Vitamin D and Omega-3 have a larger effect on depression than antidepressants
(blog.ncase.me)939 points by mijailt 3 days ago
939 points by mijailt 3 days ago
I also noticed that. Opened issue: https://github.com/ncase/blog/issues/4
Hi, author of the blog post here! Yes thank you for catching this awful typo, it's fixed now! I did write "4000 or 5000 IU of Vitamin D" everywhere else in the article -- main text, conclusion -- just my luck that the one place I mess up is right at the very start.
(Do not take 5000 mg, that's 200,000,000 IU. You'd have to chug dozens of bottles per day)
Hi, I’m curious about medicine in general and I’m considering going back to school.
what formal education do you recommend so that I can better understand this data?
It’s clear you’ve dealt with anxiety before, but this analysis is super thorough!
And thank you for quickly fixing that mistake - that could have really harmed someone.
Colon Blow: "It would take over 30,000 bowls. [ a giant pyramid of cereal bowls shoots up from under the man, who yells in terror as it rises ] To eat that much oat bran, you’d have to eat ten bowls a day, every day for eight and a half years."
That would be 5g. At this point everyone should notice that something is off. :-D 5000 mg of vitamin D3 = 200,000,000 IU (200 million IU)
People don't always realize: https://www.chemistryworld.com/news/university-fined-in-caff...
doctors prescribe vitamins in MG, but they're sold in IU. It's an easy mistake to make.
If you don't have an underlying condition it is way better to get the Vitamin D from the sun in 10-30min increments per day after which you are saturated for the day. Overdose is not possible via the sun (excluding sun burns of course).
> A single, optimal sun exposure session might produce the equivalent of 10,000 to 25,000 IU from a supplement, but it will not keep increasing with more time in the sun. That's your max per session.
From NHS Scotland:
"In Scotland, we only get enough of the right kind of sunlight for our bodies to make vitamin D between April and September, mostly between 11am and 3pm."
https://www.nhsinform.scot/healthy-living/food-and-nutrition...
Personally I found that taking Vitamin D supplements made quite a bit of difference - and I spend a fair amount of time outside (~3 hours each day).
And in Norway we often don't see the sun during certain months, due to it only being up for a few hours in the middle of the day (when we're working). And even if I was outside I would be covered in clothes.
We have a saying here to take cod liver oil all months ending with R (in Norwegian that's September to Februar) to get both omega 3 and the vitamin D.
Your suggestion sounds a bit detached from reality of many people.
In many countries it is physically impossible to get enough vitamin D from the sun, even if you go out naked.
Also did you ever notice that the cheap apartments in many places are facing north and do not have a balcony, and of course do not have a private garden? Now you are reduced to going to a park which in the "cheap" areas is also not a good spot to chill for 30 minutes.
Yeaaah, in Finland the sun just fucks off for multiple months over the winter.
It's much cheaper to take a few pills than it is to travel 3000km south to see the sun for 30 minutes :D
We even put Vitamin D in milk by default just so that people would get some extra.
> it is way better to get the Vitamin D from the sun in 10-30min increments per day
spoken like someone who has never lived in the UK
I would argue to do both in the winter, since sunlight has other benefits than just Vitamin D synthesis, like mitochondrial health and better circadian signaling for better sleep quality.
This is nonsense advice for pretty much anybody that is shovelling snow right now.
.. how do you calibrate this against a cloudy sky? It's pretty dark up here at 56 degrees north, and on top of that it's been overcast for days.
It also sucks a lot when it's dark before starting work, dark after leaving work, and during the day rather cold to be exposing skin to the sun.
Isn't the oral intake pretty much negligible anyway? I remember getting a vitamin d supplement in a syringe (to be put on bread, from a physician) containing a very large dosis.
I'm not stating the dosage is wrong. Looks like it is anyway.
Oral has felt very effective for me. I take a daily supplement that has roughly 100% of the recommended daily dose of everything. I split it in half.
For D3, it is 25mcg / 1000 IU / 125%
After splitting in half it's 12.5 mcg / 500 IU / 62.5%.
I take with some fat-containing food to allow ir to absorb which is usually breakfast (yogurt, some nuts, some kind of fruit, oats), and it's a night and day difference in my mood (how easily I can control my temper if already agitated, how easily I brush off annoying stuff, takes the intensity off of my reactions and mood during conversations).
I did a blood test before starting, and if normal is between 30 - 70, I was at 10. Dr prescribed megadose of D2, followed by daily D3, but I skipped on the megadose and went straight to D3 -- makes me wonder if a megadose would build up my stores since D is fat-soluble and make it so I could miss a day and not notice.
All of the above is anecdotal from me, a self-professed cave dweller, but it's been a couple of years now, and I still notice the difference. Also, what I heard from people in Boston is that 90% of them are on a vitamin D supplement. My friend from there laughed at me when I was raving about it, saying "yeah, literally everyone here is on it".
It is easily possible to overdose on oral Vitamin D tablets and damage your body.
Source? There have been many articles on HN showing the RDA to be ~10x too low (something like 5,000 IU) and that the daily safety limit to be significantly higher than that (something like 30,000 IU).
Edit: for clarity I am not saying it is impossible to overdose on oral tablets, but rather that with most tablets 400 IU to 1000 IU and the safe limit so much higher than these, it seems like it would be extremely unlikely for someone to be taking 30+ tablets daily. Not impossible, but not easy either.
That’s a large enough error that it calls the rest of the writing into question, in my opinion.
Also, be careful taking 5000 IU/day of Vitamin D. I did this for a few months and it was enough to send my blood levels over the top of the range, even in winter.
Too much Vitamin D is not good for you. The supplement fans have gone too far in recommending too high of dosages. My doctor said she’s seeing a lot of people with excessively high Vitamin D levels now that it has become popular.
It's usually pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
> It's pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
No, that’s literally what I was doing when I reached the excessive range: 5000 IU/day in winter with an indoor job.
This commonly repeated idea that everyone is deficient and you can’t overdose on 5000 IU/day is wrong.
> Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
Literally what I did.
Every time I explain this online it seems like the supplement people ignore what I wrote and just parrot the same “5000 IU/day and everyone is so deficient you can’t overdose” myth.
Even 5000IU a day is huge and will likely result in calcium buildup.
This was linked on here a couple of months ago: [The Big Vitamin D Mistake [2017]](https://pmc.ncbi.nlm.nih.gov/articles/PMC5541280/)
> A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L.
> This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
> ...
> Since 10 000 IU/d is needed to achieve 100 nmol/L [9], except for individuals with vitamin D hypersensitivity, and since there is no evidence of adverse effects associated with serum 25(OH)D levels <140 nmol/L, leaving a considerable margin of safety for efforts to raise the population-wide concentration to around 100 nmol/L, the doses we propose could be used to reach the level of 75 nmol/L or preferably 100 nmol/L.
Multiple previous discussions:
https://hn.algolia.com/?q=vitamin+d+mistake
Vitamin D is a favorite topic around here:
It depends. I have MS and I take 10k IU. My cousin who also has MS takes 20k but gets regular blood tests for it.
I don't know why this is downvoted, I had a very similar experience a while back. I took 4000 IU/day for about 4 months, insignificant sun exposure and ended up at 60 ng/mL (lab listed normal range as 30-40).
My starting levels were unknown but I assumed they were low given my usual sun exposure and some low-energy symptoms (which resolved a couple of weeks after I started taking it). I discontinued VitD then and now I only take 1000 IU/day in the winter.
According to what I read in a newspaper article, the recommended dose is much lower, at 800.
According to the internet, it is way higher, probably over 9000.
Edit because the comment might be to shallow for HN: I sympathize with the struggle against depression and, after first-hand experience, share the skepticism against the widespread prescription of antidepressants and the methods of evidence presented for it.
Very serious and important topic.
Regarding Vitamin D, I am also supplementing in the Winter, but I have not read the article, which says it has an estimated reading time > 10min. I use one 1000IE (0.025mg according to the package) tablet a day max.
I'll bookmark this discussion page to read TFA later maybe.
You got it backwards, it would be more beneficial in areas with few hours of sun for darker skin folks, since they do not absorb as much Vitamin D as fair skin folk do.
No, it's to make it easier to dose different kind of biologically active substances. They can have significantly different "recommended weight to eat of this per day", IUs make that sort-of comparable and easier to remember.
The usability issue with IUs is that people are used to scales measuring weight and containers measuring volume, but an IU is different for each substance.
