The causes of depression are much more complex than the serotonin hypothesis suggests:
You'd be forgiven for thinking that depression has a simple explanation.
The same mantra — that the mood disorder comes from a chemical imbalance in the brain — is repeated in doctors' offices, medical textbooks and pharmaceutical advertisements. Those ads tell us that depression can be eased by tweaking the chemicals that are off-kilter in the brain. The only problem — and it's a big one — is that this explanation isn't true.
The phrase "chemical imbalance" is too vague to be true or false; it doesn't mean much of anything when it comes to the brain and all its complexity. Serotonin, the chemical messenger often tied to depression, is not the one key thing that explains depression. The same goes for other brain chemicals.
The hard truth is that despite decades of sophisticated research, we still don't understand what depression is. There are no clear descriptions of it, and no obvious signs of it in the brain or blood.
The reasons we're in this position are as complex as the disease itself. Commonly used measures of depression, created decades ago, neglect some important symptoms and overemphasize others, particularly among certain groups of people. Even if depression could be measured perfectly, the disorder exists amid myriad levels of complexity, from biological confluences of minuscule molecules in the brain all the way out to the influences of the world at large. Countless combinations of genetics, personality, history and life circumstances may all conspire to create the disorder in any one person. No wonder the science is stuck.
Journal Reference:
Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022). (DOI: https://doi.org/10.1038/s41380-022-01661-0)
(Score: 2, Disagree) by its_gonna_be_yuge! on Monday February 13, @08:07PM (7 children)
... a very depressing article.
(Score: 4, Interesting) by JoeMerchant on Monday February 13, @08:50PM (5 children)
I believe the animal model test for "level of depression" sums up the condition nicely, it's the forced swim test:
1) A rat is placed in a deep vat of water which they cannot climb out of.
2) A platform is placed at a random location within the vat which the rat can swim-search for, find, and stand upon - resting and able to hold its head above water.
3) After training 1 & 2 for a certain number of trials, "the test" is administered in which the rat is placed in the same deep vat of water, this time with no platform
4) The sooner the rat stops swim-searching for the platform and allows itself to drown, the "more depressed" it is.
The sooner one "gives up" and stops striving to X (assuming X is important, to them) the more depressed one is.
One of the clinically proven temporary cures for depression also sheds significant light on the condition: ECT, electro-convulsive therapy. It used to be gruesomely hideous (back when they used it as a "cure" for homosexuality), breaking your own bones with muscle spasms and such, but today it is quite refined - still 50 or 60Hz AC 110 or 220V applied to the temples, but current limited and timed for maximal desired effect and minimal side effects. It is one of the more effective short term cures for depression, when it has the side effect of: memory loss. Unfortunately: the depression usually returns, and the dark joke in the industry is:
A great many people are depressed because their life sucks, much like a rat in a vat with no platform, all they can do is swim but never find relief. Once the ECT amnesia either wears off, or they make new memories of how much their life sucks, the depression returns.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 2) by Freeman on Monday February 13, @09:48PM
I'll take one serving of Depression for $100, please. No, you can keep the Electro-therapy, thanks though!
Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
(Score: 1, Insightful) by crafoo on Monday February 13, @10:00PM (3 children)
Very interesting post. My experiences with people agree. Once they give up, that's depression. Some people feel like they are in a situation they are trapped in and have no power to escape. Some people have a very negative aspect of their life they feel they have no power to change. Some people were just brainwashed with fairytales and lies about what life is and what they should expect from life. Some people are surrounded by assholes constantly undercutting them, intentionally destroying their confidence, mood, outlook.
I guess some people fight against their suffering and some do not. I don't know, pick one and quit complaining.
(Score: 5, Touché) by JoeMerchant on Tuesday February 14, @01:31AM
>Some people are surrounded by assholes constantly undercutting them, intentionally destroying their confidence, mood, outlook.
Does Google send you a constant stream of gaslighting stories in your news feed too?
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 2) by coolgopher on Tuesday February 14, @02:26AM (1 child)
I'll add a slight-disagree here. It's quite possible be depressed and feel trapped with no available options without having given up. Giving up (at least for me), would mean actually walking past the checkout.
(Score: 2) by aafcac on Tuesday February 14, @03:49PM
Yes, giving up is more likely to result in suicidal ideation than mere depression. Depressed people do still have some hope, otherwise they'd off themselves and be done with it. They just move and think more slowly and have lessened, or no, ability to enjoy things or seek out pleasure.
