being "mostly better, quickly" rather than "fully better, slower".

We don't know how to really measure things like depression, so we rely on animal models and medieval tests such as "Lets throw this mouse into a bucket and see how long it takes for it to give up treading water".

When we are able to take 'in situ' measures in a live person without risking their life, we may start to make progress on better treatments.

I swear, I do not reject the possibility that hallucinogenics can cure depression better than existing meds, but the almost religious enthusiasm for such a poorly studied chemical is deeply concerning.

And yes, before you accuse me of being a pharma shill, I know that the lack of serious study is due to legal restrictions and not scientific evidence. But that doesn’t change the fact that they’ve not been studied rigorously. In my State, they are being actively studied, let us hold back the praise until the results are in.

E.g. I finally started talking to girls, because I wouldn’t care about rejection that much. => Got into my first relationship and was happy.

Also, I started working on my passion project full time and I recently registered a company for it. Two years ago I would have not thought about doing this, as working for an employer is way „safer“.

But I don’t care about failing anymore.

It had no obvious cause and months of therapy had no impact. Within a few days of taking sertraline, it was essentially cured. I still get anxious from time to time but I'm able to live a completely normal life again. I had a few side effects (GI especially) for a few weeks but now the only side effect I have is I yawn a lot more, which is pretty tame.

I'm a big believer in the gut-brain connection and wonder if maybe it was something to do with the drug's GI effects that helped, but ultimately I have no idea and it doesn't really matter.

Is there a conspiracy shutting down depression curing alternatives all around the world?

Or as the Unabomber said, "Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness. Science fiction? It is already happening to some extent in our own society. Instead of removing the conditions that make people depressed modern society gives them antidepressant drugs. In effect antidepressants are a means of modifying an individual's internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable."

I think you're right. The problem is, this is the only life most of us have lived, and so we cannot imagine it otherwise, like a fish who cannot conceive of a world above water, or even that water is the medium surrounding it. If our entire society is causing this, then what can we do? Wage slavery, oligarchy, attention theft by tech companies, disintegration of community from various causes. Life for so many people is crawling through glass Monday through Friday, then getting shitfaced on the weekend. Is that happiness? How do we escape?

At the end of the day we are probably happiest when we are foraging for berries or mushrooms. This whole abstract 'society' crap we put upon ourselves leads to a lot of self directed scorn, embarassment, disrespect, and no doubt depression. How many billions of calories have been burned to fuel thoughts of worry about an outfit choice around the world? How many grey hairs have sprung up as a result of fretting about appearance? The stress society tries to shovel on you is such a waste of energy and does nothing to help you.

It's pretty depressing if you dwell on it for any period of time.

Also, we always like to think we will be happy “once I have…X” and then we get X and say well actually what I need is Y.

Most unhappiness is driven by vanity and desire (a bargain you make with yourself where you chose to be unhappy until you get something) to be better than our peers.

Until you can be content with nothing you wont be content even with everything.

If people can be happy in concentration camps we can be happy in dead end office jobs. They cant stop us from being happy.

Yet there are more depressives around than ever.

The idea that we're somehow way more exploited than the people who came before us does not seem compatible with any history book I've ever read.

Don't all those rich people also get depression? I think that rules out a marxist reading here.

If you're going to go this general direction, i'd say a better way would be, we now live in a system where work is never done, stress is pretty constant, and labour is less physical but more mental in the modern world. Perhaps our mind is just not made for continous mental labour. Being a farmer in pre modern times sucked, but at least you could turn your brain off more often.