Another issue is insulin syringes are labeled in "insulin units," which hapless folks reasonably assume can be abbreviated "IU."
If you are measuring out a certain number of IUs, and your calculator or formula hasn't asked you which substance you're working with, you're gonna have a bad time.
Wow, so what value is there in LLM slop exctracted from already dubious self-medication advice?
They're saying that it successfully filtered out the bit where the author told people to overdose by 40000x. I guess that's the value.
Only recently again I read in the newspaper, that most products are overdosed. There is a typical number that the vitamin D products usually show, and in the article it said, that only up to 800 IU is safe, and everything above is an overdose. There are many products out there with 2000 UI or maybe even more. Beware.
EDIT: Wow, the HN-local doctors at it again. Imagine getting downvoted for sharing information from newspaper article (and honestly labeling that info as such), that probably was written by someone consulting medical professionals. But hey HN will know better!
So? What's your claim here? Are you claiming that our skin works the same way as our digestive system? That would be a ridiculous claim. And fyi, many people get a proper sunburn, if they stayed in the sun for 30 min straight without protection, at least in summer. So your 30 min statistic doesn't really tell us anything about something being healthy or not.
Can you provide a link to the newspaper article at least while whining about the downvotes?
I would like to, but I cannot, since it is a region-local newspaper that comes as actual paper, that only has a paid online offer, to which I have no access, nor could I post a link to that. If I went through recent paper form newspaper, I could get a photo of the text in German, but then I would (A) need to spend that time, and (B) need a place to upload pictures, without having to make an account, and only then get back to you with a link. To be honest, I am too lazy to do that, just to justify a comment on HN.
If you have useful information to share, please do so. Telling people "Do more research" adds nothing to the conversation.
It's unbelievable crazy what the author suggests, even say "10,000 IU if you're feeling daring / have darker skin / live in less sunny climates.".
Just a simple look at the side effects of high dosages:
Safety and side effects
Taken in typical doses, vitamin D is thought to be mainly safe.
But taking too much vitamin D in the form of supplements can be harmful and even deadly. Taking more than 4,000 IU a day of vitamin D might cause:
Upset stomach and vomiting.
Weight loss and not wanting to eat.
Muscle weakness.
Not being able to think clearly or quickly.
Heart rhythm issues.
Kidney stones and kidney damage.
Hi, author of the blog post here! Thanks for your concern. I do still stand by my claim, since more recent peer-reviewed studies have shown that up-to-10,000 IU is safe. As written in the post:
> McCullough et al 2019 gave over thousands of patients 5,000 to 10,000 IU/day, for seven years, and there were zero cases of serious side effects. This is in line with Billington et al 2020, a 3-year-long double-blinded randomized controlled trial, where they found "the safety profile of vitamin D supplementation is similar for doses of 400, 4000, and 10,000 IU/day." (though "mild hypercalcemia" increased from 3% to 9%. IMHO, that's a small cost for reducing the risk of major depression & suicide.)
So why then does Mayoclinic, etc, all say 4000 IU is the limit? I think because policy is decades behind science (this happened with trans fats), and also policymakers are much more risk-averse. (this is why in California, thanks to Prop 65, up until ~2018, there used to be a warning in every coffeehouse that coffee causes cancer.)
But thanks to your comment, I will edit the intro to note what the official max safe dose is, and that more recent peer-reviewed research shows it's too low!
To my understanding Vitamin D is regularly underdosed. Several points:
1) There are lots of studies that correlate Vitamin D production with sunlight exposure. For example, https://pubmed.ncbi.nlm.nih.gov/20398766/ this one lands on 1/4 of a MED = 1000 IU. Of course now we have a MED definition problem, but we're roughly talking single digit numbers for a white person in midday sun in NYC to reach 1/4 of a MED.
2) If you also supplement with Magnesium, a lot of your side effects go away. Vitamin D3 depletes Magnesium absorption.
FWIW just anecdotally I took 160,000 IU per day for a few months along with 800mcg to 2mg of K2 MK-7 and about double the suggested amount of magnesium citrate. I slowly titrated up to that amount over a few months. I am not suggesting anyone else do that as I had a specific purpose slow action TPA when combined with many protease so to speak but just my own experience I did not have any of those issues. I don't know how they came up with them so I figure they are just guessing like they did with the toxic level of selenium which has a funny back story. I am back down to 5000 IU a day. Years later still none of those issues. But that is just me.
I did have one issue related to magnesium however. If I did a very high dose of magnesium taurate and a couple of other chelated forms I would have trouble catching my breath after physical exertion similar to chronic high doses of iodine. Not the end of the world but it was unnerving.
Don't anyone else do what I do. I experiment on myself more than scientists experiment on mice minus the whole dissection bit. I am just continuing some experiments from the 1900's but as I understand it AI will be learning all of those soon. Fascinating stuff really.
Hi, I'm the author of the main blog post. Just wanted to say that's a fascinating experience, 160,000 IU a day! I mean, I'm not going to try that, but that's good to hear that 5,000 IU/day for years has been working fine for you. Thanks for sharing!
I respond well to magnesium oxide and magnesium citrate in capsules but the chelated magnesium gives me heart palpitations or makes them more frequent if I am already having them. I hadn't noticed shortness of breath since the palpitations would have outweighed that.
It depends on the person, as a sample size of one I was on 5,000IU and my levels were still on the low end (almost still deficient), and my calcium levels were still safely on the low side as well. Ultimately people should be getting their levels checked before and after to see exactly what the effect on them is
Be careful - many studies in the Vitamin D meta-analysis *enrolled patients already taking antidepressants.* [1] Reporting effect sizes without specifying "on which population?" is misleading.
(As an aside, Cohen would be the person not to tell you to assign qualitative values to effect sizes. They are as arbitrary as any other threshold used by working statisticians.)
[1] https://www.cambridge.org/core/journals/psychological-medici...
EDIT – that is, please don't draw the conclusion that you can substitute supplements for antidepressants. The meta-analyses don't seem designed to examine that hypothesis, and I doubt anyone would ever participate in a such a trial. In general (and as a working biostatistician), I would be very, very, very cautious applying estimates of average effect to myself, you, or any other individual person in a field as murky as psychiatry. That's why even the stingiest American health insurance plans still have an incredibly large range of antidepressants in their formularies.
Hi, author of the blog post here! Thanks for bringing this up -- it wasn't my intention to say one should replace antidepressants with vitamins (the conclusion even says "(Don't quit your existing antidepressants if they're net-positive for you!)", but you're right that the intro may give that impression. I'll edit the intro to say you can stack, not substitute, regular antidepressants.
> many studies in the Vitamin D meta-analysis enrolled patients already taking antidepressants.
Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
Table 1 of the meta-analysis ( https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ) shows the raw sub-group analysis. There were 9 studies on patients using antidepressants, 13 on patients who weren't, the rest were Mixed or Not Reported (...how do 6 studies just not report that?) Anyway,
Effect size of Vit D for people on antidepressants: −0.54 (−0.85, −0.23)
Effect size of Vit D for people NOT on antidepressants: −0.28 (−0.40, −0.16)
Both negative. Weirdly, the effect of Vit D seems to be a bit stronger for people on antidepressants, but the difference isn't statistically significant at the p<0.05 level (P subgroup difference is 0.23)
(As for why those effect sizes, -0.54 & -0.28, are lower than what I (and that meta-analysis itself) report, -1.82, that's because the majority of RCTs for any group used far less than 5000 IU. Table 2 in that paper shows the effect (with 95% CI) for various dosages.)
I'll lightly edit my blog post to emphasize stack them, don't substitute. Thanks again for your comment!
> Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
I think the point here is that such a study selects for people where their antidepressants are already known not to work very well for them, or they wouldn't be interested in participating.
Based on your own citation, this is untrue. The citation you have linked is a meta analysis of 31 trials, many of which specify no medication use at recruitment.
You are however correct about population being important (which is a big reason meta analyses can be very useful).
I saw a thing from HealthyGamerGG youtube[1] that he said one of the things about depression is that it causes/influences one to avoid the things that would make their life less depressing.
eg just to paint the picture: you're depressed so you don't get out of bed, therefore you don't go do your workout, therefore you lack endorphins and look in the mirror and see squishy, you're sad about how squishy you are and so you get more depressed. You're more depressed so you also don't do your dishes, when you do get out of bed you are depressed you feel like a slob and you're squishy, so you get more depressed...