(Score: 4, Insightful) by SomeRandomGeek on Monday February 13, @09:57PM
Personally, I am encouraged by this. Whenever I heard the serotonin imbalance theory, I thought "That is obviously false! Next they're going to bleed me and balance my humors!" Knowing that you don't understand is an important precursor to understanding. Looking for a complex explanation instead of a simple one is a good step forward.
(Score: 2) by DeathMonkey on Monday February 13, @08:51PM (3 children)
It's called a metaphor...
The internet was never a highway or a bus or made out of tubes, either.
(Score: 4, Funny) by Gaaark on Monday February 13, @09:53PM (2 children)
Like the song says:
My wife is a highway; I'm gonna ride her all night long....
;)
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 2) by RS3 on Tuesday February 14, @12:02AM
For some more misheard lyrics fun:
https://www.youtube.com/watch?v=1wMaF-l5SAY [youtube.com]
https://www.heart.co.uk/photos/funniest-misheard-song-lyrics-ever/ [heart.co.uk]
https://www.kissthisguy.com [kissthisguy.com]
:-}
(Score: 3, Insightful) by JoeMerchant on Tuesday February 14, @01:55AM
Dopamine, adrenaline, serotonin, they're all fun for a little while, but there's a price to pay sooner or later...
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 3, Insightful) by Anonymous Coward on Monday February 13, @08:58PM (12 children)
I don't follow trends in psychiatry closely, but over decades there is changing opinion about there being physical causes for psychiatric conditions versus there being behavioral causes (abuse, trauma, the double bind, etc.). I think the article leans towards physical causes fairly heavily. Perhaps the answer is "somewhere in the middle". Certainly many (most) humans are born into lives of servitude for no good reason they can tell, so depression does actually make sense. Why would you "treat" that?
(Score: 5, Insightful) by JoeMerchant on Monday February 13, @09:07PM (11 children)
>Why would you "treat" that?
Sell pills and more entertainment products, win win!
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 1, Insightful) by Anonymous Coward on Monday February 13, @09:23PM (4 children)
Unfortunately it's probably even uglier than that. It means the servile, depressed human has accepted blame for their condition. A further indignity - which is the real prize in our narcissist culture.
(Score: 4, Funny) by Runaway1956 on Monday February 13, @09:56PM (3 children)
Sounds a lot like Hinduism to me. If you're suffering in this life, it's because you were an evil bastard in your past lives. If you want to stop suffering, stop being evil.
Abortion is the number one killed of children in the United States.
(Score: 0) by Anonymous Coward on Monday February 13, @10:41PM
I for one welcome our enlightened Hindu overlords.
(Score: 2) by aafcac on Tuesday February 14, @03:56PM
The purpose of that is mixed. It did lead to the caste system where some people would fail regardless of what they did, but it also offers a less nihilistic explanation of why some people start with more than they could possibly use and others are born into abject poverty. It also gives some hope that through our actions that some benefit from our actions may come later on.
It's probably less damaging than the American belief in upward mobility, at least the Hindu view on karma, dharma and registration can't be specifically disproven, like American upward mobility that has a similar effect on the lower classes.
(Score: 2) by DeathMonkey on Tuesday February 14, @04:59PM
Indicating that humanity is not at the top of the reincarnation pyramid.
Actually.....that checks out. Dude was probably one real asshole of a dolphin!
(Score: 3, Insightful) by DannyB on Monday February 13, @09:37PM (5 children)
Soma seemed to be a plentiful and socially acceptable drug in Brave New World.
How often should I have my memory checked? I used to know but...
(Score: 2) by Freeman on Monday February 13, @09:50PM (4 children)
So, what you're saying is that LSD was the savior and we just messed everything up?
Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
(Score: 3, Interesting) by DannyB on Tuesday February 14, @02:43PM (3 children)
I wouldn't think soma was LSD because that would make the Delta's less productive rather than more productive. The idea was to keep everyone happy with their miserable lives, and working.
How often should I have my memory checked? I used to know but...
(Score: 0) by Anonymous Coward on Tuesday February 14, @09:23PM (2 children)
> happy with their miserable lives
This is a mind-bending concept. Explain?!
(Score: 2) by sjames on Tuesday February 14, @11:00PM (1 child)
Treat people like crap, drug them until they stop noticing and become "OK" with it. The alternative would be to not treat people like crap, but that would require a major re-organiozation of society and especially the economy so nahhh.
