
Drugs alone won't fix our epidemic of depression - pmoriarty
https://www.theguardian.com/society/commentisfree/2018/jul/19/drugs-alone-wont-fix-our-epidemic-of-depression
======
rednerrus
For the majority of people, the following should get you straightened out:

Get your diet straightened out. Stop eating so many refined carbohydrates. Eat
some green vegetables.

Get more sleep. You get 5-6 hours of sleep a night and wonder why you feel
sluggish and shitty every day.

Stop with the stimulants. You drink 36 ounces of coffee a day and wonder why
you can't get any sleep.

Get some exercise. You want to sleep better, wear yourself out physically as
well as mentally.

Put the screens down. It's fucking up your sleep and giving you a false sense
that you're getting the human interaction that you need.

Stop drinking so much alcohol. As a society, we drink too much alcohol. It's
no wonder we're fucking depressed, we fill our bodies full of CNS depressants.
It fucks up your sleep, increases your stress and anxiety levels and makes you
feel really shitty the next day.

There are cases of depression that are caused by legitimate, not self-induced,
chemical imbalances. The majority of depression cases are relatively self-
induced and could be fixed with simple behaviour modifications.

~~~
majos
I promise I am not pursuing the tiresome argumentative tactic of demanding
formal sources as a way to postpone defeat. But, seriously, do you have a
source for

> The majority of depression cases are relatively self-induced and could be
> fixed with simple behaviour modifications.

I am _very_ wary of telling a depressed person that it's probably just a
matter of making the right lifestyle tweaks.

~~~
rednerrus
Part of the reason why I quantified it. There are legitimate cases of
depression caused by non-self-inflicted chemical imbalances.

I’m not advocating for people who are currently taking anti-depressants to
drop their pills tomorrow.

The studies (I’m on the train so I’m not trying to cite these sources, google
it) show that lifestyle changes with antidepressants is much more effective
than antidepressants alone.

Even if you have a non-self-inflicted chemical imbalance, your shrink is
likely to prescribe all of the things I listed.

Source: my shrink, and every shrink worth their salt.

~~~
WalterGR
_Part of the reason why I quantified it._

You _qualified_ it. If you quantified it, you would have provided numbers
backing up your argument.

~~~
rednerrus
Fewer than 30% of people with MDD episodes have treatment resistance
depression. The majority of people with depression respond to treatment. The
efficacy of diet, exercise, and sleep are on par with drugs.

~~~
DanBC
> The efficacy of diet, exercise, and sleep are on par with drugs

This is simply untrue.

------
wu-ikkyu
I remember my worst bout with depression, it was a downward spiral.

Work and school had me indoors 60+ hours a week, so lots of stress and no
Vitamin D.

I had little to no time for cooking, so I ate junk processed fast food for
most meals.

All of these things left me so drained that I stopped exercising and didn't
have the energy to go to social events. I stopped hanging out with my best
friends.

What little time and energy I had left was spent laying on the couch indoors
on my phone obsessing over the news (which of course is overtly negative and
divisive) and arguing politics on social media.

Anti-depressant drugs provided marginal relief from a complete breakdown but
it wasn't until I started "working to live", getting outdoors, eating healthy,
exercising frequently, meditating (when needed), quit watching the news and
deleted my social media accounts that my mental health returned.

There are a handful of simple things that human beings require for adequate
mental health or "chemical balance", and yet there are massive societal
pressures and trillions of dollars being spent sabotaging those basic human
needs. Unfortunately it's much easier to pop a pill than to confront such
difficulties.

~~~
zokier
> it was a downward spiral.

> Anti-depressant drugs provided marginal relief

> Unfortunately it's much easier to pop a pill than to confront such
> difficulties

Don't you feel that that final statement is a bit disingenuous considering
that for many people (of course can not comment if that was the case for you)
medication is the tool that enables them to cut the spiral and start working
on their issues.

~~~
Valmar
For many people, they believe that it is _the_ final solution, because that is
how it is advertized by the drug companies and psychiatrists, and how it is
marketed to many doctors. That is how most end up people treating the drug.

The drugs themselves don't actually offer very much. It is the belief that
they're working, the placebo effect, that makes them seem to offer relief.
Eventually, many negative side effects will rear their ugly heads... and the
cycle goes on. They then switch to a different drug or withdraw completely,
suffering the negatives along the way, only worsening their mental health.

It's better to not start using the drugs at all, but instead engage with
regular face-to-face social connections and a healthy lifestyle of healthy
nutrition, more exercise, meditation, socializing, etc. This way, one does not
have to deal with any of the potential negatives of the drugs.

------
m15i
Maybe we can transform our society into one that is less depressing?

~~~
chongli
We can't do anything of the sort. Nobody really has control of society. We're
a bunch of bumblebees trapped in a beach ball. Sometimes it goes in the
direction we want it to go, other times not.

~~~
jschwartzi
Let me be blunt and say that this attitude is exactly why nobody ever tries to
change society. Instead of assuming that because you're one person you don't
matter, why not take the attitude that you're one person and what you do has
an impact on everyone around you?

You can't change the world by treating everyone well but you can sure as shit
make all their days better, and that's what we should be doing. If you want to
live in a world that isn't isolating, stop isolating the strangers around you.