Whereas adding anti-depressants, and other virtuous cycle things like vitD/O3, exercise et al. Give the boost necessary to _make your life less depressing_ ...
So if you know someone who's depressed, it might be helpful to help them make their life less depressing too. (in addition to all the best medical advice!)
[1]- he's a real Dr... Dr. Alok Kanojia (Dr. K), a Harvard-trained psychiatrist (MD, MPH) specializing in modern mental health
>he's a real Dr.
Careful, he is also a believer in Ayurveda[1]. Which basically basically categorizes people into different elements like fire and water and then tries to change their diet and habits to match their elemental style or something. You can hear him talking about it here [2]. Kinda reminds me of Humorism [3]. Dr. K seems like a nice enough guy but don't get too lured in by the "Harvard-trained" credentialism.
[1] https://en.wikipedia.org/wiki/Ayurveda [2] https://www.youtube.com/watch?v=rQ2xnThRGPg [3] https://en.wikipedia.org/wiki/Humorism
I agree there's nuance, but he's way above the "has a webcam and yeti blue" bar that most of youtube falls under, that was my point in putting his credential up. Not to rise him to a perfect status, but to not allow him being on youtube to fall to the minimum bar of youtube.
I found this to be the case. Tried Sertraline for a while, gave me headaches and made me feel sick. Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped. I also felt quite an extreme uptick because I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood. I suspect one of the main reasons my mental health declined was due to the lack of Omega 3.
Disclaimer, not saying vegans should stop being vegans, just make sure you find a good supplement, and make sure you understand the difference between EPA/DHA Omega 3.
All my nutrient numbers improved when I became vegan because nearly every one in the US/UK is deficient in VitD, Omegas and B12.
Fortunately today’s vegan communities are much more aware of this so I started taking these supplements right up front and all my blood markers improved dramatically since when I consumed meat/dairy.
It’s annoying to hear some push back against this when it’s as simple as taking relatively safe supplements (just make sure you talk to a doctor, and not a social media influencer, about how much you should take, and if you get a chance to regularly check your bloodwork don’t miss out).
My cholesterol improved massively, but over time, a few, such as Omega 3 suffered. But those were ultimately my own fault, wasn't managing it properly. So, I'm absolutely not suggesting there's an issue with veganism, this isn't really why I fell out of it. So I do want to stress I wasn't suggesting people should steer clear of Veganism, just something to be mindful of. Oh, and my cholesterol immediately shot back up again when I stopped being a vegan. So, swings and roundabouts with every diet/lifestyle, I guess!
Why did you become a vegan if apparently even non-vegans are deficient in B12? Do you supplement B12? Since B12 is mainly found in meat, and B12 deficiency is irreversible.
why do you think the reason for them becoming vegan has something to do with B12 levels? likely they became vegan for different reasons, became much more aware of the importance of B12 and started taking a supplement.
every vegan should supplement b12, so they probably do too
I think they meant their vegan diet didn't naturally have Omega 3 in it if they didn't take supplements; not that they couldn't take the supplements once they realised it.
> Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped
I would bet that 95% of that improvement or more was due to the exercise.
Your anecdote is common: People start taking Vitamin D or fish oil as part of a bigger plan to have a healthier lifestyle and then they attribute success to the pills, not the lifestyle changes.
> I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood
I see your disclaimer, but just for more context, vegans can get Omega 3 without taking pills per se. Flax seeds are an excellent source. I often add a spoonful to a bowl of oatmeal or as a pancake topping along with fruit sauce and granola.
Grind the flaxseed before eating them so your digestive system can access more of the nutrients in flaxseeds.
from https://www.bhf.org.uk/informationsupport/heart-matters-maga... :
Eating ground flax seeds gives you more benefits than whole seeds, as whole seeds remain undigested and pass through the system.
Most people can’t chew flaxseeds effectively, so they grind them first or swallow them whole. (They are tiny.) Nutrition experts do recommend grinding them first to release the fiber and the beneficial fatty acids. Flaxseeds are helpful for constipation and may lower cholesterol as well.
Ground flaxseed goes rancid easily, however, so it should be kept in the freezer until you are ready to use it. If you buy it ground, you wouldn’t have to use the blender or coffee grinder to break those seeds up before you have breakfast.Flax seeds are a very tedious and inefficient way to get omega-3 as a vegan, particularly because they contain ALA, a short chain omega-3, which our bodies are extremely inefficient at turning into long chain fatty acids.
Just get an algae oil based DHA+EPA supplement.
Flax seeds & other seeds provide ALA but not EPA & DHA. You need all 3.
The body has some ability to convert ALA to EPA & DHA, but at extremely low rates (particularly for DHA) - it's not a consideration in practice.
So no, eating seeds will not fulfill your body's requirements.
With depression it is important to find the cause of it.
You might be depressed because you life objectively sucks. Then you symptoms are good and healthy and a signal to make changes in your circumstances.
You might actually have a good life but still feel depressed because there is a chemical imbalance in your brain. (Very simplified). That is when drugs come in.
It might be just a seasonal thing and you need to go outside more and take some supplements.
You might have some other undiagnosed issue. You might have ADHD, autism and other things that cause you to struggle and develop depression as a side effect.
So find out what works and what doesn't work for you.
Objectively in the sense that there are actual causes in you life that distress you and cause your symptoms instead of thinking your life is shitty because you are depressed. Of course being able to determine if it is your depression talking or if things are objectively bad isn't easy and people often need outside help from a therapist for that. Plus it isn't really clear cut in practice.
On a sidenote, I know that knowing that it is "just your depression talking" is also a pretty hard pill to swallow and not always helpful. Personally I have a lot of fears that I know are irrational but that doesn't make them any less real.
And even if your problems are external, sometimes you need to focus and your inner self first, find some strength and help so you can tackle the external problems later. But for other people "working on yourself" can be avoiding the actual problems they need to work on.
And yes happiness is always relative.
I don't think that's true. I think that just shows how disconnected we are.
We tell ourselves that we must have "better lives" than say a native american in the year 1000AD, but there's no reason to think that.
I think odds are that maybe the native american was happier -- having a small group that you spend time with outdoors every day, getting extensive exercise, having a clear sense of purpose, eating healthy fresh food every day, never once thinking about politics or bills or global warming. I bet they liked their life more than a depressed divorced accountant in our modern society, even if we have more material wealth or health access.
I guess there are different types of "life sucks" that can or cannot contribute to depression, my current understanding is that a lot of it depends on whether you feel you have some control over the situation or if you think you have absolutely no power over it
According to Victor Frankl (psychiatrist concentration camp survivor, author of Man's Search for Meaning) being in a shitty situation without any control over it isn't necessarily bad. Humans can still be mentally okay in the face of extreme unavoidable suffering like in the camps. The key thing is that you need to have some purpose / meaning in life (often a loved one or dependent).
Isn't people in the past had less control? There were dying from infections and not only had no vaccines and drugs they didn't understand how infections are spread. They also suffered from various natural disasters not having a protection a modern civilization gives us.
I don't know enough about how people lived in the past but I would tend to agree with you that they might have had less control than us on many things. But what I meant was that it depends on how much control you *think* you have rather than the control you actually have. So I think a lot of it is about perception, in 100 years time people might wonder why we weren't all depressed because we had a life expectancy of "just" 80/90 years, but for us it's just normal and expected
> You might be depressed because you life objectively sucks
The problem with this that to a bad situation different people react differently - some trying to do what they can to improve the situation or at least don't make it worse and some give up and let situation to slip and become worse and worse (becoming a self fulfilling prophesy). It's not a choose one makes I think (it's likely a biological predisposition) but the difference is still exists.
People prone to depression genuinely believe the main (only) reason for a depression that the life sucks and as a result they avoid medical help and don't do anything which could help them.
This stuff is complex. There are no magic potions or hacks that work for everyone. No amount of positive thinking can fix physiological issues that you have because of some underlying condition. But it's quite possible to create new issues as a side effect of being depressed, stressed, chronically exhausted, etc. So, working on those issues is probably smart.
And each of those things can be caused by physiological issues as well. You might feel stressed because you don't sleep well. You might sleep poorly because you suffer from e.g. sleep Apnea. Which in turn might be because of a mix of physiological and other reasons (diet, weight, alcohol abuse, etc.).