(Score: 2) by DannyB on Wednesday February 15, @03:38PM
Without the drugs, they might get very strange ideas. Subversive ideas. Heck, they might even try to unionize. OMG!
How dare they demand restroom breaks!
How often should I have my memory checked? I used to know but...
(Score: 5, Interesting) by Gaaark on Monday February 13, @09:55PM (6 children)
it's a lack of sleep (due to my son) and, i believe, my guts: when my guts are bad, I am more likely to feel off/depressed.
Gut flora/whatever, i think is the solution to A LOT of problems with the brain.
--- Please remind me if I haven't been civil to you: I'm channeling MDC. ---Gaaark 2.0 ---
(Score: 4, Interesting) by krishnoid on Monday February 13, @10:46PM (5 children)
To repeat myself, I think it's important that whenever you're prescribed antibiotics, to finish the final dose of antibiotics before going to sleep, then in the morning take at least one dose of probiotic pills containing a spectrum of replacement gut flora, then skip breakfast and maybe lunch so they have a chance to establish themselves in the gut before anything else does, and before they get mixed with food, digested, and just pass straight through.
This is assuming probiotic pills actually work, but it's a noninvasive thing to try in any case.
(Score: 1, Insightful) by Anonymous Coward on Monday February 13, @10:54PM (1 child)
Don't forget electrolytes!
(Score: 1, Touché) by Anonymous Coward on Tuesday February 14, @12:06AM
I'll harvest some from some batteries.
Q: is car battery sulfuric acid better, or potassium hydroxide from carbon/zinc, NiCAD, NiMH, etc., better?
(Score: 2) by JoeMerchant on Tuesday February 14, @02:04AM (2 children)
I had a heavy course of antibiotics for several weeks to treat osteomyelitis. Coincidentally, I had started making homemade kefir which produced far more kefir than the family would normally consume, but I kept it up for the duration of my antibiotic treatment.
About half way through the treatment the doctor examined my throat and said "you should have thrush by now, why don't you have thrush?" I didn't like her much so I just shrugged and said "I don't, do I?". She confirmed I didn't.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 3, Insightful) by krishnoid on Tuesday February 14, @02:58AM (1 child)
I'm starting to think doctors are more like car mechanics, in that they apply a prescribed repair and observation protocol, at least in the more litigious developed areas [youtu.be]. If something's outside of it, it's not part of the protocol. I wonder if it's like this:
Like how free-willed humans in large groups interact messily in a field called "social science" -- more observational and less strictly reproducible experiments than STEM -- I'm guessing microbiomes kind of do their own thing too, so a familiar level of guaranteed reproducibility is out the window. If it's not part of the experiment, then the observations may never make it through the loop to the care delivery protocol.
(Score: 0) by Anonymous Coward on Tuesday February 14, @09:27PM
Fortunately for the bottom line, we innovated these three steps into a single consolidated step where untrained grad students without fail (because nobody wants to fail duh!) produce whatever results are needed to approve the new treatment.
(Score: 4, Insightful) by darkfeline on Monday February 13, @11:52PM (1 child)
The reason we're in this position is very simple. You can make a lot of money selling life long prescriptions to treat chemical imbalances. Try following the history of this particular medical "theory" and its key proponents.
Join the SDF Public Access UNIX System today!
(Score: 3, Informative) by pdfernhout on Tuesday February 14, @01:51AM
See also for alternatives: https://therapyinanutshell.com/depression-is-not-caused-by-a-chemical-imbalance/ [therapyinanutshell.com]
"When you have depression, you deserve as much good information and treatment options as possible. Therapy, exercise, a nutritious diet, good sleep, and reducing stress usually get better results in the long term than only medication..."
Video version:
"Depression Is Not Caused by a Chemical Imbalance"
https://www.youtube.com/watch?v=QsZqbrFTUm0 [youtube.com]
More resources I've collected on health and wellness are here:
https://github.com/pdfernhout/High-Performance-Organizations-Reading-List#health-and-wellness [github.com]
The biggest challenge of the 21st century: the irony of technologies of abundance used by scarcity-minded people.
(Score: 3, Insightful) by Opportunist on Tuesday February 14, @12:02AM (4 children)
Look around yourself. If that doesn't make you depressed, I guess you've found some kind of drug that lets you black out that information.
