Vitamin D and Omega-3 are the two supplements that consistently appear to be super powerful in small studies and then fail to do anything significant at all in larger studies.
Pause for a moment and consider the mere plausibility of the claims in the first few paragraphs: The effect size for antidepressants is 0.4, but the effect size for Vitamin D is 1.8? Are we to believe that Vitamin D supplements have an effect size 4.5X larger than antidepressant drugs, and nobody noticed this massive discrepancy until now?
Effect size is also a favorite metric in this vein of supplement-over-pharma writing because it’s so commonly misunderstood and it’s so easy to find small supplement studies that have outlier effect sizes.
To put it in context, even common OTC pain meds can have effect sizes lower than 0.4 depending on the study. Have you ever taken Tylenol or Ibuprofen and had a headache or other pain reduced? Well you’ve experience what a drug with a small effect size on paper can do for you.
Please be very careful when someone tries to tell you that supplements are miraculous and pharmaceutical drugs don’t work at all. I know too many people who delayed trialing SSRIs for years due to internet driven fears and lost many years of their lives to depression based on content like this. People with cabinets full of dozens of supplement bottles that were chosen based on studies, too. Then they finally decided to try real antidepressant medications and wished they’d done it sooner.
As much as I wish we could all just cure depression by taking a simple Vitamin D supplement that has 4.5X higher effect size than antidepressant drugs, this claim just isn’t passable.
Anecdotally, Vitamin D and B12 had more of a positive effect on my mental health than therapy or any of the half dozen prescription meds I tried.
Hiking has the biggest effect though.
I think maybe the problem is that therapists are diagnosing people, and psychiatrists are prescribing pills based on those diagnoses, but neither are ordering bloodwork to check for deficiencies. Which leads to a lot of people suffering from lack of basic health, and treating the symptoms with SSRIs that have withdrawl symptoms a million times worse than most of the problems they treat.
Now to your point, I seriously doubt that vitamin D will hold up against anti-depressants and therapy if we control for other health and quality of life issues. I just think there is a ton of misdiagnosis, and lack of root cause analysis in the mental health field, and health care in general.
I don't have the energy to do all that when I'm down though. I hate all sports though I do like hiking (there's no team or competitive bullshit) but I'm too clumsy for it.
I remember reading that pine trees give off a chemical that is a natural human bronchodilator.
One thought of why people love hiking, especially in piney woods, is that the chemical allows humans to process more oxygen which in turn helps them feel more "energized".
I point this out for two reasons:
1. It's a fascinating bit of trivie
2. It highlights that there are MANY confounding variables so it will always be tough to figure out the isolated impact.
I bought an E-Bike two years ago and it’s changed my life. I want to ride my bike all the time, and am counting down the days to spring. During the warmer months I run all the errands I possibly can with my bike instead of driving, and ride for pleasure often, going on multi hour bike rides. It’s just such a blissful feeling, and as I’ve gotten more fit I’ve been able to turn down the bike assist and built a lot of leg muscles.
I do understand there are many things that can make it infeasable to bike during winter, but if you miss your bike absolutely give it a try! I bike year around in Norway. Studded tires help tons, and that the city maintains the bike infrastructure during winter.
Getting an e-bike has got me out getting exercise way more than a regular bike ever did. Being able to dial my effort up and down pushes me further, quite literally in distance and fitness goals. I'm by no means fit and almost did a 5 hour 40 mile ride one day. I completely used up the battery in that time, my legs were cooked from the effort. I would have never attempted something like that on a regular bike unless I was fit.
Are you riding on roads or trails? How are you treated by other road users? I'm tempted by ebikes but live in semi-rural UK with very poor (and getting worse) road surface and lots of blind bends.
