Comment by ghusto

I'm not an expert so maybe someone else can clarify further, but in relation to sleep medications I've heard that they should not be used for more than two weeks, or they can permanently fuck up your sleep cycle.

They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.

At least that's how it was a while ago. Maybe the situation has improved.

Bit off-topic, but melatonin taken at right doses appears to work very well. (commonly prescribed doses are 10-30x too much and likely cause tolerance). See the post https://slatestarcodex.com/2018/07/10/melatonin-much-more-th...

> Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.

It's not at all clear that chemistry is the root issue. The brain is a synaptic graph that does something. Some graphs can have weird paths that lead to pathologies (maybe bad feedback loops). Chemistry seems like fairly a blunt instrument for bludgeoning a "bad" graph into one that's "better".

Forced habits, like cognitive exercises from psychology, can sometimes rewire the graph by themselves because that's how the brain learns/adapts, but we still don't have a good grasp on how to do this truly effectively in many cases.

That said, the blunt instrument of chemistry can sometimes be useful, particularly if it enhances neuroplasticity, as I think psychedelic research is beginning to show.

> Chemistry trumps psychology

To nitpick: The mind is applied biochemistry. Psychology intervenes in the chemistry, like many other activities do. The goal of that is to solve the root cause so that your future levels will be maintained at the right level, instead of just forcing the level by sourcing the respective chemicals externally.

A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.

The neurotransmitter model of mental illness is largely incorrect. It's much more complex than just "Depressives have less serotonin, therefore lets give a reuptake-inhibitor to keep serotonin in the brain".

If you view a world at a certain angle there is always something to worry about: 1. World in not perfect, it doesn't confirm to how we want it to be (and could not even in theory given that different people want it to be different) 2. The future cannot be predicted with 100% accuracy so even if all is perfect today you can worry that it will turn bad in the future.

When looking at the same reality one persons sees the situation as OK and another as a an endless and hopeless disaster it is hard to tell who is right. A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.

Arguably specific chemical patterns don't emerge and persist on their own. Basic causality will indicate that something caused that pattern, whether it is a disorder or a traumatic event. Chemical processes are not random. Otherwise, carbon based life forms would have never lasted this long

The parent commenter describes seasonal Winter depression. If the problem was brain chemistry, wouldn't it be with them from birth until treatment? Who has Seasonal Type 1 Diabetes, or Seasonal Dwarfism, or Seasonal Missing-an-Eye-From-Birth? Depression generally isn't something children have from birth, it's something adults get temporarily.

A few HN submissions recently are in the style "thinking about doing the thing is not doing the thing. Planning the thing is not doing the thing. <etc etc>. Only doing the thing is doing the thing". Comparing a brain to a large software project with bugs hiding in it, in that vein giving the computer 11 hours of 'sleep' each night is not debugging the code; overclocking or undervolting the CPU is not debugging the code; installing the latest updates and patches is not debugging the code. 'knowing there is nothing to worry about' is not debugging the code. Only debugging the code is debugging the code. Reading a badly explained idea on an internet comment and dismissing it with a mocking "thanks I'm cured" isn't debugging the code. Saying "I've tried everything" isn't debugging the code.

A more specific example, if you are going on a rollercoaster and you are experiencing physical and mental symptoms of worry - nervous, anxious, angry at the person pushing you to ride, twitching and trying to back away, eyes looking around searching for an exit, coming up with excuses to do something else instead, nervous shaking, dread tightness in the chest, affected breathing, perspiring, gritted teeth, etc. etc. then washing over all that with "I know there is nothing to worry about so this must be a problem of brain chemistry" seems a clearly incorrect conclusion.

Such a person clearly has a worry. Quite likely one that's out of proportion (e.g. "rollercoasters kill thousands of people every day!"). Possibly one that's completely incorrect (e.g. "going more than 10mph makes people's insides fall out!"). Quite likely a less clear and less obvious one - which could be anything, e.g. they saw a documentary about a rollercoaster which behaded a child and that's their only thought about rollercoasters; they saw a show about fighter pilots pulling high-G maneouvres and passing out and think that will happen to them on a big rollercoaster; they see the rollercoaster track and support flexing and don't understand that a some flexibility doesn't mean weakness; they went to a theme park as a child and older children bullied them into riding a scary ride and they wet themselves and figuratively died of shame and buried the memory; they were pushed into learning to drive at 15 by their wicked stepfather and this is pattern matching to the same kind of experience; etc. etc.