(Score: 4, Interesting) by anubi on Tuesday February 14, @04:29AM (3 children)
I'm getting that too. I used find solace in my work. But not much market for what I enjoy doing that doesn't involve interfacing with "leadership" types that make creativity a living hell, with our differing goals...theirs being cost and profit driven, and mine primarily making a useful thing driven. You know, open source vs. patented, customer can't modify it kind of product. I don't get along with MBA types.
Right now, I am seeing just how efficient I can make a lithium cell charger/balancer for 300 AH cells (4.2 V LiFePO4 300AH cells, maintained individually, but assembled into 48 volt arrays for powering refrigeration compressors.).
I used design this kinda stuff for an aerospace contractor before the business suits bought the place and laid off the worker bees to improve the bottom line that the executive bonuses were tied to. So I design weird stuff, and often have to design the SMPS right down to winding the magnetics. Wire size, core geometry, size, core material, MOSFET drive topologies, some of which were our own design and I have yet to see them even named. One can arrange reactances to do quite useful things. The one part I don't use in my converters is a resistor. But I do sometimes have to use some in the analog control loop.
One thing I have learned...the existence of a team of highly trained technical nerds, socially compatible, working together, each doing his thing, is an extremely rare occurrence, the result of decades of social and technical interaction, and a team, given the right conditions, may slowly but surely self-organize.
Much like a gemstone, which may represent eons of self-assembly.
But these teams are easily destroyed. Generally, by controlling economics. The team may be repurposed to flip burgers or greet people to Walmart. However, the reverse is highly unlikely to happen.
I am presently observing the destruction of centuries of work done by our ancestors.
All over the world.
Instigated by our so-called leaders.
Isn't this enough to depress any sentient entity?
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 0) by Anonymous Coward on Tuesday February 14, @09:17PM
3.2 volt, not 4.2 volt cells.
(Score: 1, Insightful) by Anonymous Coward on Tuesday February 14, @09:37PM (1 child)
Looking back over 25 years in science, I too see only rare pockets of collaboration. The focus is more and more on reporting to "stake holders", who ironically have no skin in the game except to cream off your profits while beating you to death with management cliches. All risk on the guy doing the work who is supposed to sweat blood for the boss, just like on TV's The Apprentice. I don't think science nor scientists work that way.
(Score: 1) by anubi on Wednesday February 15, @01:15AM
They don't. I believe that's why we have to import so much stuff.
And for the time being, it will work that way.
Burning ones house to keep it warm.
We used to call this "killing the goose that lays golden eggs" in the belief that by simply doing away with the goose, one could get all the eggs, right now. Seems that paradigm must have been part of a business education. I've watched that happen at several companies and two churches.
I hate seeing all this useless, unnecessary, woe our leaders are fomenting on us while using their leadership status to shield themselves from the fallout.
If I did such things, I would be shot, and in my mind, rightfully so, in the eyes of all I hold as true.
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 3, Interesting) by DrkShadow on Tuesday February 14, @02:36AM (3 children)
Depression is an analytical state of mind: something is wrong; take a step back, look at things in detail, figure out the problem. Then fix it. Then move on with life. This is depression: the analytical, reserved state of mind, in which you're identifying a problem.
Most people identify this problem:
- job sucks
- not enough money
- getting rejected
- etc
Ok. Fix it. and get on with life.
That last part is what causes _chronic_ depression: not fixing it. In fact, most people can't fix most of those things. Job sucks? People, boss, customers, etc treat you like shit? You need a job though. You can't quit. No one's hiring. You can't change jobs. Go back to work tomorrow, this sucks. Get home, play games; feel down. Friends start noticing the change in behavior, start not inviting you. Why don't I have friends?
etc, etc, etc.
The problem has been identified, but the fix has been rejected. Now you're stuck in the depressed state, looking for the problem -- but your mind isn't finding one -- _another_ one -- because the problem was found and rejected as unsolvable. So your mind keeps looking, and you maintain the depressed state, ever seeking the problem.
The fix, then, is to recognize the core problem. Yes, your job really does suck. Or, yes, people really do dislike you. In fact, recognize it, and make SURE your mind recognizes it. Make it into a core of your being, acknowledge it and welcome it: recognize this thing about yourself. It must become your reason for every decision. Pay too low? That's why you're not going to the movies this week. Boss treats you like shit every day? That's why you're going to smile back at them when they shout at you today.
By recognizing and accepting the problem, and acknowledging the fix as "this is my life," you're fixing the problem. At least, you're achieving what your mind wanted: you've identified the problem, and you're working through it.
