And while it is true that depression often has situation occasions and standing situation causes, clinical depression is different from ordinary sadness or even grief caused by loss or misfortune. It will often be triggered by causes too minor to produce feelings that dark, or last long after the situational cause has disappeared. That's on the one hand.
The other hand is that in a great many cases, antidepressants actual work to improve people's lives. They can be, literally, lifesavers, since depression and suicide (especially manic depression and suicide) are strongly correlated. (A quarter of untreated diagnosed manic deppressives commit suicide. Half attempt it.)
The fact that we don't know how the drugs work appears quite irrelevant, except as a subject for research. For millenia, folk practioners knew that foxglove was good for the heart, but not why. Our ignorance of the mechanism does not cast doubt on the observed reality of the effect.
Now, many people avoid SSRIs for another reason -- they are counterlibidinal for many people even when they are successful in treating depression. They make it harder or even impossible for 30-40% of usser to become aroused, to orgasm, or to even have sexual interest. That pushes depressives to other drugs like Wellbutrin or Lamitcal that we also don't understand the mechanisms of. Wellbutrin and Lamictal are not counterlibinal. But that's another story.
So, yes, chemicals do make us sad. And other chemicals can help, even if we don't know why. It's actually destructive to suggest otherwise, which is why I go one about this. Of course the environment contributes and environmental changes can improve things too.
jks
--- Doug Henwood <dhenwood at panix.com> wrote:
> [a reply to all that vulgar materialism of "brain
> chemicals make me sad" type]
>
> Wall Street Journal - November 18, 2005
>
> SCIENCE JOURNAL
> By SHARON BEGLEY
>
> Some Drugs Work
> To Treat Depression,
> But It Isn't Clear How
>
> Hardly any patients know how Lipitor lowers
> cholesterol, how Lotensin
> reduces blood pressure, or even how ibuprofen erases
> headaches. But
> when it comes to Prozac, Zoloft and Paxil, ads and
> glowing accounts
> in the press have turned patients with depression
> into veritable
> pharmacologists, able to rattle off how these
> "selective serotonin
> reuptake inhibitors" keep more of the brain chemical
> serotonin
> hanging around in synapses, correcting the
> neurochemical imbalance
> that causes depression.
>
> There is only one problem. "Not a single
> peer-reviewed article ...
> support[s] claims of serotonin deficiency in any
> mental disorder,"
> scientists write in the December issue of the
> journal PLoS Medicine.
>
> Indeed, a steady drip of studies have challenged the
> "serotonin did
> it" hypothesis. A 2003 mouse experiment suggested
> that SSRIs work by
> inducing the birth and growth of new brain neurons,
> not by monkeying
> with serotonin. In March, a review of decades of
> research concluded
> that something other than "changes in chemical
> balance might underlie
> depression." And as Jeffrey Lacasse and Jonathan Leo
> write in PLoS
> Medicine, although ads for SSRIs say they correct a
> chemical
> imbalance, "there is no such thing as a
> scientifically correct
> 'balance' of serotonin."
>
> How did so many smart people get it so wrong?
> Medicinal chemist Derek
> Lowe, who works in drug development for a
> pharmaceutical firm,
> offered an explanation in his "In the Pipeline"
> blog. "I worked on
> central nervous system drugs for eight years, and I
> can confidently
> state that we know just slightly more than jack"
> about how
> antidepressants work.
>
> It is not for lack of trying. In 1965, psychiatrist
> Joseph
> Schildkraut of Harvard University suggested that a
> deficiency of a
> brain chemical causes depression. With the success
> of drugs that
> block the reuptake of these chemicals, that idea
> started to look
> pretty good.
>
> Yet the evidence was always circumstantial. You
> can't measure
> serotonin in the brains of living human beings. The
> next best thing,
> measuring the compounds that serotonin breaks down
> to in
> cerebrospinal fluid, suggested that clinically
> depressed patients had
> less of it than healthy people did. But it was never
> clear whether
> depression caused those low levels, or vice versa. A
> 2002 review of
> these early experiments took them to task for such
> flaws.
>
> There had always been data that don't fit the
> serotonin-imbalance
> theory. Depleting people's serotonin levels
> sometimes changed their
> mood for the worse and sometimes didn't. Sending
> serotonin levels
> through the roof didn't help depression, a study
> found as early as
> 1975.
>
> There is little doubt that the SSRIs do what their
> name says, keeping
> more serotonin in the brain's synapses. But the fact
> "that SSRIs act
> on the serotonin system does not mean that clinical
> depression
> results from a shortage of serotonin," says Dr. Leo,
> professor of
> anatomy at Lake Erie College of Osteopathic
> Medicine, Bradenton, Fla.
> No more so, anyway, than the fact that steroid
> creams help rashes
> means that rashes are caused by a steroid shortage.
>
> A clue to how SSRIs do work comes from how long they
> take to have any
> effect. They rarely make a dent in depression before
> three weeks, and
> sometimes take eight weeks to kick in. But they
> affect serotonin
> levels right away. If depression doesn't lift
> despite that serotonin
> hit, the drugs must be doing something else; it's
> the something else
> that eases depression.
>
> The best evidence so far is that the something else
> is neurogenesis
> -- the birth of new neurons. When scientists led by
> Rene Hen of
> Columbia University and Ronald Duman of Yale blocked
> neurogenesis in
> mice, SSRIs had no effect. When neurogenesis was
> unimpeded, SSRIs
> made the mice less anxious and depressed -- for
> rodents. As best
> scientists can tell, SSRIs first activate the
> serotonin system, which
> is somehow necessary for neurogenesis. That is what
> takes weeks.
>
> Claiming that depression results from a
> brain-chemical imbalance, as
> ads do, is problematic on several fronts. Patients
> who believe this
> are more likely to demand a prescription. If you
> have a disease
> caused by too little insulin, you take insulin; if
> you have one
> caused by too little serotonin, you take serotonin
> boosters.
>
> Most people treated for depression get pills rather
> than
> psychotherapy, and this week a study from Stanford
> University
> reported that drugs have been supplanting
> psychotherapy for depressed
> adolescents. Clinical guidelines call for using
> both, and for
> psychotherapy to be the first-line treatment for
> most kids.
> Psychotherapy "can be as effective as medications"
> for major
> depression, concluded a study in April of 240
> patients, in the
> Archives of General Psychiatry. Numerous other
> studies find the same.
>
> The hegemony of the serotonin hypothesis may be
> keeping patients from
> a therapy that will help them more in the long term.
> The relapse rate
> for patients on pills is higher than for those
> getting
> cognitive-behavior psychotherapy.
>
> Some 19 million people in the U.S. suffer from
> depression in any
> given year. For many, SSRIs help little, if at all.
> To do better, we
> have to get the science right.
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