[weej]

For those suffering from depression, anxiety, stress please consider meeting with a psychiatrist and psychologist.

Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine). All the pushing through and search for answers, triggers, or source of problems won't solve this.

Secondly, cognitive behavioral therapy (CBT) can work well for analyzing the 'why' you feel and/or behave the way you do. It provides perspective, insight, and tools for helping cope with problems (control/mitigate or potentially eliminate).

Both of these are tools that can dramatically improve your life. I've been there and still am. Seek the support you deserve. Tomorrow will bring a better future.

[slothtrop]

> Some brains are neurologically misconfigured

This is almost always symptomatic. There's a fair amount of research on dopamine depletion. Addiction, including but not limited to drug use (e.g. high-fat-high-sugar food, pornography) can show deceases in receptors. Vitamin D3 deficiency can pose a problem. Sedentary behavior. etc.

I'd recommend CBT principles to anyone, research shows they're as effective as prozac. The point is many changes can be implemented before resigning to perpetual medication.

[zxexz]

I'd be cautious of the claim that CBT is 'as effective as Prozac', or another chemical solution, in general. A cursory glance at the Wikipedia Criticisms section for CBT points out at least several concerns with the existing research[0]. Anecdotally, a family member of mine went through a complete round of CBT, for a mental health disorder, and they said that it seemed mostly just like standard therapy, and perhaps increases mindfulness a bit, but definitely felt it could not hold a candle to standard treatment. I should point out that they followed the protocol quite rigidly, and embraced the therapy with an open mind.

No doubt CBT has varying effectiveness between individuals. Somewhat tangentially, I find this[1] article cited in the Wikipedia page[0] to be an interesting read; a meta-analysis of ~70 studies, showing a seeming decrease in effectiveness of CBT over 30 years.

[0] https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy#C...

[1] https://www.semanticscholar.org/paper/The-effects-of-cogniti...

[slothtrop]

A single study is listed as being challenged. Have others:

From 2010 - "In this 36-week study, partial and nonresponders to placebo, and responders and partial responders to Prozac, CBT, and combination treatments in the 12-week trial were openly treated (TADS Team, 2007). As in Phase 1, Prozac and combination groups received additional encouragement and contact (medication management). Despite this, all treatment conditions converged by 30 weeks and remained so by Week 36, with significantly more suicidal ideation in the Prozac-alone group. The percentage of suicidal events for those on Prozac, whether in combined or alone groups, was nearly 12%, double the 6% in the CBT group. Despite the convergence of efficacy and continued risks, TADS is often cited as evidence that combining psychotherapy and medication produce superior results (e.g., NIMH, n.d.)." -- https://www.researchgate.net/profile/Dickson_Adom/post/What_...

"Collectively, the findings detailed inA.C. Butler et al. / Clinical Psychology Review 26 (2006) 17–3127 this review suggest that CT is highly effective for adult unipolar depression, adolescent unipolar depression,generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, PTSD, and childhooddepressive and anxiety disorders. The comparison-weighted grand mean effect size for these disorders when compared to no-treatment, wait list, or placebo controls is 0.95 (SD=0.08). CBT is associated with large improvements in symptoms for bulimia nervosa, and the associated effect sizes (M=1.27, SD=0.11) are significantly larger than those that have been found for pharmacotherapy. CBT also has shown promising results as adjunct to pharmacotherapy in the treatment of schizophrenia." -- https://www.get.gg/docs/Empirical-Status-of-CBT.pdf

Prozac yields a risk of side effects, and ceasing use brings a strong risk of relapse. Comparatively CBT offers a lasting solution.

[heavenlyblue]

Do you have any sources suggesting pornography leads to the reduction of your dopamine receptors?

[slothtrop]

Directly, less so. I imagine it will come because other addictive behaviors have been linked to dopamine depletion.

"Another metabolic parameter strongly supporting a neurobiological basis for natural addiction is found in studies examining dopamine receptor depletion. Wang et al., demonstrated dopamine (D2) receptor downgrading with obesity similar to that seen in drug addiction, and the levels correlated with BMI.[31] An animal study recently published by Johnson and Kenny found that rats exposed to “palatable, energy-dense food develop a profound state of reward hyposensitivity and compulsive-like eating. The maladaptive behavioral responses in obese rats probably arise from diet-induced deficits in striatal D2R signaling. Overconsumption of drugs of abuse similarly decreases striatal D2 receptor density, induces a profound state of reward hypofunction, and triggers the emergence of compulsive-like drug taking behaviors. " -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115160/

[diehunde]

How can be almost always symptomatic but at the same time run in some many members of the same family? When you go to see a psichiatrist one of the first questions the ask is if there's history of mental illness in the family.