Or you might be working too hard, which makes you stressed and causes you to lose a lot of sleep. Different causes that have similar results. Including long term physiological results. Your brain can actually get damaged if you chronically abuse it or neglect it. Many "between the ears" type problems are actually physiological.
Root causing your issues enables you to deal with them properly instead of fighting the symptoms.
Anyway, I take vitamin D and a few other things. Getting yourself checked out regularly once you hit middle age is a good idea. There's a lot of stuff that is long term lethal that a checkup can detect early. And some of it is fixable. I have the usual cardio vascular challenges that many people struggle with because of a combination of genetics, age, and life style. And indeed a vitamin D deficit.
I was also recommended to consume more omega-3 as well. Eat salmon. Work some flax/chia seeds in your breakfast. I put flax seeds in my yogurt and use it as a thickener in sauces as well. You have to grind it to dust for it to get absorbed properly. Dirt cheap and it doesn't mess with flavor/texture too much. I keep a jar of ground flax seeds in my fridge. Takes 2 minutes to top it up every 1-2 weeks or so with some freshly ground seeds.
But I'm also aware that me being a stressed startup founder has health consequences that a few pills and suplements won't fix for me. I need to actively make sure I get my rest and sleep. I deal a lot better with stressful situations when I'm well rested. And I seem to be better at avoiding getting in to those as well. And I feel happier. Sometimes the best thing I can do for my company is having a proper weekend or going to bed early enough that I can get my 8 hours of sleep. You can survive on 4 hours (been there done that), for a while. But most people are not at their peak performance if they do that. And it's not good for you to work yourself to exhaustion all the time.
That's the sorta standard socially accepted way of thinking about this. but uh... to a lot of people it doesn't ring quite true.
For example: if your life objectively sucks, why aren't you doing anything about it? Some people whose lives suck fix their lives, and other people get depressed and do nothing; what's the difference? And: all of us know somebody who appears to have a good life and therefore their depression is presumably a chemical imbalance thing but if you're being honest the vibes in their life are a bit off, actually, like you can tell they're not really getting everything they need out of it, that they're clearly good at masking (for example people who are clearly not thriving in their relationships) .... in which case sure medication could help but you can't shake the feeling that facing the reality of their life would help a lot more.
However! Questioning this stuff becomes a bit of a moral minefield. "Believing" in the chemical imbalance theory is part of why it's medically helpful. If your life has sucked for years and you could find no way of fixing it and then SSRIs helped, then you basically need to believe that it really was a chemical imbalance, because believing that it might not be threatens to take away the thing that's making your life work. So much so that I would bet at this point there are already readers of this comment who are ready to angrily reply to my preceding paragraphs, because the model I just described threatens their existence. (If so, wait a sec and read the rest...)
On the flip side, for some people not believing in the chemical imbalance model for some particular case might be important. Maybe they want to feel responsible for their life being bad, so they will be motivated to do something about it, and being happy due to drugs would make them feel complacent and okay with years passing by at a shitty job or something. Or picture someone whose parent has gone their whole life unable to take them seriously as an adult, which as a result means the child and parent have a bad relationship, and then picture the parent complaining about depression and taking medication for it. This can be really infuriating: the child thinks about the parent, "your life sucks because of the tension created by not treating people around you with respect, and you're so incapable of recognizing this even when it's told to your face regularly that you're taking drugs to feel better despite not fixing the problem". Now ascribing depression to medical problems seems like avoidance, and having people write off your frustrations and say that you're just depressed and need to take a drug for it is frustrating.
Just saying: the two narratives really get tangled up. I don't really know what to do about it, but I do think that some harm is done by harping on the concept of a "chemical imbalance". A lot of the issue is avoided if you just think of the drugs as helpful but don't choose any model (with its moral implications) for what exactly it is they're helping with. Just treat them as a tool for making you feel better.
Also, I suspect that people who have an intuitive aversion to mental health drugs are probably way overindexing on that intuition. I definitely did this for a long time, as did some friends I knew growing up. Turns out whatever your issues you can sometimes just deal with them sooner than later if you accept that doctors might be onto something. (Actually I think the reason people get stuck avoiding medication for so long is precisely that they feel like they're not allowed to be skeptical of them... which makes them kinda plant their feet in the ground and refuse to be open to it. That's kinda why I'm typing this long comment, to tell anyone reading that it is a reasonable thing to feel. And now that you know that maybe try them anyway..?)
The first thing I would do in case of depression is to make sure that the patient's energy levels are good and that mitochondria and other energy-related biochem phenomena work as expected.
I know first-hand that low energy-levels and lacking energy production mechanically lead to depression.
Also, look at how people (children also) experience the world and their relationships and their stresses when they are tired (or even just hungry) compared to when they are fit...
Fix those, and the depression might be gone.
This is not bashing against anti-depressants, they play their role to. But in some cases, energy-management is key.
There are tests out there like https://www.chrismasterjohn-phd.com/mitome
(No affiliation, just have been subscribed to the founder’s substack for a while)
Chris Masterjohn is a noted quack. He takes bits of actual science and research and weaves them together into narratives that make it sound like he has everything figured out with his unique protocols, but it doesn’t hold up to actual scrutiny. People spend years following his ever changing protocols without getting anywhere (beyond placebo effect and a large bill for supplements)
I know I won’t convince the parent commenter but hopefully I can convince other readers not to go down this road or invest any money in anything related to him.
Pure ad hominem FUD. “This guy sometimes disagrees with scientists employed by the government, don’t listen to him!”.
The technical details are beyond my understanding but I’ve heard from a PhD in the field that Masterjohn’s understanding of metabolism is second to none. Whether his protocols work or not is certainly a case by case matter (like any health protocol), but he always appears to substantiate it with well-cited lines of argument, and is willing to engage with interlocutors.
As for spending years with changing protocols without getting anywhere besides spending lots of money, well that can be said for people with complex issues who go the institutionally approved route as well. It isn’t discrediting in its own right that a protocol didn’t work for some.
Just as an example, here is a small part of it: MTFHR mutation causes megaloblastic anemia: https://news.ycombinator.com/item?id=45085439
It's interesting that one way to improve mitochondrial dysfunction is getting sunlight, the same way you get Vitamin D.
> A 2014 systematic review concluded that vitamin D supplementation does not reduce depressive symptoms overall but may have a moderate benefit for patients with clinically significant depression, though more high-quality studies were determined to be needed.
The meta-analysis cited in the article is from 2024 and specifically mentions the Shaffer et al. 2014 review cited by Wikipedia as being low quality:
> Some of the available reviews, owing to the limited number of trials and methodological biases, were of low quality (Anglin et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al., 2014).
Therefore what to do? I have seen these Hacker News vitamin D ads appear every few months for the past 15 years, or so. I always seem to have a vitamin D deficiency, so it reminds me to take supplements. I take them for a few months, hoping to see a change, but I don't feel any benefit. Then, I forget to take the supplements until the next time I see an ad. How to know if they're actually doing something useful?
Until you see an article like this which calls for '5000 mg' of supplementation, decide that you didn't take enough and overdose...
HN and dubious self-medication advice go hand-in-hand. Please consult a medical professional instead of a bunch of ad-tech devs.
If you're not in the respective fields it can be pretty difficult to distinguish good from bad research. I am not able to do so.
If you (or your close ones) don't suffer from depression, then I guess it's best to ignore it until scientific consensus has formed. That will for sure show up on wikipedia. As far as I can see as a layperson there is a lot of correlation with Vitamin D that breaks down in interventions and Vitamin D is recommended mostly for babies and elderly people. On the other hand I see Vitamin D pushed as a miracle drug not unlike Vitamin C used to some decades ago and regular reports of overdosing of supplements leading to organ failure.
If you're suffering from depression, you should talk to your doctor. They will be able to help you to weigh potential benefits with risks
Can I just add: In addition to this, if you struggle with anxiety or have some sort of ADHD, then try cutting out caffeine entirely. Not just switching to "decaf" (which isn't), but cutting out tea and coffee, and switching to an alternative like Barleycup.
Doing this has had a massive positive effect for me, and combined with decent nutrition and daily exercise, has been wonderful.
Agreed, anyone that already struggles with something like this should quit caffeine. My life is so much better off of it, but I struggle to stay off of it because I'm addicted to the 2hr productivity boost vs the all-day steadiness when you're not on caffeine. Things that improve for me were: No sense of urgency for every single thing. Significantly improved confidence. Word things better and speak better in general. No hard crash later in the day. All my scattered thoughts become cohesive. No more random heart palpitations.
