
Researching alternatives to the chemical imbalance theory of depression - nradov
https://www.huffingtonpost.com/entry/opinion-hari-depression-causes_us_5a6a144de4b0ddb658c46a21
======
JamesBarney
No serious scientists have thought depression was caused by any simple story
of chemical imbalances that drugs were directly fixing. The author acts like
everyone has been assuming that depressed people have an ssri deficiency. And
that's it's a huge insight to consider therapy.

And people have tried therapy for a very long time. The best studies show it's
as effective as anti depressants. But here's the rub, it's very expensive to
go the therapy.

My wife had a condition that is more amenable to therapy than drugs and that
cost us $500/week, and the only reason she could make her appointments was
because she didn't need to work. I have no idea how a working family would
have been able to afford it.

Her ssri's are 15$ a month and she has to see a psychiatrist every 3 months.

------
PaulHoule
It is environment + chemistry.

"Underdog" animals develop a low serotonin state.

[http://www.ulm.edu/~palmer/TheBiochemistryofStatusandtheFunc...](http://www.ulm.edu/~palmer/TheBiochemistryofStatusandtheFunctionofMoodStates.htm)

Many of the behaviors and attributes associated with "poor" people are similar
to the low-serotonin state described above.

If you are "ground down like a minion", SSRIs attenuate the negative impacts
of that.

~~~
pharrington
A better catch phrase is "affective neurology," the simplified explanation of
which is phenotypical expressions causal to the organism's nervous system and
apparent behaviors. Here, our working models of the nervous system obviously
involve a considerably higher level of abstraction than chemistry.

------
draugadrotten
[https://www.independent.co.uk/voices/johann-hari-
depression-...](https://www.independent.co.uk/voices/johann-hari-depression-
anti-depressants-psychiatrists-pills-therapy-change-lifestyle-job-
psychology-a8151606.html)

"But I wish that I, or one of my colleagues, had a chance to meet him on this
voyage. He suggests that depression is treated as if caused by “broken”,
chemically imbalanced brains and so sufferers are treated with
antidepressants, without question. This treats a patient like a “machine with
malfunctioning parts”.

This is far from reality. Rather than seeing mental illness as annexed from
the rest of people’s lives, helping patients through assessing their social
and psychological situations, as well as biological aspects, is the bread and
butter of the work of psychiatrists and other mental health professionals."

~~~
DanBC
Especially in the UK where IAPT (Improving access to psychological therapy)
makes available a short course of cognitive behaviour therapy, free at the
point of delivery.

------
TheAdamAndChe
While the article raises some good points, the title is such clickbait. We've
known for decades that many mental disorders have psychological roots, and
that a combination of psychotherapy/CBT and medication is far more effective
than medication alone.

------
aaavl2821
Brain chemistry is certainly important in depression but we don't know enough
about it to rely on it for treatment. A large investigation was done into
genomic links to depression and there were no markers related to serotonin /
dopamine genes. SSRIs were discovered through serendipity largely and nothing
new has really been developed since bc we don't know much about the brain
(though we think NMDA receptor agonists and some allosteric modulators of GABA
r may work)

Therapy is the right way to handle a lot of depression cases, but very few
people get it because of stigma and the fact that psychiatrists can't make
money doing therapy unless the patients are rich

------
bryanlarsen
And it just leaves us hanging. It says there are 9 major causes, and then only
discusses one of them. A quick Google doesn't come up with an obvious list,
and little agreement on the number 9.

~~~
dang
That title was bad. We've updated it with representative language from the
article.

------
norswap
Meh writing. There are nine causes of depressions? What are they? Which one is
he going to focus on?

------
EtDybNuvCu
And for those of us who had nothing bad happen to them during childhood, but
still feel depressed?

~~~
azhu
Bad can be just as well defined as a lack of good, much like depression
itself. Consider that it may be an exercise in futility to try to discern the
"true cause" of your emotional state, and that it may be more worthwhile to
begin implementing solutions than to attempt to further deconstruct your
problem. Human psychology is much like software save for one very important
distinction: you cannot read the code. As such, trial and error remains the
best strategy.

~~~
phkahler
>> Human psychology is much like software save for one very important
distinction: you cannot read the code. As such, trial and error remains the
best strategy.

And there are many models of what may be wrong. You can often fit a model onto
your situation, but it helps most when you find the "right one" for you and
deal with it appropriately. The software bug in the brain can look like a
number of things, but they are not all correct. Trial and error is correct
here.

------
dang
Hari's book on depression had another thread recently
([https://news.ycombinator.com/item?id=16092975](https://news.ycombinator.com/item?id=16092975))
but perhaps this article is different enough.

~~~
DanBC
It's useful to discuss mental ill health on HN, but Hari isn't a good starting
point for these discussions.

He's mostly wrong; he misrepresents the current thinking; he mangles the
science; etc.

We spend so long correcting his mistakes that there's little room left for
discussion.

[https://amp.theguardian.com/science/brain-
flapping/2018/jan/...](https://amp.theguardian.com/science/brain-
flapping/2018/jan/08/is-everything-johann-hari-knows-about-depression-wrong-
lost-connections)

------
scott_s
The author, Johann Hari, recently had a Guardian piece on depression. His
representation of psychiatric research and clinical practice was so cartoonish
that he has burned up his credibility with me. Steven Novella (a clinical
neurologist) discusses that article here:
[https://theness.com/neurologicablog/index.php/more-mental-
il...](https://theness.com/neurologicablog/index.php/more-mental-illness-
denial/)

This article is similar, in that Hari is claiming, without evidence, that
depression is _always_ caused by life events. It's a strange claim to make,
not only because it's made without any support, but because modern psychiatric
research and practice most certainly incorporate traumatic life events as
potential causes of depression.

~~~
pc2g4d
In the original article Hari doesn't claim depression is always caused by life
events. Rather he says this:

"The more I investigated depression and anxiety, the more I found that, far
from being caused by a spontaneously malfunctioning brain, depression and
anxiety are mostly being caused by events in our lives."

Emphasis on _mostly_.

At least in the article above, Hari never claimed life events were the sole
cause of depression. But he did claim---in my experience accurately---that
doctors around the world push the idea that depression does have a single
cause, "chemical imbalance". My doctor never asked what was going on in my
life---and there was plenty. He just gave me drugs and told me I'd have to
take them for the rest of my life. That story is very common, and that's why I
find value in an article like Hari's. And the mischaracterization of normal
human reactions to painful life events as "illness" is odious to me. It's like
saying a suffocating person is "ill" because they're not doing well without
oxygen.

~~~
draugadrotten
> doctors around the world push the idea that depression does have a single
> cause, "chemical imbalance".

This sounds like something a scientologist would say. I remember actor Tom
Cruise talking using these words

[https://www.csicop.org/si/show/tom_cruise_scientology_bash_p...](https://www.csicop.org/si/show/tom_cruise_scientology_bash_psychiatry_apa_fires_back)