I largely ride on paved bike trails that are wholly separate from the roads, or suburban residential roads that have a Swiss cheese of bike trails interconnecting via parks. It’s never the fastest way, but there’s almost always a “safe way” to bike somewhere, due to a lot of effort by our city council. I’m more avoidant of the major roads, an elderly man was extremely close to me and my kid in her bike trailer when he made a right turn, I think I’d be more cautious if I didn’t have so many accessible ways to bike separate from the roads.
Oddly a lot of the “guys with road bikes wearing full gear” seem to just ride on the road anyway. I have no idea why, I’ve double checked the laws and I’m allowed to ride there.
A few months ago I tried walking with a weighted vest, and my body and brain got completely shocked in a really good way. Wakes up everything. So that is in my mix now.
Walking with 20 then 40 lbs was a lot easier than I expected, and the results were much greater.
I will say that my LMHNP ordered a blood test for me during my ADHD evaluation. I live in the Pacific Northwest and had a serious vitamin D deficiency, apparently like everyone else who doesn’t supplement. also got me started monitoring my blood pressure.
I can definitely tell that the Adderall I was prescribed had an immediate, huge benefit. Not sure about the vitamin D.
But I really appreciated that he took a wide angle look at my health.
> Vitamin D and Omega-3 are the two supplements that consistently appear to be super powerful in small studies and then fail to do anything significant at all in larger studies.
That statement is broadly true for most outcomes studied, but specifically for depression the larger study results are pretty mixed.
I'm surprised that metastudies are inconsistent. Vit D and O-3 probably do have a large effect in a deficient populace (so, like, Seattle or landlocked areas respectively). Metastudies should be good at mitigating that (but I guess you can choose the studies that coincide with the outcome you want).
Either way, the conclusion to this whole debate is incredibly simple: get a blood panel done and go from there - it might not even be one of these that ails you.
What the article states, then fails to take into account, is that is the mean effect size, and there is huge variation.
Anti-depressants are notorious for producing different effects for different people.
What that high variance means in practice, is for any anti-depressant, the people who get good results are getting a much higher effect than 0.4. And the other people move on to try something else.
So to keep comparing 0.4 directly to the effect of Vitamin D and Omega-3 directly is very misleading.
I believe presenting vitamin D supplements as effective in treating depression is kinda misleading. It's rather vitamin D deficiency that is super effective at making you miserable, but it's not the only thing that can do it to you. And since a lot of us are in fact deficient (and the threshold of being categorized as deficient may be placed too low too), it will appear as being quite effective overall, especially compared to other drugs that act on less common and poorly understood causes.
Thank you. Fixing a vitamin deficiency is an obvious benefit to physical health. But does it "cure depression"? To the extent that your depression was caused by vitamin deficiency, sure. But then didn't you just cure a vitamin deficiency? I'm sure a lot of things starting improving once your body starts getting proper nutrients after years of neglect! That doesn't indicate causality.
As far as we can tell, "depression" is a label we put onto a big bag of issues with similar symptoms, but that may require different interventions. Vitamin D deficiency may very well be or lead to one of those, and it definitely doesn't help when coexisting with something else either.
Hi, author of the blog post here! Thank you for writing in with your concerns. First:
> Please be very careful when someone tries to tell you that supplements are miraculous and pharmaceutical drugs don’t work at all.
I'll concede I unintentionally gave the tone that one should replace antidepressants with supplements, even though the conclusion specifically writes: "(Don't quit your existing antidepressants if they're net-positive for you!) you may also want to ask your doctor about Amitriptyline, or those other best-effect-size antidepressants."
I have now edited the intro to more explicitly say "you can take these supplements alongside traditional antidepressants! You can stack interventions!"
===
> and nobody noticed this massive discrepancy until now?
> Several meta-analyses of epidemiological studies have suggested a positive relationship between vitamin D deficiency and risk of developing depression (Anglin et al., 2013; Ju, Lee, & Jeong, 2013).