Really, it won't make your job better, or increase your pay, or get you more friends. At best, it'll get you to be content. Why aren't you happy? Because a very rare few are happy. If that's your problem, then _recognize_ that as your problem, and accept it: you aren't happy. So what are you going to do tomorrow? Sit on the couch and cry? or go ride a bike, because that's not going to make you happy either, but at least it'll make you more fit.
Recognize the problem that has no solution in modern society. Make it a part of every decision that you make. Recognize it as the cause of every single decision that you make. Don't ever forget the problem, not even for a minute. Then you can leave the depressed state, the cause for depression is resolved, the problem is identified and understood.
But just like lithium pills, it's not going to raise your pay.
(Score: 3, Insightful) by krishnoid on Tuesday February 14, @03:15AM
Be careful -- there are situations, events, and time periods, and then there's a persistent sort of experience that transcends all of those. I think people confuse a persistent, uncorrelated disorder in mood with space/time/event-circumscribed perceptions. If the circumscribed situations are extensive (e.g., war), then sure, it could show up as a long-term issue, but don't otherwise discount the possibility of an internal sort of persistent dysregulation.
But go and get on that bike. Because if you do have a long-term condition and it improves one day, at least you won't have to start from *that* point trying to become physically healthier.
(Score: 2) by Common Joe on Tuesday February 14, @08:07PM
I'm sorry. I think I missed something. What is "the fix"?
Acknowledging that my life is sucky is not a fix.
(Score: 2) by acid andy on Wednesday February 15, @12:10AM
In other words you're describing someone having certain expectations of what they want out of life and finding over and over again, no way to meet those expectations. That can certainly lead to depression. I'm not sure I would describe the analysis process as the depression itself; the depressed state may include some analysis of problems but from my experience it's also a process of withdrawal, disillusionment with the regular routines and pastimes and the brain just shutting down to a degree to escape the pain of everyday existence.
When unmet expectations were the initial cause, you can try to adjust your expectations, much as you suggested, or the luckiest ones may find that by changing their environment, their attitude to risk, learning new information, or receiving external help, the expectations actually do get met after all.
Either way, once the person has been through a significant period of depression, AIUI it doesn't take much in the future for those brain patterns to be triggered back into action once again, even though the original causes of the first depression may be long gone by many years.
Master of the science of the art of the science of art.
(Score: 2, Interesting) by unhandyandy on Tuesday February 14, @04:27AM
Depression may not be a disease.
It may be a reproductive strategy.
Perhaps consciousness is too taxing for some at the bottom of the food chain.
Shutting down feeling may be a viable strategy.
Happiness may not be essential to life on Earth.
(Score: 2, Interesting) by pTamok on Tuesday February 14, @08:19AM
I think depression as a diagnosis, in common with many other diagnoses, is an umbrella description that covers a collection of different illnesses that show similar, if not identical symptoms. Part of the reason for my belief is the number of different treatments that ameliorate 'depression' for some people: everything from electro-shock therapy, to LSD, tricyclics, SSRIs, lifestyle therapies, and talking therapies. There is also a spectrum of depression: sub-clinical, minor, major, bipolar, chronic, acute.
What many people with chronic depression say is that there is a world of difference between having a low mood for a few days, and chronic depression where you feel hopeless for months or years. Whatever the causes of depression are, it certainly ruins lives.
Many well-known and accomplished people have had to manage depression: Dickens, Lincoln, Churchill, Tolstoy, Beethoven; so much so that it there is a trope of the 'gifted but tortured artist'. They are people who managed to cope with depression, unfortunately many don't.
Some of the other comments, are, I think, insightful, in that a common thread appears to be people who cannot make changes in their lives that they believe to be necessary. Continual frustration leads to depression in some. Why that is is not known. I hope effective therapies can be found.
(Score: 1, Insightful) by Anonymous Coward on Wednesday February 15, @12:15PM (1 child)
Anchored down by decades long mortgages or soul destroying rent (1/3 of your wage? how did this happen), living in a box (no, really, I live in a concrete box only a bit bigger than a jail cell), living too close to other people (dogs barking all day and night, traffic noise, the usual), hopped up on whatever entertainment there is now (was netflix, was movies, was drive ins, what next?), alcohol and drugs cheap and good enough to dull the mind, and a lifelong ambition not to be like your parents destroyed as you walk the same path they did just with different clothes and better coffee.
Who would not be depressed?
(Score: 0) by Anonymous Coward on Wednesday February 15, @12:19PM
Coolio had it: