[paufernandez]

Agree. But sometimes there is no "root cause", the brain is still a mystery. If you had been depressed even when you knew there was nothing to worry about, you would see it differently, because then you deduce that the black cloud is produced within.

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

[naasking]

> 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.

[citrin_ru]

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.

[16bitvoid]

That's incredibly reductive. I'm sure some people's depression can boil down to a matter of perspective, but it's naive to extrapolate that to everyone with depression.

I'm incredibly optimistic and am content with my position in life. My default state is being mindful of the present and I don't think about things too far into the future. I very rarely ever feel stressed out over things in life.

However, none of that changes the fact that I feel completely empty and find no joy in things. Interests are nearly non-existent, emotions dialed to 1, and the only thing I'm motivated to do is lay in bed staring at the ceiling... unless I'm on sertraline.

Admittedly that's just anecdotal, but I worked in a clinical neuroscience lab researching treatments for severe treatment-resistant depression (read: people who tried so many options including CBT that they even tried electroshock therapy). The only thing that helped those subjects was a regimen of personalized neuroimaging-guided transcranial magnetic stimulation for 10 minutes every hour for 10 hours every day for a week. Even then, it wasn't permanent. Some saw improvement for months, others only weeks.

For some people, it's not just a matter of "perspective".

[ajross]

This is the "people with anxiety should just stop being worried" attitude that failed to help for centuries. Whether or not you believe SSRI's are clinically effective, denying the existence of mental health disorders is not helping.

No, anxiety and depression aren't simply a matter of perspective.

[Forgeties79]

> 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.

Or because of a legitimate chemical imbalance or some other cognitive issue they can’t control alone. Right?

[sfn42]

Depression and pessimism are not the same thing.

[arghwhat]

> 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.

[fwipsy]

Psychology can change neurochemistry but only in certain limited ways. Many people are on antidepressants long term because that's the only thing that works for them. Taking antidepressants is already stigmatized enough. People should just do what makes them feel best over the long run. Your rule of thumb does not trump hard-won personal experiences.

We don't really know how SSRIs work, but there's some evidence that it's through desensitizing serotonin receptors, not directly addressing the lack of serotonin. If so, "use it or lose it" doesn't apply; long-term adaptation is the point, and SOMETIMES does persist after quitting.

[Roark66]

>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.

There are ways to "hack it".

For example, ~6 months ago I started trt (testosterone replacement). It was the best decision health wise ever. I feel way better psychologically, first time in my life I managed to stick with cardio training for so long (before 3 months was the most). There are other benefits too.

So what about the "loose it" part? Well there is a hormone called HCG one can take a twice a week to trick one's balls into producing some natural testosterone. Its use prevents atrophy and infertility.

[pixl97]

>A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" -

Very basic and very often wrong rule, so take it with a grain of salt.

Insulin for example is the opposite. "lose it then use it" would be a general rule for type 2 diabetics where insulin resistance commonly due to weight gain is the primary problem. Losing the weight leads to better uptake and usage. For a type 1 "lose it then use it" you typically lose the ability to produce insulin to an an autoimmune disorder, then are stuck using insulin for the rest of your life.

The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up. Evolution, at grand scales, doesn't care if you survive as long as enough of your population survives and breeds. At the end of the day you might just be one of those people that was born broken and to work properly you need replacement parts/chemicals. A working medical system should be there to figure out which case is which.

[Wojtkie]

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".

[Projectiboga]

The creator of the Serotonin hypothesis admitted it was wrong, and he shifted to melatonin's precursor later in his career. The challange with any research in this area is Serotonin and Melatonin both affect biological functions by gradient activity not lock and key receptor models. This pair is how plants and animals respond to seasonal changes which vary year to year. Serotonin is the warm and light lide melatonin is for cool and or dark.

My personal preference is to always suggest getting actual daylight on your retina for 20 min three times a week. Not through glasses, including eyeglasses, but can be through eyelids. That loads transferatin, as in transfer, this loads the enzyme that make serotonin. This then allows the body a better chance to make the intermediate between Serotionin and Melatonin, and is the one believed to help. But the patents have expired so it is like an orphan drug now.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3779905/

[bossyTeacher]

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

[jodrellblank]

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".

[Noaidi]

> If the problem was brain chemistry, wouldn't it be with them from birth until treatment

Ha, of course it can be! Our brain chemistry is not stable through our life! Many children are born with epilepsy, but some people develop it later in life. epilepsy, like all neurological disorders are nature AND nurture, genes AND the environment.

Using your roller coaster analogy, there very well may be genes that control; how much fear someone experiences when riding a roller coaster. The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if youa re too afraid to ride a roller coaster you should take xanax.

[weregiraffe]

>humans evolved in Africa, connected to oceans and trees and tribal living

Human evolved to have no modern medicine, indoor heating or refrigerators.