[slothtrop]

That's still not causation. A history of depression doesn't mean these members all had inherent brain misconfigurations. The brain's chemistry is not static in the first place. There could be afflictions, deficiencies, environmental conditions or cognitive biases spanning generations that could lead to these issues. Everything we experience is expressed as a chemical reaction in your brain, whether you're happy or sad. No one looks at an ecstatic person's brain and assumes they're wired to be ecstatic. Grief and depression can run long.

By virtue of the success rate of therapies such as CBT and others, the evidence for inherent "bad" brains runs thin.

[mnm1]

> Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine). All the pushing through and search for answers, triggers, or source of problems won't solve this.

Do you have proof of any of this or are you just regurgitating the bullshit you've been fed? I've been searching for years and all I can find is that this hypothesis is bullshit without any evidence behind it whatsoever. Even psychiatrists and neurologists know it's bullshit. It doesn't help anyone to pretend like this is true and it can be harmful. Encouraging people to take drugs based on what is essentially a fantasy is likely a huge part of the problem. If I'm wrong, I'd like to see the proof I've been trying to find now for over a decade.

[scns]

You can show via SPECT brainscans that the over- or underactivity in certain parts of the brain correlates strongly with psychological symptoms. For example you can show that people suffering from ADD have a lowered activity in their prefrontal cortex. Or that people with an overactive deep limbic system suffer from depression. Check out Dr Daniel Amen's work. He did over 83000 brainscans.

https://www.youtube.com/watch?v=esPRsT-lmw8

edit: added count and link to video

[mnm1]

That's a far cry from demonstrating that specific neurotransmitter imbalances are the cause of depression.

[scns]

True. It seems depression is created and sustained through distorted thoughts. Check out David Burns' "Feeling Good".

[diehunde]

What proof specifically would you like to see?

[mnm1]

Proof that "Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine)" and that this is the cause of depression.

[diehunde]

No I read that, I meant, what type of experiment that proves that statement would you like to see. Because I feel like if I point out some research you would find something weird about them just to dismiss them, so I'm asking beforehand what kind of setup or study would like to see.

[mnm1]

One that demonstrates that serotonin/dopamine is actually the cause of depression and that taking drugs affects those neurotransmitters and relieves depression. If we're going to say to someone that you are depressed because of a chemical imbalance, you must first prove that is actually the cause. Then you must prove that the medicine affects that neurotransmitter and relieves the disease. This hand wavy "chemical imbalance" idea is barely a hypothesis. Prove it. Measure serotonin in a live brain and demonstrate the causation with depression. Demonstrate that the level is truly imbalanced compared to a non depressed person. Show that changing the level relieves depression.

Instead, we don't even know how depression drugs work and last I checked, measuring neurotransmitter levels in a live brain was impossible. That would be ok as science doesn't know everything, but then we need to stop with the idiotic "chemical imbalance" lie.

[diehunde]

So according to that logic, we should also stop with the lies for the current medications we use for schizophrenia or epilepsy or Alzheimer's disease because we don't know for sure the cause and we can't prove it? Even when we see many people getting effective treatments from these drugs?

[sas3bot]

there exists conditions like adhd where some brains are wired differently from birth

[mnm1]

So you say but provide no proof. Also, that's very different than saying it's caused by a lack of/too much serotonin, dopamine, or some other neurotransmitter or receptors without a shred of proof, as the parent claims. The reality is, there is no proof of anything like that causing depression, anxiety, or other mental health issues. How would we know if such things cause disease when we can't even measure them in a live person? The whole chemical imbalance idea is bullshit to sell drugs to patients. I'd love to be proven wrong but no one has any evidence to do so. Even professional psychiatrists know that the idea is bullshit. But it does sell a lot of drugs whose efficacy is questionable at best. So the facade lives on and people continue to parrot this harmful bullshit.

[smacktoward]

This. I had great results from working with a cognitive-behavioral psychologist. She helped me see patterns in my life that I had never even suspected were there before. I'm skeptical that I could have gotten the same results by reading a couple books on CBT on my own. The exercises were valuable, but so was the outside perspective, and I don't think either would have worked as well without the other.

