[marincounty]

I agree with your post, except this part, "mimic clinical depression (serotonin/norepinephrine imbalance), or ADHD (dopamine imbalance), generalized anxiety (GABA imbalance), seasonal/chronic fatigue (acetylcholine imbalance), and so on. "

They really don't know what causes anxiety, or clinical depression. The are having a horrid time finding the true cause of these ailments. If anyone is seeing a MD who claims to know what causes depression and anxiety see someone else. It gotten so disappointing in the research community; very few companies are actively even looking for the root cause to these horrid diseases. So many people took these tri, and hetrocyclic drugs for depression, and if they worked--it was most likely placebo. Yes--panic attacks, and generalized anxiety respond to benzodiazepines most of the time, but hey are addictive, and no researcher who is smart would Not claim to know how they work. I wish you well.

I truly believe the best medicine is knowing you are going to get better. The placebo effect is sometimes stronger than any antibiotic. I sometimes believe the placebo effect is the only verifiable existence of God? When I am sick, I do a little research on the Internet, but have found it's better to just believe the medicine will work. Oh yea, I try to chose my doctors well--Board Certified who actually tried to keep current after years of practice.

[derefr]

> They really don't know what causes anxiety, or clinical depression.

True in spirit, but untrue definitionally. The thing is, the psychiatric profession still basically subscribes to a Behaviorist theory of mind when it comes to treating neurological problems. There's no consideration of what's going on in your head when you have a neurological malady; your head is a black box, where drugs go in, and altered behaviors sometimes come out. "Clinical depression" isn't the name of a specific thing that we know goes on in the brain (in fact, it seems to be a whole cluster of things); rather, clinical depression is "the thing which taking an SSRI usually makes lessen." When a psychiatrist says you may be clinically depressed, what they're really saying is, "you have symptoms that may be manageable by the effects of this or that drug." They have no idea whether they're treating the root cause, or just masking it, and a lot of them don't care. They just want to see your behavior alter, like a rat given a swim test.

And really, thinking of things like SSRIs as "medicine" is part of the problem. SSRIs and the like are crutches--given to you to lessen the symptoms of a problem enough for it to stop being overwhelming, so that you can actually manage to make it to the CBT-practicing therapist every day, have the energy to find the the better job to get away from your horrible boss, etc. I wrote more on this here: https://news.ycombinator.com/item?id=6347620

(P.S.: In this case, though, if I might be a bit more pedantic: I didn't say that all those maladies in my post were caused by those imbalances. I said that inducing those imbalances, in the way that Lyme disease does, will mimic the symptoms of those maladies. Clinical depression may not be "just" a serotonin imbalance--but inducing "just" a serotonin imbalance tends to produce the symptoms of clinical depression. ;)

(P.P.S.: note that I never used the word "disease" or "illness" once. See my link above--these words don't apply to things like nearsightedness, so they don't really apply to the kind of problems neurological imbalances manifest as, either.)

[electronvolt]

Certain forms of affective disorders (recurrent unipolar depression, bipolar disorder) are actually best managed with consistent drug use, and there's evidence that although things like CBT can help manage symptoms (and dealing with the impact of being diagnosed), the depression isn't situational, being on antidepressants or mood stabilizers is often the best treatment plan. A person with bipolar depression (or recurrent, unipolar depression) who approached it your way and decided to go unmedicated when they felt 'better' could very easily have another episode, which is generally seem as bad (since that's how people are killed by it). Equating serious mental illness with a limp or nearsightedness (and not recognizing it as a serious illness: 25-50% of bipolar patients attempt suicide, many succeed) is dangerous if those with it believe you and somewhat dismissive.

On a more relevant note, there has been more and more fMRI work on identifying the actual issues within the brain. I know less about unipolar depression, but some results have shown that bipolar patients actually have slightly different brain structures and vastly different neural activity during an episode. Science is actually working on figuring out the black box mind-thing, and hopefully it'll keep getting better at it. Treatments just have to slowly catch up.

(Edited: grammar/spelling, due to writing on a tablet.)

[derefr]

Did you read my linked expansion on the topic? Some people need crutches, temporarily; others need wheelchairs, permanently; and others don't need, but function more optimally with, glasses. There are chemical imbalances that resemble all of these states. (I have ADD myself, which is quite solidly in the third group.)

[jwdunne]

I agree. Although drugs don't attack the root cause, which appears to be unknown and can come from a variety of life experiences, they can lessen the symptoms such that the sufferer can explore and tackle the issues leading to the depression within themselves, perhaps even via the help of therapy.

Depression is, as we know, very deadly. The method it uses to kill is to destroy happiness, self-worth and motivation. This could mean a person with depression feels helpless, feels deserving of the ill feeling and could also have zero motivation to help themselves. With these symptoms lessened, it can give suffers the room they need, so to speak, to identify and overcome all of the issues in their lives.

We say depression has no clear root cause but that makes a lot of sense. A person can only have so many little negative experiences before every single experience looks negative. If dozens of insignificant but still negative events happen in my life, I can bet my mood won't be that great and I will have a hard time pin-pointing exactly what's making me feel this way. Sometimes even big negative issues which you believe you have overcome could still have left latent habits which can wreak havoc on your mood.

[girvo]

When I talk to people about my depression, I try to point out that "depression" is a really really loose label for what seems to affect people very differently (as anything that deals with the brain would, of course). For myself, I will have a depressive episode that just hits me, for no reason, and means that I can't get out of bed or face the world, and have suicidal thoughts every single day.

That's my depression. I'm also one of the lucky ones that SSRI's help -- I use them the same way you would a band-aid; I take them for a couple of months, and the episode passes as long as I keep up my job, exercise, healthy sex and social life.

All of this (and CBT) lets me manage my depression... but it's just that, MY depression, how my symptoms manifest, how I can fix it, etc.

Good post.

[pessimizer]

SSRIs are also like placebos in that they have no more of an effect than placebo.

[moheeb]

This is provably wrong. When stopping Cymbalta it is common to suffer severe withdrawal symptoms.

[glenra]

> The placebo effect is sometimes stronger than any antibiotic.

When it comes to depression, the primary factor isn't really a "placebo effect". It's true that most of the treatments do no better than a fake pill, but they also do no better than doing nothing at all and just waiting.

Moods have cycles. You tend to go to the doctor for treatment when your mood is UNUSUALLY BAD. Some random time later, you'll probably feel a lot better. Maybe the seasons will change and you'll get more sunlight, or things will get better at work, or just...random fluctuation.

If at your MOST DEPRESSED you go see a doctor who believes in treating depression with pills, he'll assign treatment A. You try that a while; it doesn't help. So he has you switch to treatment B. Still depressed. Treatment C. Now you start to feel better. A believer in medicine takes that to mean "Drugs A and B don't work for you, but C cured your depression!" But you were certain to be taking SOMETHING when you got better, so maybe it's just a coincidence that you were taking C at the time that happened.