~~~
fossuser
I generally agree with you that people are apathetic and assume that something
can't be done simply because it's hard or they don't feel like trying.

That said I think there's an element of truth that society generally creates
incentives that can lead to outcomes nobody wants [1]. You can get
equilibriums where without effective coordination people are trapped,
sometimes the trapped state can prevent effective coordination itself.

It's not an easy problem to fix.

[1] [http://slatestarcodex.com/2014/07/30/meditations-on-
moloch/](http://slatestarcodex.com/2014/07/30/meditations-on-moloch/)

~~~
jschwartzi
This isn't an easy problem to fix systemically, but we need to be making
different decisions as individuals. Society changes in the little decisions we
make every day, and not by leaps and bounds through fiat.

When people chose to smoke pot, knowing that it was illegal, they were
normalizing it. Those were small decisions by individuals that snowballed into
legalization. Gay marriage and the acceptance of homosexuality followed the
same pattern, where individuals decided to be more accepting, and that
snowballed into societal acceptance.

Society is made up of individuals, and we are part of society. Throwing up our
hands and abdicating responsibility doesn't serve anyone.

------
rjkennedy98
There are plenty of reasons to believe that drugs are actually making it
worse. Robert Whitaker's Anatomy of an Epidemic was the first to make this
point. Burden of mental illness has doubled while the antidepressant treatment
has been made common place.

We have no long term studies showing SSRIs help in the long term. None. (My
brother even wrote a review paper on long term studies of mental health
treatments). And we all know people that have troubled with SSRI withdrawal
symptoms, had to switch drugs, change doses, add a mood stabilizer to
continually manage what in the beginning was a mild depression due to loved
one's death or some other temporary condition.

~~~
jumelles
This is untrue.

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(17\)32802-7/fulltext)

"All antidepressants were more efficacious than placebo in adults with major
depressive disorder."

~~~
windows_tips
That's not a long-term study. It's a one-off 'meta-analysis'.

~~~
capnrefsmmat
Yes, it's not a long-term study -- it's a summary of 522 studies involving a
total of 116,477 people treated for 8 weeks on average.

The authors do note that 8 weeks is not long enough to see some antidepressant
side effects, which is a problem, but if they see evidence of improvement
after 8 weeks, that's quite different from having no evidence of improvement
at all.

Unless you mean to suggest that over the very long term, say several years,
people on antidepressants end up no better off? I would be interested to know
if that has been studied.

~~~
Valmar
> if they see evidence of improvement after 8 weeks, that's quite different
> from having no evidence of improvement at all.

There may show that there are short-term improvements, but it says nothing
about the medium to long-term effects on depression.

It's therefore worthless for being able to perceive any of the longer-term
negative side effectives of the drugs.

It almost seems like a study that the drug companies would find as favourable
advertizing for their drugs. It makes me suspicious that it may have been
funded by drug company money.

~~~
capnrefsmmat
> It almost seems like a study that the drug companies would find as
> favourable advertizing for their drugs. It makes me suspicious that it may
> have been funded by drug company money.

The funding is openly disclosed:

> This study was funded by the National Institute for Health Research (NIHR)
> Oxford Health Biomedical Research Centre (BRC-1215-20005) and the Japan
> Society for the Promotion of Science (17K19808). The views expressed are
> those of the authors and not necessarily those of the UK National Health
> Service, the NIHR, or the UK Department of Health.

One of the authors, John Ioannidis, is famous as a crusader for better
evidence and better statistics in medicine; he's the author of the famous "Why
Most Published Research Findings Are False" paper about the potential for
false positives for medicine. I would be willing to trust the statistical
evidence, though I think you're right to be concerned about 8 weeks as too
short a time period.

------
WalterSear
No, mindfulness training, exercise and nutrition aren't sufficient to counter
the increasing adversity any more than drugs are.

~~~
mjevans
Agreed, depression can also be caused by poor environmental conditions. Being
depressed can make escaping those conditions harder or even impossible; and
that is assuming that the conditions /can/ be escaped in the first place.

My own personal theory is that at least some of the 'depression' we are seeing
today is the result of dysfunction in society and the general social contact.
People no longer have a place they feel they can belong, a stable /career/
path let alone one that offers actual opportunity to become the best they want
to be out of their potential.

~~~
amelius
Perhaps religion plays a role too. I mean, our brains evolved to be religious,
and now we're basically shutting that part off, without asking if that's a
good idea from a neurological/psychological (scientific) viewpoint.

~~~
mjevans
My own beliefs about religion are that it came to be partly as a way of
'binning' 'unsolvable' problems out of the way and also as a way of helping
people be less bad to each other.

The trouble starts when you mix different (or groups without) religions; the
defect in the meme shows ugly results such as the crusades, etc.

~~~
Erik816
It also gives you some way to try to grasp the transcendent and provide
meaning to your life. Those things are hard to replace with better science for
the hard problems and better ethics/government for the behavior issues.