All of these likely got better due to the overall effect of decreased anxiety and not making ADHD worse. I'm not myself when on caffeine. Nikola Tesla quit all caffeine/other stimulants for a reason.
The silly thing is that when I drank caffeine, the hit from it would make me overcreative. Yes, I might do more, but it probably wasn't what I was supposed to be doing - I'd pursue some new and exciting thing with tremendous fervour, before realising later that it was a load of nonsense.
> Not just switching to "decaf" (which isn't)
Going to argue here, this is wildly bad advice. Decaf practically has no caffeine, it has 2-7 mg from what I can tell which is less then chocolate. 2-7mg is like impossible to notice and might aswell be water with how little there is.
My advice was along the lines of saying, in the 1950s, "give up all cigarettes, not just 'low tar'". Potential straw man here, but surely you wouldn't call that "wildly bad advice".
My comment was predicated on the belief that we wildly underestimate the negative effects of caffeine, as well as its activities at lower doses.
I love coffee so much, I'd prefer to deal with the anxiety, and I do suffer from it.
Or the addiction just makes you think that this is good for you when actually you'd feel better without it?
It's the smell, texture and taste of coffee I love, not really the caffeine. I tried decaf, doesn't taste the same.
I did the same thing and experienced the same effect.
I'd add that my ability to sleep naturally was negatively affected as side effect of medication. I tried a various combos to induce sleep and found the best solution to just be... exercise.
No caffeine, exercise, sleep lead to a significantly reduced anxiety and more.
Downside with going completely off caffeine is you get so tired and unfocused and it lasts for ages.
I tried doing this for almost a full year, and while the improved sleep and generally improved mood was fantastic, and even toward the end it was so much harder to get any focused work done.
I think my average level of useful focus is just simply higher with caffeine. I was off it for three years, which is well beyond the time it would take to lose any tolerance, but never really reverted back to the same level of focus that I get with caffeine.
I'm not sure my overall focus over time is higher with caffeine, but it does allow me to nudge more of it into the useful part of my day. However I'm a fast metaboliser of caffeine, and it doesn't impact my sleep at all, so could be that there's a genetic component to one's experience here.
Stimulants (of caffeine is one) are the de-facto treatment for ADHD, not entirely unlikely caffeine is keeping me subclinical.
I am in the middle of trying this out. When I first stopped caffeine I had better sleep and very vivid dreams every night. I also feel better as I think coffee was making my stomach too acidic which was causing me other indigestion problems, not to mention that coffee was nuking my teeth as well with acid.
Im on week 3 of no coffee now, I will maybe give it a month or two more to make a judgement call if I want to continue with coffee or not.
It is unfortunate as I really enjoy coffee, but it causes some issues for me with anxiety and stomach problems.
This is not true. Caffeine is not necessarily helpful for ADHD. It has a different mechanism of action from ADHD stimulants. They are not interchangeable. Not all stimulants help ADHD.
Also there’s a growing trend of diagnosing every focus problem as ADHD when many patients might have focus problems secondary to another condition like anxiety. It’s sadly all too common to find someone who believes they have ADHD due to TikTok self diagnosis or even a lazy doctor’s diagnosis but their core problem is actually anxiety. For these people, stimulants of any kind can actually worsen focus even if then provide a short term perception of helping due to the energy boost.
Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee.
I’m quite sensitive to caffeine, yet I can drink green tea all day without noticing much effect, while even a light coffee or a caffeine pill is clearly noticeable. I can also drink tea before going to sleep without any problems.
> Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee
You can absolutely get high doses of caffeine from tea if you really want to. It comes down to the type of tea, how much is used, and how strong it’s brewed.
There is nothing special about tea that breaks the rules of caffeine. It comes down to the content of the leaves, quantity, and extraction into water.
> while even a light coffee or a caffeine pill is clearly noticeable
Caffeine pills generally have really high dosages, FYI. Even light coffee drinkers can be caught off guard by how much caffeine is in a typical off the shelf caffeine pill.
> There is nothing special about tea that breaks the rules of caffeine.
There's definitely something special, just poorly studied: typical "how much caffeine is in X?" tables show tea having caffeine levels similar to coffee, but I never feel the same effects.
> Caffeine pills generally have really high dosages, FYI.
I use 200 mg tablets split into quarters for doses of 50–100 mg. Yet, they produce a much milder curve than coffee (which I no longer drink) and, as a side effect, cause no gastrointestinal side effects!
I cut coffee for over 6 months, and one of the most significant thing it did for me is that, when I resumed, I noticed that caffeine actually helped me feel more awake and alert (while I didn't notice any effect when taking a lot of it before stopping cold-turkey)
Fascinating.
Can you describe what else you tried? Other supplements? Any other non-food/supplement techniques like journaling, breathing, etc.? Any therapy and other similar human interventions?
After all those - is it / was it still the case that cutting caffeine drove the best outcome?
Not OP but I'll share my experience. For me, I have to quit caffeine for those to even become an option. Otherwise I get my short burst of productivity then everything shuts down after and I don't want to do a thing, everything feels "impossible" or like it doesn't matter at all.
Things like journaling / breathing / etc calm the nervous system while caffeine stimulates it. I would say caffeine is counterproductive to those practices.
Thanks for sharing.
I briefly quit caffeine once but it as well before any realization of anxiety. So, hard to extrapolate forward from that experience.
What feels different to me (compared to you) is this: sometimes I'll drink 2 cups of coffee in the morning and be awake but useless. Sometimes totally productive. Caffeine in some form is there - recently sometimes substituting coffee for a Celsius.
How long would you say it takes to feel the effects after switching? I did this a couple of years ago and as far as I remember the only real effect was my energy levels were more stable.
I gave it maybe 2-3 months and decided it's not worth it.
Tempted to give it another shot!
I think some of the positive effects are very quick (better sleep) whereas others take longer to materialise. My wife commented after maybe 2-3 years that I had become much more organised. I think that happened because I came off caffeine and then adapted over time to having a different brain chemistry, so I learned techniques to organise myself that I wouldn't have stuck to had I carried on consuming caffeine.
I wish I could cut down on my caffeine intake to help my ADHD. Unfortunately, I already have basically zero caffeine intake (apart from diet coke sometimes)
Counterpoint, purposely adding caffeine in the form of different mushroom coffees has greatly improved my ADHD symptoms.
At this point, I mostly avoid prescribed medications and don't take very many things at all regularly. Mostly because I've had some of the worst interpretations of the side effects of most medications I've ever been on. These include hospitalizations and side effects I'm still dealing with years after (looking at you Trulicity/Ozempic)...
I'm usually able to reason or force my way through depression and the like, but have had a few deep bouts in my life. The medications have ranged from ineffective to building a tolerance quickly, to just plain worse than the symptoms being treated. Nothing like missing your highway exit multiple times back and forth because you get lost "in" the drive on medication, or having 140 browser tabs open and losing 5 hours of work time.
Everyone is different. I am amazed at how much western society has so many hormonal issues that come down to the lack of quality or appropriate fatty acid intake and a lack of something as simple as more outdoor/sun time. I think the "low fat/cholesterol" advice for most of the past half century combined with the increase in snacking and junk foods have been massive disservices to humanity as a whole. I wouldn't be surprised if some of the effects are multi-generational in the making either.
My physician prescribed Vitamins D and B12, so a quality Omega 3 is the only supplement I currently purchase.
After an absurd amount of trial and error with every over-the-counter, trendy supplement over the last couple of decades (and lord only knows how much money), these are the only ones that seem to make a subjective difference on my quality of life and an objective difference in my bloodwork.
can vouch for a diet high in fatty fish along with supplementation of D3 + cofactors (K2, A, magnesium, zinc, copper, boron). sample size of one but noticeably improves mood and energy levels.
recent evidence [0] suggests there's not much of a link between serotonin and depression, and therefore the effects of SSRIs are either placebo or an as of yet unexplained mechanism of action. IMHO it seems much more likely that modern lifestyles (excessive screen time, poor diet, lack of socialization, no connection to nature, no spirituality, etc) have more of an effect than serotonin levels.
To many people without relevant expertise give medical advice online.
I remember a similar case with levelsio who was advocating people to take melatonin and discussing how much grams is good vs bad. When I said that people shouldn't take medical device from someone who was successful in building web apps, he blocked me.
