[baumgarn]

I think you're stepping into a fallacy here. Of course every thought process is bound to biological processes in the brain. So we can see this as some sort of biochemical mapping of our understanding and perception of the world, and our social status in it. Why should the solution to a negative outlook be to mess with the chemistry alone, through drugs?

You can just as well ask the other way around, what kind of world and experience is leading to such a detrimental biochemical mapping. The woman in the article describes this herself, she was called fat and ugly by her father throughout childhood. This has to do with social status, not brain chemistry. I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.

[thomasfedb]

> Why should the solution to a negative outlook be to mess with the chemistry alone, through drugs?

Well perhaps because it works?

> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Of course there's issues with publication bias, but this is the best evidence we have to work with. Psychotherapy ("talking") also works, and so the teaching I've received tells me to prescribe both in tandem, although the drugs "alone" do help. I'm a student doctor.

> I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.

I think your implicit suggestion here is that the correct treatment is unlearning. I suggest that this is not always possible. The plausible mechanism is that damage during development might result in "built in" changes that can't be talked away.

[Alex3917]

> all antidepressants were more effective than placebo

Comparing them to placebo isn't appropriate, you need to compare them with an active placebo and only look at studies that continue longer than two years. Of which there are all of like 2 studies.

[thomasfedb]

You should remember that we do research on real humans. Sometime this means we can't have the evidence we'd like to have.

Active placebos are designed to cause detriment to the patient - to cause side effects to convince them they're not on the placebo. Getting ethics approval to do randomised trials in depressed patients is hard enough without harming your control group.

[Alex3917]

> Active placebos are designed to cause detriment to the patient

Patients on active placebos have reduced depression symptoms as compared with patients on non-active placebos.

[rhizome]

I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.

Who besides you is saying "just drugs?" From what I've read, the greatest success comes from drugs and therapy.

[Retra]

Perhaps drugs are just easier? You spend 30 years learning how to be depressed, do you really want to spend another 30 learning how to unlive the last 30?

[HBlix]

If you had a childhood full of physical abuse, and your right leg was frequently broken until it became malformed, then the solution might involve crutches. All of which is to say, just because the damage done is in the past, doesn’t mean that it can’t have lasting effects you can’t just wish away. The developing human brain, it has been shown time and again, undergoes permanent changes associated with abusive environments. Those are real, physical changes that may require interventions beyond talking or therapy. It’s not just learned insecurity, it’s the biochemical changes wrought by years of stress during a formative period.

[jschwartzi]

The thing you're missing is that it is learned insecurity that is associated with the biochemical changes, and that by doing the work to unlearn the insecurity as the author did you can reverse the biochemical changes. You can't make the statement that the biochemical changes are the cause of the insecurity, only that they are associated with it. And that's very important, because an "if-then" statement does not imply the converse. That is, if you reverse the biochemical changes you do not necessarily make the learned insecurity go away.

A broken leg is way less complicated than the synapses that form your perception of yourself, and far better understood. You can't really conflate the two without committing a logical fallacy. Treating the broken leg and the brain changes as identical in complexity is akin to treating the construction of a rivet the same as the construction of a Boeing 737.

The fact is that you can change, and you can feel better, but you also have to put in the work to change yourself. It's the hardest thing you will ever do if you grew up in a dysfunctional family because it requires you to deny years of your experience in favor of the received wisdom of how the world really works, and not everyone can do this. But if you do the work the reward in the end is that you're not permanently crippled by addiction to psychiatric medication.

[HBlix]

Some people can change to some degree, some can’t. Some people for example can recover from PTSD with time and talk therapy, and if you insist on others doing that they’ll end up killing themselves. Not taking medication is just as much of a fallacious “one-size-fits-all” solution as insisting that everyone take medication.

[jschwartzi]

Parent was originally dismissing the complexity of the situation mentally and emotionally by insisting that there's just a simple biochemical thing that needs to be changed, like adding more gasoline or oil to a car engine to make it run longer. The reality is way more complex than that.

Change is really fucking hard and there's no silver bullet solution.