Alternatively - or just, adjacently - with the internet (and big business, and widespread university education) we are culture-shocking vastly more people into a medium that can barely be understood from a detached intellectual and philosophical perspective, and is almost impossible to fathom from historical, traditional, ancestral or biological ways of understanding (the way humans operated for vast majority of our existence). We have little history to compare this new way of life to, and it's unsurprising if it's doomed to breed mental disease by its very nature. We have awakened far more people to an absurd reality, and "what is meaning?" is no longer just a question for a tiny group of overintellectual philosophers. Some of those philosophers say that one must walk through the valley of the shadow of death before we can find that answer for ourselves - but even they're gonna admit that a whole lot of people are gonna get stuck in that valley for a while if you just throw the masses in like we have. Hopefully that's just a temporary growing pain of our society as we gather our strength and do better but - time will tell!

(P.S. rich people are just as trapped in this malaise of meaninglessness. They have more agency, sure, but they're also still part of the systemic trap and unlikely to have much better answer on how to change anything than the common man. Only so long even a rich person can hide in hedonism before the depression catches up - or they just embrace the cold reality and adopt the "I got mine" attitude which said system is naturally inclined to. Depression may very well be due to our moralistic social being nature chafing with a cruel capitalist system which has won by almost every measure possible)

Also, a psychedelic experience is definitely not necessary for ketamine's antidepressant effects. In fact, the more responsible providers and studies are careful to keep peak plasma levels low enough to avoid this, and it works just fine. A lot of unscrupulous providers are using excessively high doses to induce psychedelic experiences, but this isn't actually supported by the evidence.

SSRIs and other traditional antidepressants will continue to be mainstays of long-term depression treatment if for no reason other than their sustainability and long-term efficacy is so much better than ketamine.

If you consider the brain a state machine, inputs from the nerves - through gut-brain axis, through your eyes and ears (socialising, environmental cues, sounds of safety vs sounds of threat), through your skin (touch) etc all impact the state. This state can range from safety to fight-or-flight (anxiety) to shutdown (depression). This is hugely simplified (for example neuroinflammation, endotoxins/LPS etc can impact this also) but I've found it very useful for regulating my own state and understanding why I feel happy, agitated, low etc.

Better think the serotonin/ monoamine hypothesis of depression is akin to saying a server load balancing failure is because of "electricity imbalance". Whilst electrons are undeniably involved, the explanation is not useful, and distracts from better truths.

We have such a scarcity of safe and effective tools to probe and influence the human brain. Herein lies the hope that the diseases we invent might be treated neatly by the tools we posses. Yet, given the origin of disease and the tools are sparsely interlinked, it is too often just a fantasy.

Yet to "do nothing" is usually not acceptable and so we persist, and iteration or invention become the next hope.

I'm sure "they're doing it wrong", but these were fully licensed doctors, prescribing drugs in an approved manner.

While not fun working through the gamut of medicines, some of them finally pulled me through it all. It took almost a year to fully recover with dedication to the medicine and modifications of it and therapy.

If I didn't have a good family and primary care doctor, I guarantee I would have died in some manner unless hospitalized.

People need to realize there is danger to their words. Psychiatry is nowhere near perfect, but people are trying. It is an incredibly difficult thing to understand. But I feel people who speak against medicine have never truly experienced deep depression or anxiety. A panic attack can hit you sitting on the couch, and then by literally doing nothing, your heart rate can reach 200bpm and massive amounts of hormones making your chest and skin feel like it's burning, and next thing you're calling an ambulance because you think you aren't breathing.

SSRIs were an absolute train-wreck to be on; they made me angry and violent. I was on them for 10 years and I honestly don't believe it ever helped against depression. If I missed 1 day, I'd get the infamous "brain zaps". It took me about 3 months to taper off the damn things and it was a brutal 3 months. The last one was in October 2012 and I will never take them again. I did not experience any increase in depression either, so that makes a stronger case for them basically be worthless for me.

This makes intuitive sense to people when discussing other topics. For example, when someone is in pain they don't need to have an "endogenous opioid deficiency" for opioid painkillers to alleviate their pain. They're just in pain, and modulating the opioid system with drugs is one way we can reduce that pain. Or COX-2 inhibitors. Or a number of other substances.

Likewise, modulating the serotonin system with SSRIs is one way we can modulate depression symptoms. People don't need to have a "serotonin deficiency" to see benefits from modulating their serotonin system.

Maybe it’s a bit cute, but with this understanding, I think the headline is not shocking. We will never find the one cause of depression because there isn’t one.

In my opinion, our best bet is more personalized medicine: helping people identify which rivers are filling up their lake of depression. For most people it will be a weighted combination of many things, but I think there will usually be some principal components.

[1]: https://www.science.org/content/blog-post/how-antidepressant...

> ...A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness.

> These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/

Not all patients with depression find relief from SSRIs, or medications in general, but some certainly do.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299662/

Not a mark of wisdom to use these words about such topics.

I agree that SSRIs and bipolar are a tricky mix, but they work for some patients.

That paper is very clear that they did not study misdiagnosis. They are a bit jargony with the use of "overdiagnosed."

"Overdiagnosed" does not mean incorrectly diagnosed, it means that there are subgroups who get a net harm from being treated.

A more understandable term for what they measure is "overtreated." The solution is likely better protocols for mild cases, not to state that ADHD is not a thing.

80% of ASD kids meeting criteria for ADHD doesn't mean that 80% of ADHD kids meet the criteria for ASD. ADHD seems a lot more common.

This is untrue. There is lots of data to suggest elevated LDL is a risk of cardiovascular disease and that high HDL lower risk.

Pfizer's drug failed because of safety issues, not because "There's no such thing as good / bad cholesterol".

All current nutrition advice? Does this equally include the nutrition advice that your cousin gives on Facebook, as well as the advice given by doctors of nutritional science?

I get where this skepticism comes from. Nutrition is complicated, and there's a lot of bad advice shared by random people you meet. There's also the diet supplement aisle at your local grocery store, which is full of poorly-regulated products with dubious claims. (At least, in the US, we have these. They are not regulated as drugs.)

At the same time, nutrition-based interventions are some of the most effective public health policies we've ever implemented. In the US, we have programs like WIC. We have iodized salt. We cure blindness in children. We cure scurvy. These are all amazing things--things which we kind of take for granted, because we're not ever exposed to scurvy, childhood blindness, etc.

This is not the first time I've heard such extreme skepticism of nutritional science and it just boggles the mind because if you talk to someone who works in the field, they have amazing success stories to talk about.

You know, just the other day I read about some brain scan study which suggested high-functioning autism looked, in brain scans, more like ADHD than like profound autism. But I think to some extent this sort of problem is inevitable if you're trying to dream up a taxonomy for conditions entirely from how they present themselves with a limited understanding of their biological basis.

If you really want to dive into the wealth of counter narrative research that's being conducted, here's a huge collection http://haidut.me

Go on…

(I’m adult diagnosed, for disclosure, but please do go on and tell me how suspect my diagnosis was, how I shouldn’t have been diagnosed as a child, how my medication is harmful. Go on and tell me about my life which you know better than I do.)

Emotional abuse / neglect, especially the one that occurs in childhood.

* You feel something in life is lacking but dont know what, or blame yourself for it, or look for it in in thrill seeking activities, or through buying stuff to fulffill this emptiness, or you escape from this ever present painful feeling with addiction (hint of what that thing is: being really loved, not romantically loved, but actual unconditional love, the one that only healthy parents can give and which you feel in some way when you have a community behind you. Partial love given by a lot of people ends up almost feeling like parental unconditional love.)

* Can't seem to make friends, or make friends but don't seem to connect at a deep level and end up feeling lonely anyway.

* Also the cause of social anxiety.

* Burnouts due to lack of boundaries (which also come from abuse). Feeling like you put others first all the time, and end up feeling somewhat fake.

* (...)

All of these can lead to depression. And they all have the same root-cause. And barely anybody talks about this (unless you go really looking for these communities, but unfortunately they're not really mainstream).

Essentially the awareness of everyone else's lifestyle and prosperity, amplified by the advent of print newspaper and now social media, is the key destroyer of joy.

The peasant works his farm and feeds his family and raises his kids. He knows he will not become king. He barely knows what the king's lifestyle is. In modern America we are blasted with thousands of kingly lifestyles 24/7 and are constantly asked, why aren't we living like that? Why do I have to work? Why can't I date the supermodel? Why do I have to struggle with rent?

Our minds have not evolved to deal with this super-stimulus nor the self comparison of endless idealized lifestyles we cannot all realistically achieve.

That reminds me of one of those weird little findings. People with depression appear to more accurately estimate their control (or lack of control) over a situation, than people who are not depressed. Perhaps non-depressed people are just delusionally optimistic about the chances of things going wrong. (If true "overthinking" is probably related in some way to this.)

> When participants were asked to press a button and rate the control they perceived they had over whether or not a light turned on, depressed individuals made more accurate ratings of control than non-depressed individuals.[5] Among participants asked to complete a task and rate their performance without any feedback, depressed individuals made more accurate self-ratings than non-depressed individuals.[6][7][8][9] For participants asked to complete a series of tasks, given feedback on their performance after each task, and who self-rated their overall performance after completing all the tasks, depressed individuals were again more likely to give an accurate self-rating than non-depressed individuals.[10][11][12][13][14][15]

https://en.wikipedia.org/wiki/Depressive_realism

If you did then you would know it is a very real physical problem that positive thinking can't really overcome. Not just physically in terms of brain chemistry but you often literally sink into your chair as if you were physically exhausted and don't want to move.

Depression enforces negative thought templates. No matter how good your life is going you will usually see the negative side of things and be depressed mentally and physically.

In a healthy person this is not the case. Your mood will vary widely by the situation you are in but most of the time positive thought templates will prevail and allow you to see the best even in difficult situations. It also gives you the mental/psycological energy needed to tackle difficult challenges/problems. In a fully depressed state you have no such energy no matter what your willpower is.

A healthy person has the mental and physical energy to tackle the day even when it involves hard/tedious or unpleasant work.

One paradoxical thing about depression is that it can sometimes actually feel good, in a comforting "oh it's that familiar feeling again" way. Usually that is just when you feel the onset of symptoms before the bad feelings/thoughts/feelings.

That's a pretty big claim. I know you're just putting out your own personal theory and you're not trying to declare you have the "answer", but I don't see how that follows.

A first step is establishing that depression is more prevalent now than in the 50s. You'd have to account for the lack of diagnosis then and find some other indicator of the true rate of depression.

Not an easy task, for sure, but my first thought is that depression just went untreated then and people became resigned to their lot in life and suffered.

Sertraline (Zoloft) is used to treat both depression and/or OCD. The dosages overlap too (OCD usually is a higher dosage I believe). It is also used to treat anxiety.

I suspect there is a causal chain that goes like: compulsively thinking > anxiety > depression/suicide. I'm not sure how preventing reuptake of serotonin prevents compulsive thinking, but I suspect the mechanism is closer to preventing the thinking aspect and the other feelings are further down the causal chain.

I am not an expert and I have only read a couple papers due to someone in my life taking Sertraline and having it reduce their OCD. (I thought it was only for depression based on my lay opinion)

If anyone has read anything interesting about the thinking aspect, please share links!

Medication won't help you if you're living paycheck-to-paycheck, dealing with landlords constantly increasing rents while wages are stagnant, worried that getting sick and missing a couple days of work will result in losing your place to live.

In terms of depression, an abundance of possibility leads to disappointment, deferred action, and deferred acceptance.

I can only speak for myself, but a preoccupation with trying to optimize my life in the face of infinite possibility has led to a tremendous amount of anxiety and at times depression. For lack of a better term, it is an Omnivore's Dilemma of the Soul.

I guess information size is still exploding in volume and depth, but perhaps in quite a few hundred years this will slow and we catch up through several generations. Maybe then depression or anxiety will be filtered out of subsequent generations as we cope better?

Personally I suspected a lot of it was down to poor nutrition/diet, exercise, night shift work, overall sleeping less and exposure to screens/information. The main factor I think is food e.g. sweeteners, sugars, e-number chemicals, preservatives, and salt all altering our body chemistry.

Most people used to be apart of some form of community. You made friends, made dinner together, found love , etc. In this community.

Now their's none of that. Everyone is a disposable interchangeable part. Instead of getting a stable job, and having a foundation, now we're all gig workers. Or short-term contractors. Back in the day, you'd work the same job most of your life, and that's one of the ways you made friends.

Back when I lived in LA, I was lucky enough to be a part of a fantastic apartment community. We cooked, and watched sports together. While I had to leave for other reasons, I definitely miss these guys.

The internet's a poor substitute, even at a bar my behavior is restricted by social norms. In real life I've never had anyone call me a slur, or personally attack me.

Online it's absolutely relentless, I don't use social media or online dating for this reason.

History was not neater, nor more uniform. The typical departure point in 1950s conformism, with the assumption that prior history must have been even more conformist.

But that's not how most of history treated gender roles, marriage, work, etc.

A primary example in the early parts of the book are anglo settlers who joined native american tribes either voluntarily or by force. They almost universally preferred their new lifestyle and if brought back into white society would frequently try to escape. The reverse pretty much never happened.

This is not a new theory. It's called negative self talk, and fixing that is one of the core approaches in treatment of anxiety and depression.

Part of the problem in describing/treating this condition is that depression is a huge constellation of overlapping causal mechanisms. You may be describing one set of mechanisms but it’s certainly not the only one.

(Probably making anyone who actually knows what they're talking about cringe. Take it easy, lol)

Edit: I assume you're talking about https://news.ycombinator.com/item?id=32161183, which was correctly downvoted for being a flamewar comment. Please don't post comments like that or https://news.ycombinator.com/item?id=32161488 or https://news.ycombinator.com/item?id=32161557 to HN.

Just talk to you doctor might the worst popular advice on the Internet. My experience is the opposite: until you take matters in your own hands, experiment with various treatments and preferably find an open minded doctor who is willing to help you along the way (not only with advice but mainly with providing access to medication) it will not work. It might work if your problem is simple and typical but it won't otherwise.

The reason is obvious: you are likely as smart as your doctor. They might have more experience and general knowledge but they have an hour (if you're very lucky) for you and you have all the time in the world to catch up and figure it out.

Yeah, talk to doctors if you're the kind of person who drifts to homeopathy or other shamanism but please don't solely rely on them when it comes to your health of you have a bit of a brain.

It's that natural remedies such as psilocybin and LSD which have proven their worth for a very, very long time are still being blocked by you-know-which industry.

That said, in countries where pharmaceutical manufacturers are allowed to market prescription medicines, and one was recently convicted for pushing addictive substances on huge numbers of people, a certain amount of skepticism may be warranted.

("medicine X saved my life" and "a large number of people who don't get any real benefit for medicine X are being sold it" and "medicine X may have extremely bad side effects for some people" may co-exist, as well)

https://www.science.org/content/article/nimh-wont-follow-psy...

Or this is good evidence that cellphone usage is causing suicide (~1/3 of people in US had cellphones in 2000, ~100% do now).

Your causality is poorly explained.

That's incorrect. There's good evidence that economics, in combination with lack of funding for suicide prevention programs is driving the increase in suicide rates. See https://www.bbc.com/news/world-us-canada-44416727

In chapter 2: The year after I swallowed my first antidepressant, Tipper Gore -- the wife of Vice President Al Gore -- explained to the newspaper USA Today why she had recently become depressed.

Just so that it's clear: I have nothing against Al Gore -- except that he lost the election.