[rjkennedy98]

> Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it.

Bullshit pure bullshit. This has never been shown and its disgusting that its re-iterated by people purported to be well-meaning.

[masonic]

A problem with the emphasis on CBT over the past couple of decades is that it cannot work for a fair percentage of chronically depressed people because it emphasizes challenging negative thoughts on the assumption that they are untrue.

The problem is, what if you have depressing thoughts that are totally rooted in reality? CBT doesn't have a very good answer for that.

There are other strategies and models. IPT. Psycho-dynamic. ACT (which does address the gap I refer to above).

So, a patient may well have to shop different practitioners, clinics, and models to find one that addresses your needs. After all, the response to a bad haircut is to find a different stylist, not to give up on haircuts forever.

Out of pocket costs can get excessive. If price is a major factor, consider university teaching clinics, which can often provide talk therapy (generally with student therapists, and quality/interest can vary a lot) on a sliding scale based on ability to pay. In SV, for example, there is the Gronowski clinic staffed from Palo Alto University).

[metabagel]

“ The problem is, what if you have depressing thoughts that are totally rooted in reality?”

I thought the point of CBT was to avoid making negative assumptions or falling into thinking traps. For example, “I’m on the street and hungry. I’ll probably be like this for the rest of my life.” This is a thinking trap - thinking that bad situations will last indefinitely. Instead, we can think, “I’m on the street and hungry, but I’m alive, and I can probably turn things around.”

[mitjak]

just to throw my hat in, I've found CBT difficult to put into practice. a vicious cycle formed as I increasingly blamed myself for not working hard enough to help myself and buckled under the pressure of completing exercises.

psychodynamic approaches and group therapy had much more palpable impact, as the missing piece I think was seeing and relating to others. not being alone and talking through issues made a world of difference compared to applying what felt like mechanical exercises of CBT.

[Trasmatta]

CBT definitely won't work for everyone, but this seems like something a good therapist could help someone work through. Self blaming like that is one of the cognitive distortions that CBT should be able to help root out.

I realize that it very likely just wasn't the type of therapy that works for you, just throwing out the alternative perspective for anyone reading this and considering CBT.

[mitjak]

for sure! i feel a lot more capable of applying the self reflective tools of CBT at this point in time. but it really felt like CBT was consistently suggested to me at a point in time when i just wasn't ready. and it took some (difficult) time to understand that there's nothing wrong with me for not being receptive to it.

[Gibbon1]

> vicious cycle formed as I increasingly blamed myself for not working hard enough to help

Something that took me way too long to understand. Beating yourself up for feeling bad makes it twice as bad. A counter argument is negative emotional stress is motivational. My argument is negative emotional stress is one of the crummier types of motivation.

[mitjak]

> My argument is negative emotional stress is one of the crummier types of motivation

i agree. i am jealous of people who find empowerment in struggle this way but insistence on CBT just made me feel more alone. now that I do not feel so hopeless about being able to affect change, i am more able to reach for self-help tools, but i'd argue that it could be dangerous to have it be suggested as the first line of help for someone that's already holed up in self-destructive tools, especially if they lack self awareness.

[banads]

>Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine).

Readers: please be aware at best the science on this statement is hypothetical, at worst it's a marketing slogan designed to sell someone drugs for the rest of their life.

[stronglikedan]

IME, it's best to start with the psychologist. They can determine whether talk therapy will be enough to correct the chemical imbalance without drugs. If necessary, they can refer you to the psychiatrist, who can give you the medication, but doesn't want to talk.

[tachyonbeam]

They can also work in tandem. You might be more receptive to therapy and analyzing your feelings when you don't feel like the world is ending. IMO, there's a threshold where antidepressants are necessary. When I lose interest in everything I care about, I don't feel like cooking, everything seems boring, and I have no energy (anhedonia), that's my threshold.

[harimau777]

I've been leery of CBT because it seems like it's too focused on how the patient thinks about their situation and not on actually creating a situation that's worth living.

It seems like for many people the issue isn't so much that they are sad or in pain so much as it is that their life lacks any sort of meaning or direction. The problem isn't so much the presence of something bad as it is the lack of something good.

In your experience does CBT engage with those sorts of issues?