And better than taking pills for the former, add hemp hearts or flax seeds to your cereal. One serving of hemp hearts has 10 grams of protein and 12 grams of Omegas 3 and 6. Flax seeds are lower in protein but an even better source of Omega 3 in particular.
Never going to advocate against eating whole foods if they taste good! But beware, the ALA omega 3 fat in flax and plant sources is not the DHA and EPA omega 3 fats used by animal cells, and so it's not as potent as what's in fish.
The main problem with ALA is that to have the good effects attributed to omega-3s, it must be converted by a limited supply of enzymes into EPA and DHA. As a result, only a small fraction of it has omega-3's effects — 10%–15%, maybe less. The remaining 85%–90% gets burned up as energy or metabolized in other ways. So in terms of omega-3 "power," a tablespoon of flaxseed oil is worth about 700 milligrams (mg) of EPA and DHA. That's still more than the 300 mg of EPA and DHA in many 1-gram fish oil capsules, but far less than what the 7 grams listed on the label might imply.
https://www.health.harvard.edu/heart-health/why-not-flaxseed...
Also, beware of omega 6 fats. Seed oils (corn, soy, canola) used in commercial food products are incredibly omega 6 dominant in terms of polyunsaturated fat content. Consequently, the ratio of omega 3 to omega 6 fats we consume has plummeted as food production has industrialized. Omega 3 fats are precursors to generally anti-inflammatory signaling compounds, whereas omega 6 fats are precursors to pro-inflammatory signaling compounds. The bias in fat intake leads to more pro-inflammatory signaling in the body, and a lot of alt health types have alleged this is a major causative factor in the obesity epidemic.
This is important for depression, because chronic brain inflammation as a cause of depression was one of the going hypotheses at least a decade ago when I last looked into all of this. Upping omega 3 intake is an intervention that can address chronic inflammation, which is potentially why it improves some cases of depression.
Pretty much nobody in the west needs more omega 6s these days. I hear even farmed salmon eat primarily corn and soy based feeds these days, meaning their fat ratio is skewed much more heavily toward omega 6 than wild salmon and fish.
I'm not an expert, but I've done a bunch of reading on this previously, and also skimmed the article which also mentions some parts of this.
First, when taking omega 3 supplements, you generally care about increasing the ratio of omega 3 to omega 6. Hemp hearts have much more omega 6 than omega 3, so they're not very effective for improving the ratio.
Second, hemp hearts contain ALA, while what you generally want to improve is EPA and DHA (this is also covered in TFA). The body can convert ALA to EPA and DHA, but it's not efficient.
So all in all, if Omega 3 for the article's stated benefits is what you want, this is not the way. I recommend looking into eating more fish, or if you want a vegan route, algae-based supplements. [0] is a decent source from the NIH about foods and their Omega 3 content, split by ALA/EPA/DHA.
[0]: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthPro...
The ratio of Omega 6 to 3 needs to be below 4:1 to be a good source of Omega 3, and hemp hearts are at 3:1, so they're listed as a good source of Omega 3.
Flax seeds are even better just for Omega 3 at 1:3, but hemp hearts have other benefits, like more protein, which is why I called them out. That said, I eat a fair amount of flax seeds as well.
Just to reiterate, both of those (hemp hearts and flaxseed) only contain ALA, while what you're generally looking for is EPA and DHA. TFA also explicitly mentions it's only talking about EPA.
This is not to say that they're unhealthy of course.
EDIT: see the sibling comment by code_biologist, it's much more comprehensive than what I've written.
Surprised this hasn‘t been mentioned at all in such a long discussion:
I became pretty suspicious of most supplement brands last year. Many omega-3 capsules are rancid (which can have adverse effects and can easily go unnoticed with a capsule), and the vitamin D brands I tried didn‘t seem to do anything for me at all.
I switched to cod liver oil instead. It‘s a staple in Scandinavian cultures, so there are several well-controlled brands available that taste neutral (or are lightly flavored, e.g. lemon). It’s a combined substance containing omega 3, vitamins D, E, and A, and appears to be much more bioavailable than many capsule-based supplements, especially given the oxidation issues. Don’t want to prime anyone - try it yourself - but many people, myself included, report fairly immediate effects. I am not talking about the capsules, they are a fairly recent invention, I mean the plain oil on a spoon like in the old days.
Alongside magnesium, it’s currently my only „supplement“.
I can only provide anecdotical evidence, which is ... not evidence, really.
Within my peer group of people on the spectrum (which very often comes with a depression, which is logical) we've discussed Vitamin D studies for years. And multiple of us decided to give it a try for a couple of months. And neither those who tried it INSTEAD of an SSRI, nor those that took both (SSRI + D) could report any measurable difference.
I have a theory on why is that: It is known that low levels of Vitamin D is one likely cause for depression - in Northern Europe, where during winter time people do not get enough sunlight, that correlates very clearly with the suffering of depression.
But potentially it simply does not work the other way round: I moved to near the equator, and I therefore basically have sunlight shining out of my butt, but still am depressed. It makes sense that in this case Vitamin D makes no difference at all.
In summary my theory would be: Vitamin D only has an effect on a depression that was caused by a lack of Vitamin D.
I’ve been taking them when I was in hell, for abotut half a year, you know what? I think they didn’t help me a bit. But Mirtazapine did.
Coincidence? "Vitamin D is currently the only Essential Vitamin or Mineral which appears to have deficiency rates at a similar level to Magnesium"
https://examine.com/supplements/magnesium/research/#nutrient
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial https://pubmed.ncbi.nlm.nih.gov/30541089/ "Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
So it might well be that general deficiency in Vitamin D is caused by the deficiency in magnesium status. This would also be an explanation why we see Vitamin D deficiency in sunny Africa: https://theconversation.com/think-vitamin-d-deficiency-is-no...
Confusing mg and IU units up front really do NOT inspire confidence on the topic and conclusion as a whole.
Super interesting, just sad that Omega-3 supplements are one of the main drivers of unsustainable Krill overfishing https://seashepherd.org/2025/02/25/protecting-the-oceans-vit...
Why does this keep popping up?
"Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being."
https://pmc.ncbi.nlm.nih.gov/articles/PMC4907952/#:~:text=Bo...
The only problem here is that "going from an F to a C in mental health" is vastly different than "going from a C to an A." It's very well known and well documented that antidepressants have very little effect on mild depression compared to say, exercise, but that F grade of depression tends to be a different beast with different causes.
That's not to suggest that exercise etc isn't great, just that society has come a long way in destigmatizing mental health and just being like "oh just take fish oil" to someone dealing with that kind of depression, either through shitty genes or childhood trauma or whatever, can be really harmful.
Anecdotally, I've been taking a 5,000 IU vitamin E supplement this winter. Seattle area, indoor desk job, I am a vampire. It does seem to help, I would rate it as going from a C to a B grade. I'd prefer not to use antidepressant medications to fix a problem that for me is mostly caused by living at a different latitude than I grew up in.
Do be aware that not all vitamin E supplements actually contain the dosage that they are labeled at, and that inclues both no-name brands and some big name brands. I'm having trouble finding a good reference on google due to AI and SEO pollution. But I recall Nature Made was labelled accurately and that is what I buy.
My wife on the other hand has struggled with life-long anxiety/depression even when living in Atlanta. For her a fairly low dose of lexapro enables her to live her life like a normal person. We wish we could get her mother to give it a shot for a few weeks, as she now can see a lot of similarities in both their personality traits that were affected by a life of untreated anxiety.
We also have cat that would probably have been put down for fear-biting of people and attacking our mild and mellow dog until we got his aggression under control with kitty prozac. I kid you not, it's a transdermal fluoxetine cream we put in his ear each day. Without the constant anxiety stimulus in the way, his real personality came through and he is actually very sweet. To me at least. Still bites my wife, but not hard anymore, just enough to keep her alert.
Vitamin D toxicity is absolutely real, causes hypercalcemia, and can occur even at the 4,000 IU dose. I would really recommend you be getting regular bloodwork done if you go beyond that. Here’s a fun podcast on a case study. https://www.barbellmedicine.com/podcast/episodes/episode-381...
One flaw in this analysis is that the source he cites for antidepressant effectiveness didn't include tranylcypromine (or any MAOI class drugs), which the STAR-D trial found was one of the most effective antidepressants.
(The STAR-D had a cumulative remission rate of 67%, I don't know how to convert that to the format he used)
Otherwise I agree that vit D and omega 3 are underrated for depression, it would be interesting to see if they have a cumulative effect with antidepressants.