> Although some review studies have presented suggestions of a beneficial effect of vitamin D supplementation on depressive symptoms (Anglin et al., 2013; Cheng, Huang, & Huang, 2020; Mikola et al., 2023; Shaffer et al., 2014; Xie et al., 2022), none of these reviews have examined the potential dose-dependent effects of vitamin D supplementation on depressive symptoms to determine the optimum dose of intervention. Some of the available reviews, owing to the limited number of trials and methodological biases, were of low quality (Anglin et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al., 2014). Considering these uncertainties, we aimed to fill this gap by conducting a systematic review and dose–response meta-analysis of randomized control trials (RCTs) to determine the optimum dose and shape of the effects of vitamin D supplementation on depression and anxiety symptoms in adults regardless of their health status.
===
> even common OTC pain meds can have effect sizes lower than 0.4 depending on the study. Have you ever taken Tylenol or Ibuprofen and had a headache or other pain reduced? Well you’ve experience what a drug with a small effect size on paper can do for you.
I must push back: that's an effect of 0.4 plus placebo effect and time.
There's now RCTs of open-label placebos (where subjects are told it's placebo), which show even open-label placebos are still powerful for pain management. So, I stand by 0.4 being a small effect; even if you took a placebo you know to be placebo, you'd feel a noticeable reduction in pain/headache.
> We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%)
of OLP.
In other words, if the effect on antidepressants vs placebo is ~0.4, and the effect of a placebo vs no placebo (just time) is ~0.7, that means the majority of the effect of antidepressants & OTC pain meds is due to placebo.
(I don't mean this in an insulting way; the fact that placebo alone has a "large" effect is a big deal, still under-valued, and means something important for how mood/cognition can directly impact physical health!)
> Researchers have noticed it for 13 years! From the linked Ghaemi et al 2024 meta-analysis
You’re cherry picking papers. Others have already shared other studies showing no significant effects of Vitamin D intervention.
For any popular supplement you can find someone publishing papers with miraculous results, showing huge effect sizes and significant outcomes. This has been going on for decades.
With Omega-3s the larger the trial size, the smaller the outcome. The largest trials have shown very little to no detectable effect.
I think a lot of people are skeptical about pharmaceuticals because they see the profit motive, but they let their guard down when researchers and supplement pushers who have their own motives start pushing flawed studies and cherry picked results.
> In other words, if the effect on antidepressants vs placebo is ~0.4, and the effect of a placebo vs no placebo (just time) is ~0.7, that means the majority of the effect of antidepressants & OTC pain meds is due to placebo.
You keep getting closer to understanding why these effect size studies are so popular with alternative medicine and supplement sellers: They’re so easy to misinterpret or to take out of context.
According your numbers, taking Tylenol would be worse than placebo alone! 0.4 vs 0.7
Does this make any sense to you? It should make you pause and think that maybe this is more complicated than picking singular numbers and comparing them.
In this domain of cherry picking studies and comparing effect sizes, you’ve reached a conclusion where Vitamin D is far and away more effective than anything, placebo is better than OTC pain medicines, and OTC pain meds are worse than placebo.
It’s time for a reality check that maybe this methodology isn’t actually representative of reality. You’re writing at length as if these studies you picked are definitive and your numeric comparisons tell the whole story, but I don’t think you’ve stopped to consider if this is even realistic.
I just picked the most recent meta-analysis I could find, which also specifically estimates the dose-response curve. (Since averaging the effect at 400 IU and 4000 IU doesn't make sense.)
> Others have already shared other studies showing no significant effects of Vitamin D intervention.
Yes, and the Ghaemi et al 2024 meta-analysis addresses the methodological problems in those earlier meta-analyses. (For example, they average the effects at vastly varying doses from 400 IU and 4000 IU)
> According your numbers, taking Tylenol would be worse than placebo alone! 0.4 vs 0.7
No, I understand this fine. Taking Tylenol would give you active medication + placebo + time, which is 0.4 + 0.7 + X > *1.1.* Taking open-label placebo is just placebo + time = *0.7* + X.
