Whether depression is chemical or environmental... knowing the difference makes a huge difference. When I was 16, I didn't need Prozac... I needed to be removed from my environment. When I had postpartum my environment was awesome. And postpartum was with last kid. Which confused the hell out of me... my life was going really good, no stress, not my first time... and I couldn't shake the depression. We need to stop asking a pill to fix environmental issues ... and a good therapist usually ends up outside of the scope of most insurance (better pay, I can't fault them. Broken system)


This by far is absolutely the biggest issue I have with psychiatry and our structure of medicine in this country. We're constantly trying to treat environmental problems with medication. This ranges from someone worsening their arthritis at their job and being prescribed more pain killers to a child in an abusive household being prescribed Xanax for panic attacks. And it really comes down to our culture expecting doctors to pick up the slack of the failures in our social structures.


I do think there has to be a chemical imbalance in some. When I had postpartum, amazing and supportive husband. Really great life. No job to rush back to, happily chose to stay home with previous child. I was seriously confused as to what had me crying. And not the crying to a Hallmark movie kinda cry... it didn't have a trigger. And would last for days... it took me a couple months before I even asked a doctor about it


Absolutely. I think post partum depression is the easiest example (to understand) of a chemical imbalance. Similarly hypothyroidism and certain TBIs. The body becomes unable to regulate the flow of chemicals because of clear physical causes. Even if, as of yet, how that disruption works isn't clear the physical trauma is.


I don't like how Dr. Amen pushes vitamin line etc... but he has a point about how we don't look at the brain we diagnose (speaking in general, not "me"). I wish I could afford scans to differentiate between physical/Nutritional/Environmental. I think I've broken most generational garbage. And I encourage our kids that if they choose to have kids... do the same *create an upward trajectory*


>I wish I could afford scans to differentiate between physical/Nutritional/Environmental. First those scans would have to exist. They don't. Amen clinic is a hack taking money from the desperate.


Wait... what do you mean the scans don't exist? I've not heard. I've been under the impression he's done scans, to compare normal to not. And he held one up on some show he did an appearance. I assumed it was from MRI.


Is decreased serotonin ***a*** cause of depression? Absolutely, and there's ample evidence for this. Is it ***the only*** cause? Far from it. As the title points out, depression is complicated - for some, the primary cause is a chemical imbalance involving serotonin or another hormone/neurotransmitter. For others, the primary cause can be emotional trauma or other negative life experiences. For many, there can be a mix of causes. This is why no single pharmaceutical or therapeutic intervention has anywhere close to 100% effectiveness, and why one treatment might do wonders for one person but do nothing for another.


A huge problem is that people still think it is ok to medicate people to cope with bad situations instead of changing the bad situations.


Don't think they do, I'm not sure a psychiatrist is gonna say "well ik your husband beats you but uh can't do anything about it so here's some antidepressants"


Sure maybe not there, but plenty will say "here's some ritalin" when the kid's in a class of 35 other 11 year olds. Or will give anti-anxiety meds instead of giving a doctors note for time off. Usually this is because there's something (such as poverty) preventing the patient from actually fixing the underlying issue. Cant take time off to de-stress if you'll starve; cant get the kid in a smaller class if all the classes in your public school system are just as big.


An absence of evidence is not evidence of absence, but neuroscientists have been testing the serotonin hypothesis—which proposes that a deficiency of serotonin is a cause of depression—for almost 60 years, apparently with little to show for it, [Eleanor Cummins](https://newrepublic.com/authors/eleanor-cummins) writes.


The "serotonin hypothesis" has always been a bit of a strawman, though. If someone has a sprained ankle and you give them ibuprofen, they will feel better. This is like someone coming along and saying "we checked, and people with sprained ankles don't have less average ibuprofen in their blood than other people. So you were wrong about ibuprofen deficiency being the cause of their pain!" And like... yeah, no one was claiming that. That doesn't change the fact that ibuprofen can be a useful tool for lessening some symptoms.