Saying "there is nothing to worry about, rollercoasters are safe enough and you know it, so your brain chemistry must be broken" isn't debugging the problem. It isn't even explaining the problem. Why would broken brain chemistry particularly affect them at a theme park, or in Winter, and not the rest of the time? How was this broken chemistry identified and measured and quantified and that hypothesis proven?

Likewise, just because the parent poster has tried sleeping and exercising and taking Vitamin D, doesn't address that humans evolved in Africa, connected to oceans and trees and tribal living, and not commuting to a fluourescent lit beige box filled with strangers writing JavaScript while being bombarded with news items about wars and genocides and stories of how everyone else is having a wonderful Christmas, earning more money than you, with a cost of living crises always on their mind, etc.

> "Good enough chemistry enables cognitive treatments."

Drugs can force people to carry on with a life that's making them miserable when they have no other available options to find out why and fix it. That isn't evidence that "there is no root cause"(!). Any more than turning it off and on again can let you get on with your job, but that doesn't show there's no root cause for a program locking up.

> "then you deduce that the black cloud is produced within."

And you have a lifetime of your prior experiences affecting your mood. When you remember that your aunt hit you when you swore at the dinner table, or you saw someone slip on ice and fall over and break their wrist, or watever, every life learning experience is "the mood is produced within".

They allow me to function. I've gone through various dosages of various types to find the ones that work best for me, but they have never stopped working. They also allowed me to stick with CBT therapy, and after 20 years my therapist told me I didn't need him anymore ("Call if that changes").

Your second paragraph reveals a biased motive behind your opinion.

I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?

> The last thing that your doctor wants is giving you pills so you go away

Except for all the doctors who do want just that.

> Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick"

While such patients exist, I don't believe they're a global majority, and the group of patients who want the exact opposite, more time rather than "quick", is the bigger out of the two.

Literally a few comments down from this one:

> N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to). She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".

> I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.

>Also, prevention.

Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.

Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.

With that said, does anywhere have enough specialists to cover as many sessions as would be needed for as many people would seem to need it?

The easiest way to deal with horrible trauma is to prevent said trauma in the next generation.

What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.

And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.

I don't know, people really suck.

Which knowing the side effects of Ambien is pretty bonkers.

>people want easy fixes that do not require any change in habits

Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.

The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.

The "hate" on antidepressants is mostly from a place of "The kids are taking pills for things that aren't diseases and just need to get out more" and other stupid takes about how "back in my day we didn't have this much mental illness", which is why the hate is maintained even for things like ADHD medications which are so thoroughly proven scientifically that they are one of the best proven treatments humans have access to for any disease.

Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.

The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.

We just don't really have much in terms of better treatments because we know so damn little about depression.

The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.

Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.

Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".

I was diagnosed a while back with a chronic neurological disorder. One that has a heavy effect on my mood and can conversely be triggered by my mood. The underlying cause is scientifically proven to be physiological. I lack a specific neurotransmitter due to inactive cells in my hypothalamus.

For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).

While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.

> I’m just always astonished at “have you tried not being depressed?”

There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"

It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.

Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.

> I know this road leads to SSRIs at the very least, so I always reply in the negative.

Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.

To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.

You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:

1.) It's killing my libido 2.) It's too strong

For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.

And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!

Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.

Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.

All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.

There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.

> The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo.

^ citation needed

What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?

> The hate is (among other points) because they are only arguably, marginally, better than placebo

Only true for some. Inarguably, well-proven false for others.

Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.

after being prescribed Mirtazapine, then Trazadone I realized I don't think I've had restful sleep as long as I can remember. I need a sleep study done probably but until that the quality of life from taking something that has virtually no negative side effects for me is insane.

meanwhile people are like "just take magnesium or melatonin lol"