You might want to take magnesium with Vitamin D, because taking vitamin D depletes magnesium. Not sure if it's strictly necessary, but if you're already low on magnesium it might be an issue. I once got tinnitus (which lasted a few months) when supplementing Vitamin D, the only explanation I've figured is that my magnesium was very low, which can cause tinnitus. Might be something else too, who knows.
Anecdotal, and even meta-anecdotal, but hey: four months ago I started to supplement omega 3 thanks to this hyperbolic HN comment: https://news.ycombinator.com/item?id=45169875
Unlike the commenter, I didn’t suddenly turn into a chess grandmaster, but I did notice that my winter blues didn’t show up this year, the first time in a decade!
As a neurologist I cannot be persuaded. Their is a huge placebo and confounding component in the spectrum stress-depression. There are syndromes where AD drugs make wonders, literally saving lives, and others where they are useless. But taking 150000 IU of vitD per month definitely doesn't have the effects it promises.
For a single time fix (“rewire brain to be healthy again”) you need psychedelics (psilocybin has seen multiple studies where its effect is way better than psychopharmacological drugs). A single dose can make you healthy for a year to come, potentially also for life as you’re no longer a potential victim to it ever again.
> due to some quirk of evolution, Omega-3, -6, and -9 are the ones biological life uses most. As far as I can tell, there's no specific reason they're all multiples of 3. Probably just a coincidence.
This curio bothered me as well. I didn't yet get a fully satisfying explanation for this either.
There's this diagram, showing for example the full pathway of how linoleic acid catabolizes: https://commons.wikimedia.org/wiki/File:Linoleic_acid_beta_o...
It shows dependencies of the process onto several very specific molecular machines we call enzymes.
(main pathway, handling saturated fatty acids)
° Acyl CoA dehydrogenase -- removes 2 hydrogens from carbons immediately after the carboxylic head, forming a π-bond (double-bond) between the α-β carbons;
° Enoyl CoA hydratase -- adds water as H-OH to that α-β carbons π-bond;
° 3-hydroxyacyl CoA dehydrogenase -- converts the added -OH hydroxyl group to =O keto group;
° β-ketothiolase -- grabs the two keto groups, and snips off 2 carbons from the chain, carrying them off in bound form as a molecule of acyl-CoA;
° Dienoyl CoA reductase -- collapses two neighboring π-bonds into one;
° Enoyl CoA isomerase -- converts cis- to trans- variants, making them compatible with Enoyl CoA hydratase. Pathway continues from there.
Besides catalysis (combustion of the acids for energy), the two other paths for consumed fatty acids are excretion, and laying them into cell walls and membranes. These two paths aren't selective; they mostly don't care about the length of the chain, and where which π-bonds occur in it, if any.
So this must imply, that the "quirk of evolution" lives somewhere on the anabolic (synthesis/production) side of fatty acids; definitely not on the catabolic side.
This made me think of Pauling (https://en.wikipedia.org/wiki/Linus_Pauling) who was a famous scientist and big proponent of high-dosage C-vitamin. He claimed it could cure everything from a cold to heart disease and cancer. Later studies did though not find any benefit of high-dosage C-vitamin and that potentially had a higher risk of prostate cancer. Pauling died of prostate cancer.
Edit: This may also be of interest: https://en.wikipedia.org/wiki/Orthomolecular_psychiatry
I have seasonal affective disorder and was taking a medication that sort of helped, but was causing mood swings if taken even slightly out of rhythm, increased my blood pressure, and was just generally not that effective, but it was better than nothing. Last winter I switched to vitamin D (it was already uncovered in blood tests I had a deficiency, which is what turned me onto it - when I started taking it, I felt a lot better) and omega 3 and I won't go back. I wish someone had told me a decade ago, probably would have saved a lot of damage to my organs (another reason I got off of it)
I used to have very rough winters. Despite the fact that I ate well and was outside 2+ hours every day. I got my blood tested and I had very low vitamin D, two tiers below normal. This was the first winter being on Vitamin D, and my energy and hunger levels stayed normal. I never crashed or had extreme hunger or trouble sleeping.
Getting Vitamin D from food is a fools errand, and since sunscreen and protective clothing slow vitamin D from the sun drastically, it's in most people's best interest to get it tested.
Before you start taking crazy amounts (or any amount) of vitamin D just get a blood test. It's simple. As part of my insurance I can get a bunch of different blood tests, but I did have to pay about $50 extra to add the vitamin D test.
Based on the test I was just a tad under where I should be and so now I am taking 800 IU per day. I may stop in the summer when I get more sun.
I read somewhere that too much vitamin D has similar effects as too little (permanent hair loss, anemia, etc) but that may have just been on a blog similar to the linked blog on this submission.
I used to take a supplement with 10k vit D units. Made by a reputable company here in Europe.
I did a blood test for vit D metabolites (oh 25 or something). It turned out I was deficient.
The doc gave me 8k units as a prescription drug. In theory weaker. After 2 months I was no longer defiecient (kinda borderline). After 4 months the doc decided to go down to 4k iu.
Now I wonder why some experts are telling people to take 10k iu? Is it because the supplements are crap and contain 10% of what they claim? (I've been taking vit K as well)
I think the general idea is that the stats labs use to decide what is normal is not necessarily ideal, and like everything else will vary per person.
Too much Vitamin D3 can be toxic, so doctors are reluctant to tell you to go over published guidelines. but if you don't have other issues, and stick to what you can get OTC from a normal vitamin brand and follow the instructions, you're probably safe. There was a story a while ago about a woman who died from too much D3, but it turned out she was taking a whole bottle's worth every day for years.
This is all in a book called The Depression Cure by Stephen S. Ilardi (https://bookshop.org/p/books/the-depression-cure-the-6-step-...)
I read this years ago and it's fascinating. Looks like it's been updated for a second edition last year.
I am taking so much Vitamin D and I can confirm!
It is depressing ... :(
(Note: my own real therapy is to do what is fun. That is, humour. This can occur via social interaction; it can also happen to some extent by studying human behaviour via ... youtube videos! There are some surstromming videos that are just epic display of human behaviour. If aliens ever arrive here, I'll show them the Top 3 videos there. Either they will laugh too - or flee from this strange planet.)
Chia is awesome for making pudding out of random liquids. I have to restrain myself from eating a batch of coconut milk cinnamon chia pudding in a single sitting.
I’ve personally found meditation, exercise and healthy food intake are more effective for self regulation and coping with tough emotions over medication and supplements.
Each human being is unique, as is the recipe for sustained positive metal health.
I think it’s helpful to consider and experiment with different ideas and strategies.
I strongly disagree there is one single solution that can provide significant lift for a large population.
Try NSAIDs. Depression is a set of emotions. Emotions affect the body. I thought to try NSAIDs to deal with the physical discomfort. That partially shutdown the feedback loop of mood -> body discomfort -> reinforcing mood.
There are studies that show this is an effective intervention.
I was an RA at the RAND Corp who put together literature reviews for mental health interventions like this. The Vitamin D result is implausible. If true it would be the biggest breakthrough in the history of psychiatry.
This is the referenced meta-analysis: https://www.cambridge.org/core/journals/psychological-medici...
The largest N study (N=18,353; more than half of the entire 31 study sample) included is https://jamanetwork.com/journals/jama/fullarticle/2768978, which found: "Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group...and the placebo group."
The highest dose study (100,000 IU/week) included is https://pubmed.ncbi.nlm.nih.gov/30532541/, which found: "...the treatment response or BDI scores did not differ significantly between groups."
The paper/supplementary materials doesn't include a simple table of the depression outcomes for the 31 included studies, which is a glaring omission.
I think someone just messed up here. Maybe missed a decimal place?
For a more realistic perspective, here's another careful meta-analysis of RCTs of Vitamin D for depression that found null result: https://www.sciencedirect.com/science/article/abs/pii/S08999... (granted, 2015). And another from 2025 that found a .36 effect size, which is plausible and still fantastic: https://www.frontiersin.org/journals/psychiatry/articles/10....
I don't mean to dissuade people from trying these given the low risk profile, just don't expect to go from a C to an A.
A useful way to look at the effects of vitamin d and omega-3s: supplementation isn't really a hack, it's more that their removal is a handicapping of our "normal" state. Our evolutionary conditions would have been more rich in both of those things. Also see light exposure during the day, proximity to green space, etc.