Melatonin is a naturally occurring substance in the brain. Maybe some people with insomnia have an issue with melatonin production. But regardless taking a melatonin supplement tends to help most people feel sleepy. Either can be true. Only the problem is a lot of people stop at "okay melatonin works!" Rather than seeing if they might also sleep better if they drank less coffee or got their indigestion under control. Mistaking the treatment for the cause only because it can be isn't great. But it still can be.


If what you're saying is that we should explore tools other than meds in order to alleviate depression, then of course that is absolutely true. But I think that is generally what happens currently. I don't think that the common case is that people are just instantly handed a prescription for (one of a hundred) SSRIs without some examination of their situation, behaviors, history (personal and family), and consideration of the full set of tools available. The meds that we have available can be useful, but they are certainly imperfect. Even once medication is being tried, it's usually a matter of many months of trying out different meds and dosages in order to find what is most effective for any given individual. So no one really treats them as an automatic and universal solution for all problems.


Alot of people do actually due to time and cost and simply feeling that it's good enough. Or less embarrassing. Or less difficult. I think that's a problem of culture and social structure though.


I guess we're both speculating without evidence at this point, but I think that the more common problem is precisely the opposite. Addressing mental health issues, _especially_ via medication, is heavily stigmatized. As a result, there are a lot of people for whom medication would be very beneficial but are unwilling to even consider the option because they have such terrible ideas of what that means.


I mean I'm speculating on personal experience. But yeah there's stigmatism in both therapy and medication. There are much more socially acceptable avenues people tend to try to go for first.


Just anecdote here, but my doctor 100% just started me on Zoloft with very little examination or any real history taking. This is a doctor I only see once a year for physicals and it isn’t always him specifically. I told him I got pretty anxious and some of the coping exercises I’d learned weren’t working. He started me on Zoloft without anymore questions because, his words, it’s safe and people generally tolerate it well. I had to go back at 1 and 3 months, but after that nothing. This was right before Covid and I’ve gotten the script extend twice now (36 months total including first year) without even going back in face to face. Fortunately for me, I’m a biologist and I did pretty extensive research on it before visiting him the first time and when I started taking it. Unfortunately that’s probably not the average patient.


Fair enough. That's different than the experiences that I've known, but I'm sure there is considerable variation from one provider to another.


Same experience here! I knew I didnt want to try a SSRI or something addictive due to family history so I looked into wellbutrin and decided that was the one I wanted for my anxiety. They literally asked me like 30 questions that were just "how many times did you feel X way in the past two weeks" and then they handed me a scrip. If I hadnt done any research they probably would have prescribed me an SSRI which can really mess up your serotonin levels for awhile in addition to many other side effects. But still... it was way too easy to get a prescription and they didnt take any time to understand why I wanted one.


This news recently is intriguing to me, having mental health problems for a decade and having tried literally all medications, this news makes more sense to me than anything else I’ve seen. The medications do not work for everyone, and this has never been discussed enough since most people find something that works for them from what I saw. I’ve been struggling my entire life, and the doctors never gave a fuck about me. They would tell me to my face my case was a “complicated” one. I hope this leads to new discoveries and necessary changes to how we treat people, I can’t live like this anymore and it sucks knowing other people slip through the cracks all the time like I did


Yeah unfortunately doctors are pressed for time and... This is a thing that happens. They're also liable for your safety so the more medications they try the more liable they become. But there are tons of medications that work on a variety of brain chemicals. It's still possible you jive better with something out there. I'm a complicated case too. Doctors couldn't give me what I needed. The vast majority of them are focused on trying to treat the vast majority of mental health problems. Less common cases have a much harder time finding a doctor that can really deal with their case. It sucks. But that's also the way it's always been.


I’d love if it was as simple as “opening more space for nuance” but in practice, in day to day conversations with ordinary people who struggle to understand mental illness, they’re just gonna say, “see? We told you it’s not a real medical condition, you kept telling us it was a chemical imbalance to pretend it’s a real medical problem and not just all in your head because you’re too lazy to fix it, go for a walk and eat some kale and all your problems will be solved”


What it should say is that it is good when a scientific discourse is encouraged. Unfortunately, we do not allow enough of this any longer.


Agitation on the part of the pharmaceutical industry, particularly. And rightly so.