←back to thread

169 points flaxxen | 3 comments | | HN request time: 0.001s | source
Show context
Aurornis ◴[] No.43209537[source]
Important to note that the serotonin theory of depression doesn't have to be strictly true for SSRIs to be effective. People who having passing familiarity with neuroscience often assume that psychiatric medications work by correcting deficiencies, but this isn't true. It's also not accurate to say that SSRIs "give you more serotonin" or any of the other variations on that theme.

Neurotransmitters aren't simple levels in the brain that go up and down, despite how much podcasters and fitness influencers talk about them like that. Neurotransmitter dynamics are complex and the long-term adaptations after taking medications like an SSRI can't be simply described in terms of "levels" going up and down. There are changes in frequency, duration, and movement of Serotonin across synapses that are much more complex. There are also adaptations to the receptors, including auto-receptors which modulate release of neurotransmitters (side note: some newer antidepressants also directly target those autoreceptors with possibly slight improvements in side effect profile).

So keep that in mind when reading anything about the serotonin theory of depression. This is often brought up as a strawman argument to attack SSRIs, but we've known for decades that the serotonin theory of depression never fully explained the situation. We've also known that some conditions like anxiety disorders are associated with increased serotonin activity in parts of the brain, which SSRIs can normalize.

replies(13): >>43209629 #>>43209670 #>>43209853 #>>43209868 #>>43209967 #>>43210081 #>>43212406 #>>43212686 #>>43212736 #>>43213199 #>>43213461 #>>43214117 #>>43221077 #
dondraper36 ◴[] No.43209853[source]
A fairly surprising fact revealing how little we understand the efficiency of SSRIs is that the serotonin level rises pretty quickly once you have started taking an SSRI.

Still, there is an unexplained cascade of reactions that takes weeks before patients notice any improvement.

As much as I respect proof-based medicine, the very fact that scientists can't explain how all this works made me want to stop my treatment and just do more weightlifting and running.

replies(3): >>43209975 #>>43210108 #>>43221056 #
1. Aurornis ◴[] No.43210108[source]
There's actually far more research into what happens after starting an SSRI than you're implying. We know, for example, that certain downstream adaptations takes weeks to fully appear. We also know that the initial increase in serotonin concentrations is limited by 5-HT1A negative feedback, but 5-HT1A downregulates over time and allows the synaptic concentrations to increase again.

> the very fact that scientists can't explain how all this works made me want to stop my treatment and just do more weightlifting and running

Weightlifting and running are complimentary, not substitutive. Most people can't simply replace a powerful medication with more running and weightlifting.

You might also be surprised at how many modern medications operate on partial theories. There's not actually anything wrong with that. There are a lot of medications that hypothetically should work based on scientific understanding of the brain but don't seem to show efficacy in studies.

It's more important that we validate the safety profile and efficacy in real-world testing.

replies(1): >>43210231 #
2. dondraper36 ◴[] No.43210231[source]
I am not saying that quitting SSRIs is the ultimate answer, it just works (sort of) for me mostly because I am not that depressed.

Also, having partial theories is not wrong, but in the case of SSRIs, I deliberately chose to avoid medications that I can do without (again, this is highly subjective).

Another concern of mine is that there are now warnings for some popular SSRIs that ED symptoms in men might be permanent.

replies(1): >>43212180 #
3. scns ◴[] No.43212180[source]
> Another concern of mine is that there are now warnings for some popular SSRIs that ED symptoms in men might be permanent.

They are for some of the unlucky 10%. Buspirone might help.