(Edit: Also, these aren't "my" numbers. They're from a major peer-reviewed study published in Nature, the highest-impact journal. I don't like "hey look at the credentials here", but I bring it up to note I'm not anti-science, see below paragraph)
===
Stepping back, I suspect the broader concern you have is you (correctly!) see that supplement/nutrition research is sketchy & full of grifters. And at the current moment, it seems to play into the hands of anti-establishment anti-science types. I agree, and I'll try to edit the tone of the article to avoid that.
That said, there still is some good science (among the crap), and I think the better evidence is accumulating (at least for Vitamin D) that it's on par with traditional antidepressants, possibly more. I agree that much larger trials are required.
> They're from a major peer-reviewed study published in Nature, the highest-impact journal.
No, the domain name is nature.com because it's in a Nature Publishing Group journal, Scientific Reports, which is their least prestigious journal.
It's a common mistake, and they do that on purpose, of course, to leverage the Nature brand.
It's also a mistake that implies a complete lack of familiarity with scientific publishing, unfortunately, which makes it a bit difficult to take your judgements regarding plausibility very seriously.
> It's also a mistake that implies a complete lack of familiarity with scientific publishing, unfortunately, which makes it a bit difficult to take your judgements regarding plausibility very seriously.
It's still peer reviewed, and as the sibling comment said, more applicable to this type of research. Also you now went from raising understandable objections to refusing the argument because it comes from a specific journal, which doesn't sound very scientific to me
You're right it isn't fair to reject someone's scientific argument just because they seem unfamiliar with how professional science works.
We shouldn't have believed the study more if it actually had been in Nature.
I don't think that's what I was saying, though.
The issue in this thread was about taking a step back and looking at the overall plausibility of the conclusions, taking together multiple studies.
I agree with the GP that the argument doesn't really pass the smell test.
That's still the main issue, and it is something that people who don't understand scientific publishing struggle understanding/doing, because they lack the intuition for how certain results came about.
It’s less prestigious because it doesn’t judge papers on novelty, only on technical accuracy. For incremental research like this, it is an appropriate choice. The lower prestige has no bearing on the accuracy of their findings.
> A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered
> ... This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter.
the larger the trial size, the smaller the outcome
I find this a bit surprising. Could there be something else affecting the accuracy of larger trials? Perhaps they are not as careful, or cutting corners somewhere?
Maybe. Those could be the case. But ignoring all confounding factors, this phenomenon is possible with numerical experiments alone. One of the meanings of "the Law of Small Numbers".
Sure, could be just lucky. But if there are several successful small studies, and several unsuccessful large ones (no idea if this is the case here), we should probably look for a better explanation.
It does not require more explanation: publication bias means null results aren't in the literature; do enough small low quality trials and you'll find a big effect sooner or later.
Then the supposed big effect attracts attention and ultimately properly designed studies which show no effect.
No, the other way around. It's the combination of two well known effects. Well, three if you're uncharitable.
1. Small studies are more likely to give anomalous results by chance. If I pick three people at random, it's not that surprising if I happened to get three women. It would be a lot different if I sampled 1,000 people.
2. Studies that show any positive result tend to get published, and ones that don't tend to get binned.
Put those together, and you see a lot of tiny studies with small positive results. When you do a proper study, the effect goes away. Exactly as you would expect.
The less charitable effect is "they made it up". It happens.
Just my hypothesis, but I wonder if larger sample sizes provide a more diverse population.
A study with 1000 individuals is likely a poor representation of a species of 8.2 billion. I understand that studies try to their best to use a diverse population, but I often question how successful many studies are at this endeavor.
If that's the case, we should question whether different homogeneous population groups respond differently to the substance under test. After all, we don't want to know the "average temperature of patients in a hospital", do we?
A point I think is crucial to mention is that “effect size” is just standardized mean difference.
If a minority of patients benefit hugely and most get no benefit, then you get a modest effect size.
