Prozac 'no better than placebo' for treating children with depression, experts

> treating depression

Most of the "treatment" is apparently just telling people to stop feeling sad [0], or giving them drugs

[0] https://old.reddit.com/r/thanksimcured

but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.

Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')

Depression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.

>It's not necessarily caused by anything external. Y

Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.

I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.

> You cannot necessarily just "figure out why" you feel bad

Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?

Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"

If someone is sad for a specific, identifiable and tractable reason, then they are experiencing a categorically different phenomenon to someone who just feels sad all of the time regardless of their life circumstances.

One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.

Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.

> Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.

I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?

> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.

Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.

I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".

>Like lobotomies. What do people think of them now?

Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.

https://www.cambridge.org/core/journals/bjpsych-advances/art...

>but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work

Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?

I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.

Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.

>Then how could a drug fix it?

Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.

If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.

Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.