------
jumelles
Antidepressants can literally save lives; I worry deeply about articles like
this scaring away people who need help.

~~~
throwaway435388
Agreed. Antidepressants can be very helpful.

~~~
Valmar
The many, unpredictable, and very real, negative side effects of anti-
depressants can completely outweigh any of the dubious positives, especially
when it's impossible to tell which of dozen or so available marketed drugs
will or will not have a greater slew of said effects. It's a nasty game of
Russian Roulette which can potentially make the depression far worse than if
the sufferer decided to err on the side of caution, and not take them at all.

The negatives have affected many people, and who knows just how many and even
how bad the side effects are for people.

Being driven over the edge, to suicide, is horrifying effect of some of the
drugs. Others have gone on killing sprees because the drugs drove them insane,
while taking them or from the withdrawal effects.

------
baccheion
Depression/Anxiety is often caused by nutrient deficiencies, especially
vitamin D and magnesium. Even with bleak prospects or a meaningless life,
depression/anxiety becomes mostly cognitive when properly fed/supplemented.
"Hey, this idiot just ruined my life," for example, but as vitamin D + K and
magnesium are being supplemented, it's like a passing thought slowly creeping
in.

I'm mainly referring to general depression that's not clinical. Many get
depressed/anxious "for no reason," but it's often due to deficiencies or
imbalances. It's not hard to believe when poor sleep, excess
stimulant/caffeine use, poor nutrition and eating habits, high stress/drain,
insufficient sunlight, etc all combine.

Many would benefit from a high-quality multivitamin, D + K, and
chelated/TRAACS magnesium supplement. And maybe DHA + krill oil.

Take enough vitamin D3 to keep _25-Hydroxyvitamin D [25(OH)D]_ in the 40-60
ng/mL range. Dose calculator:
[http://www.vitamindservice.com/node/87](http://www.vitamindservice.com/node/87).
Take at least 10 mcg vitamin K2 MK-4 or 2 mcg K2 MK-7 for each 50 IUs of
vitamin D3. For example, add at least 1,000 mcg vitamin K2 MK-4 if taking
5,000 IU vitamin D3.

PS: a magnesium deficiency can be corrected by applying an oil spray all over
like lotion (rinsing after 20-30 minutes) for a few weeks.

------
mikekchar
Kind of personal story, though not directly about depression. A while back, I
noticed my blood pressure skyrocketed. Then a bit later, I started having
chest pains. My heart was racing and my heart beat was irregular. Sometimes it
felt like it just stopped and then _wham_ it would kick in again. Sometimes it
felt like a horse was running around inside my chest. My chest felt heavy,
like someone had put a 25 kilo weight on it. Every breath hurt.

I went to the hospital and they hooked me up to every variety of machine
imaginable. The result? Apart from my blood pressure, everything was fine.
They wired me up to a recorder and recorded my heart for 24 hours. The result?
Everything was fine. The symptoms lasted for a week (!) and finally slowly
subsided. The blood work they took said that everything was fine.

I don't know what was going on, but my doctor said to me, "It's probably
stress. Has it been a stressful time lately?" It really hadn't. Everything was
the same as always. True, I had been quite upset about work. But when was I
_not_ upset about work? I love working and I'm serious. I go at it full
throttle. True, I had been working some stupid hours. I work remotely and I'm
8-9 hours shifted from the rest of the team. I often start at 8 am, work all
day and then work again in the evening when the rest of the team gets in. I'm
tired at the end of the day, but I like working hard.

But you know, even if all the tests in the world say that I'm fine -- I was
definitely _not_ fine. I was convinced I was going to die during that week. A
body is not supposed to feel that way. And so I decided to take it easy. I
like work, but I like other things as well. I decided to be strict on my hours
and rely on my team to fight fires in the evening (even if I started them
during the day!). I decided to take a different view of my role on the team.
Instead of trying to drive the team to success, I'll let them drive where they
want to go and watch out the window. Occasionally I'll say, "Turn left at the
next stoplight. I think you'll enjoy the view", but that's the extent of my
navigation.

I fee better now than I have in ages. I just want to warn people: stress will
kill you. I never really appreciated that before. It will _actually_ kill you,
just like any other super killer disease that haunts your nightmares. Be aware
of your mental state. You can't go through life thinking your are invincible.
Or, you can, but that life will be cut short. A lot of this stuff is in your
control and it's simply a choice to be healthy or be ill.

Of course, there are people who have mental illnesses for which they have no
control. But there are a lot of people, like myself, who just don't understand
the harm that they are doing to themselves by putting themselves in unhealthy
places. Just try to be aware and to take action once you see that there is a
problem.

I hope that helps some people. I'd rather other people no have the experience
that I had.

------
zokier
Nice strawman you have there in the title Guardian. It is almost as if you
were baiting for clicks.

> Unfortunately, the prevalent view of depression as a “Prozac deficiency
> disease”

Do you have numbers to back up that statement that such view is _the
prevalent_ one?