This is probably why this discussion always has a lot of people saying “yeah, it didn’t help me at all” and a few saying “it changed my life.”
I believe we should be focusing on more relevant statistical methods for assessing this hypothesis formally. Basically, using mean differences is GIGO if you assume you’re comparing a bimodal or highly skewed distribution to a bell curve.
That's an odd argument. If we are talking about a organ safe uncombined dosage of Tylenol or Ibuprofen being 0.4 then I think we are talking about the point just above placebo and bias where something barely has a real effect that should be hard to measure without a high power study. That's saying nothing useful with so few significant figures.
If antidepressants cost less than $4/1000 and acted as an antiinflammatory as their only common side effect then sure I'd consider replacing Ibuprofen as my pain placebo of choice.
Because it's common to hate on antidepressants, I've always personally had a bias against them.
For the past 15-20 years, november thru february are basically a writeoff due for me due to seasonal affective disorder. Cold showers, exercise, no alcohol, strict sleeping rituals. Vitamin d. I can still sleep 11 hours and feel like reheated cat shit.
Enter citalopram. "It will take up to six weeks to dial in" they said. Within four days I felt like the inside of my head was designed by Apple in their glory days. My mind became an orderly, well lit, tastefully designed space... instead of a dimly lit crack den. I'm more emotionally available, no longer tired, less cranky. I felt cozy. I could cry with joy because I could finally understand emotionally why people like the Christmas season.
I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.
This just goes to show that for me, they're extremely effective.
The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists. Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. Most of the time however, it's more of a "here, take these indefinitely".
It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.
Luckily, sertraline was an almost instant cure.
I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.
The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?
I'm not an expert so maybe someone else can clarify further, but in relation to sleep medications I've heard that they should not be used for more than two weeks, or they can permanently fuck up your sleep cycle.
They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.
At least that's how it was a while ago. Maybe the situation has improved.
I used ambien for sleep and provigil for mindfullness (the go/no go packets) during long deployments in the military and it took me years to get back to anything normal after leaving the Army. These are very powerful medications.
Rather, lack of. Melatonin is over-the-counter, generic, badly understood by the people taking it and dosed according to personal preference which means marketing it is all abouy big numbers. Bigger number on package = more sales.
The help aiding sleep is only one function for melatonin. The reason for higher suggested doses is due to its anti-oxident function. From personal experience melatonin needs to be paired with vitamin e to really clear out over night. I take vitamin e as I get into bed right before I take a melatonin sublingual. Another benefit of melatonin is that it upregulates our insulin receptors.
Even funnier is that often 0.25mg or 0.5mg is closer to the correct dose, and those sizes tend to be hard to find.
There actually is a condition that calls for extremely high (100mg+ doses), but it is a very rare thing, no one should ever consider that much without instruction from a doctor. But you'll find it right next to the normal <=5mg doses without any explanation.
The Natrol liquid isn't usually too hard to track down. They advertise it as 1 mg or 2.5 mg, but it's the same stuff, the bottle just direct you to take 4 or 10 mL respectively.
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.
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.
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.
>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.
> Some cancerous tumors produce this hormone; therefore, elevated levels measured when the patient is not pregnant may lead to a diagnosis of cancer and, if high enough, of paraneoplastic syndromes. It is unknown however whether this production is a contributing cause or an effect of carcinogenesis.
Interesting.
Well, I don't think you'll be able to avoid testicle atrophy even if it minimizes it, but the important part is understanding the tradeoff. Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.
But it's your body, your life, your priorities and decision. I also wouldn't consider it a good decision health-wise to take steroids to get huge, but I have no problem with someone deciding that absurd bulk is their main goal in life and worth the tradeoff.
>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.
You're describing entirely orthogonal issues. In case of insulin resistance, your natural production is running full blast with demand exceeding supply because the consumer stopped caring about the hormone. In case of autoimmune disease, the natural production was killed - you can neither use nor lose what is already dead, and even if some capacity was left it will either soon be killed or atrophy under external insulin, but it will not be mourned.