I would add that the issue with Omega-3, is the imbalance between Omega-3 and Omega-6. It turns out that many of the food products have been manufactured with Omega-6 rich oils and that is causing some issues. One can ingest Omega-3 supplements, try to eat foods rich on that fatty acid or reduce foods with lots of Omega-6 in order to restore that balance.
These are always tricky, vitamin D deficiency and low fat diets clearly cause depressive symptoms.
Does that mean vitamin D treats depression in general?
When most people talk of depression they aren't even using talking about major depression.
We live in a world that in many ways is comfortable but crushing. Is that depression? Or just harmful levels of understandable unhappiness? Are they different?
I had sleeplessness that eventually led to depression and gastritis. I took medication for two years to recover. The root cause was a vitamin D deficiency my level was 8 ng/mL, which was far below the required range. There was a period when i was only able to sleep with medicines. Now coming back to normal life.
I started back on Vitamin-D and Omega-3 (with extra EPA & DHA) about 2 months ago or so. Sadly, I don't feel much of a difference, but I believe the potential harms are quite minimal, so I am going to maintain supplementation for the purposes of self-experimentation.
Before anyone goes out and overdoses on Vitamn D (since lots of multiple vitamin include too much), see this article on toxicity from too much Vitamin D
Juxtaposing with the quoted passage from the post: “Because vitamin D is potentially toxic, intake of [1000 IU/day] has been avoided even though the weight of evidence shows that the currently accepted [limit] of [2000 IU/day] is too low by at least 5-fold.” --https://www.sciencedirect.com/science/article/pii/S000291652...
It cites a study about vitamin D toxicity where the range of cumulative intake causing it was identified to be 2.2 million - 6.3 million IU. When you take 6000 IU daily for a whole year you only reach the lower end of that range, and you definitely shouldn't do that without checking your levels somewhere in between. Taking it for a few months may get you above the recommended blood levels, but is very unlikely to cause issues unless you started with very high levels already (which you most likely did not).
Toxic levels of vitamin D can be life threatening, so do keep your levels in check, but you won't get there unless you really try, so if you can't get out of the bed to have your blood tested just start taking it and check it after 3 months when things get hopefully easier for you. Just make sure to get the number of zeros in the dose right.
> So why are all the official sources still so paranoid about Vitamin D
It is fat soluble vitamin, together with A, E and K. That in itself makes in more risky in terms of overdose. I didn't hear of any cases outside kids eating jars of vitamin gummies but it does happen.
Precision Medicine is the way, and maybe we will get there one day Too many effective agents are averaged away because the population for whom it is effective is just a subset of the population with the targeted symptom.
Hey OP, kudos for being so engaged in the discussion + making edits and not just firing the link off and then going AFK. Makes the comments more interesting and (I think) the actual work better.
including the mentioned meta-analysis? if yes, can you explain why you think that it's dubious?
Wrong unit in text, right? Graphs shows UI. 5000 UI would mean 125µg of D-vitamin. Which is a bit smaller than 5000 000 µg from the next
How many of you feel worse when taking vitamin D supplements? Alternatively how many of you feel only temporarily better?
Scott Alexander observes in this piece https://www.astralcodexten.com/p/all-medications-are-insigni... that the effect size for even EXTREMELY EFFECTIVE medications are remarkably low.
> Zolpidem (“Ambien”) has effect size around 0.39 for getting you to sleep faster. Ibuprofen (“Advil”, “Motrin”) has effect sizes between from about 0.20 (for surgical pain) to 0.42 (for arthritis). All of these are around the 0.30 effect size of antidepressants.
...
> Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875.
As for why, read his essay I guess. But I wouldn't take at face value the interpretation of effect sizes in the original article.
(I also couldn't say why the effect size of vit D and Omega-3's is so large, although per Scott Alexander's article if fewer people drop out of the treatment group, that should increase the effect size, so maybe the relative tolerability of the treatments is part of the story?)
Also magnesium! Magnesium bisglycinate, in particular. Great stuff.
can only say, if you have depression or mental problems: NIACIN. not the niconinamid or whatever which is a scam. do not drink alco or smoke! kidneys will suffer.
The article even states that nothing here is written in certainty. It’s just pure speculation. No, fish oil and vitamin D do not have a larger effect than SSRIs for depression.
Not to say they don’t help, but it’s asinine to state that nutrients are a replacement for selective serotonin reuptake inhibitors, whose sole purpose is to help with depression, and has been designed by an army of scientists, researchers, psychologists, psychiatrists.
To add another data point: 4,000 IU (two Kirkland capsules) daily keeps my Vitamin D levels at the high end of the reference range. I also take six Kirkland fish oil capsules which happens to hit the 1,500 mg DHA+EPA target suggested in the article.
Honestly, Costco supplements are hard to beat since they're both USP certified and are usually the cheapest.
The amount of people in this thread rejecting behavioral health as a legitimate science/field and calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense. Very sad to see.
> "calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense."
That's not what I was doing in my other comments that you replied to. If you have a knot, and imagine all the possible things you can do with your hands and body and tools in the universe and notice that to a first approximation none of them will untie the knot. Not hitting it with a spoon, not stroking your chin, not jazz hands, way more than 99.999% of possible movements will not untie it. Some of the things which won't work also include pulling yourself up by your bootstraps, "not being weak", "toughing it out". "just get over it". All those are no more effective than any other of the 99.999...% of things which won't work.
The things which will work are in a tiny space of things involving fingernails, needles, knot-eye-hand-feedback-loop and some understanding of rope and tangles. Or fire.
Just because fire will have a useful effect doesn't mean the knot is caused by an imbalance of fire and so you should keep burning your fingers for the rest of your life as "the cure" for knots. The way to untangle a knot is to develop the focused, pointed, targeted skills of untangling knots. And (I argue) the way to untangle negative thoughts is not by powering through them, toughing them out, positive mental attitude, fortitude, being strong, manifestation, dreaming big, just getting over it, or crowbarring your mood up with sledgehammer drugs to an 80-billion neuron network for the rest of your life, or anything else of the millions of other concepts one could do or imagine doing - except the focused, pointed, feedback-loop skills of untangling negative thoughts wielded by a particularly good therapist or by yourself.
Whether you develop such a thing by therapy training, meditation, prayer, Stoicism, biofeedback systems, luck, intuition... I suspect there are multiple ways which are effective that can be developed through multiple approaches, but not many. And "I tried thinking my bad thoughts away and it didn't work so it must be genetic" is not one of them.
You don’t need to chase down my comments to have the same discussion in two places, and this isn’t (only) about you.
I didn't chase you down, I was reading the whole thread.
Your one-line dismissal is annoying deliberately-vague-accusatory trollbait, and I was baited.
Have a good weekend man. Neither of us is looking particularly great here. Let’s move on.
Here you go HN commenters. Last month when I made the observation that "from what I've read recently, I've started to get the impression that the explosion in mental health problems (depression, autism rates etc) has more to do with the western diet than genetics"[0]
Y'all called me MAHA and down voted me into the negatives. Please, insult your own analytical ability by doing the same here. This time I'll just revel in your ideologically confined science denial this time.
[0] https://scitechdaily.com/simple-three-nutrient-blend-rapidly...
Except depression rates are rising at similar or worse levels in other places too, including sunnier/tropical regions and the ones with "better" diets.
The main instigator of depression is still societal as the postmodern era is pushing everyone into seclusion and addicting them to constant individualized dopamine hits, increasing the miserable effect on one's chronic mood and exacerbating one's self-consciousness about it.
My dad if he was alive would have shouted "I told you so"
why is this nonsense trending here? this is a random blog
I couldn't express this clearly in English with my current level, so the LLM interpreted my idea and expanded on it for me.
What drove you to write this comment? There are enough countries where sun is an exception in winter and this is a valid problem.
Comment is neither helpful nor is it funny.
Interesting point, there is at least one theory out there which says that neither sunlight nor Vitamin D is necessary if an individual is really healthy. The ones that feel better on the Sun and/or Vitamin D are people who are at least mildly unhealthy and it's of form of addiction where the individual ought to keep taking something to just not feel miserable.
It's going to be sunny this morning, but also -14 and also I'm too far north for adequate Vitamin D synthesis in winter. But thanks for the advice.
Please do not take 5000mg/day of Vitamin D. The author confuses IU and mg which is very dangerous.