So no I would say it is exactly the same - "use it or lose it" - but that does not mean that there is never a reason to manually overrule your body's attempt at homeostasis through direct manipulation. It just means that there is a very significant consequence to the process.
> 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.
As a somewhat sidenote, this is also why I dislike the idea of trying to classify people into "normal" and "divergent/atypical". In my eyes we're all normal people and an entirely normal aspect of being a human is that we all differ and have individually specific needs by virtue of being built by a trillion micro-meter sized workers, each with their own hand-copied version of the blueprint, only caring about the millimeter of you in their immediate vincinity and not really talking to any of the others.
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".
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.
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.
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".
I'm not telling it's a matter of perspective, my point is that I see no objective metrics to tell apart if the situation is bad so it's one expected to be depressed and when the situation is good (so only medication / therapy would help). And it makes discussions around this topic harder.
If its not just a matter of perspective and only medication can help, etc, then why do we call depression a "psychological" or "mental health" concern? Why isn't it just considered a neurological disease?
Depression is increasingly starting to be seen as a neurobiological disorder as we learn more.
In my own opinion, we need to stop viewing "mental health" as a separate class of conditions from general/physical health. A mental illness is a health/medical condition just like any other and shifting our views and diagnostic criteria in that direction would do a lot to remove the stigma associated with mental illness.
Someone with depression has a chronic illness, not a temporary "it's just in your head" condition.
It's not as liberating as you might think. A joyless existence is either suffering or nothingness. A life without meaning, either internal or external, is one where nothing is meaningful with no motivation thus one of crippling catatonia til death.
All I can say is just that it doesn't feel good and if you can't feel good about anything, your calculus of your life inevitably leads to the conclusion that existence isn't worth it.
There is only one cure/hack for Nihilism or similar...
Go somewhere where you need to work physically you az off to afford daily food. You will be so exhausted eventually that:
1 you will not have any energy left for thoughts.
2 If you have any energy left, you will give it to angriness which will lead to other circumstances which are none related to find the meaning of life.
I think a lot of people are conflating depression with "bad thoughts". That's just one possible symptom, usually as a result of a combination of both anxiety and depression.
I didn't have anxiety, just depression. I rarely thought. I existed on autopilot. I was physically exhausted on a daily basis as a division 1 athlete in college. Often went days without eating either because I simply forgot to eat or forgot to make time for it between classes and training. Didn't change anything.
I think something people are forgetting is that motivation is either driving you toward something you want or driving you away from things you specifically don't want. A complete lack of motivation means I wasn't motivated to do anything to get something, but also I wasn't motivated to anything to avoid something either. I wasn't motivated to eat to avoid hunger pangs. I wasn't motivated to quit my sport to avoid routine physical exhaustion. Instead, my empty autopilot existence just freely acted on the expectations of those around me as a proxy for motivation.
Yeah, most folk get the causation backwards. They think having meaning in life will pull you out of depression. It's the other way around. You have to get pulled out of depression to be able to find meaning in your life.
Realizing that some "chemical reactions" can change your destiny then further learning that when you want something, all the universe is bound to conspires in helping you to achieve it.
> "the etiology of depression is incredibly complex, the narrative that it is caused by a simple “chemical imbalance” persists in lay settings. We sought to understand where people are exposed to this explanation"
> "Onset of depression more complex than a brain chemical imbalance. It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals."
(These are not thoroughly checked articles, they're the first few search results; however claims that depression is caused by a chemical imbalance ought to be able to show where that idea originated, how the imbalance is measured in patients, where that hypothesis is supported by evidence, why antidepressents don't fix depression in half of patients, and several more suspicious things).
(I've written paragraphs and paragraphs thinking through some of my views in this thread. You wrote three words naming a thing which doesn't seem to exist. If you want more engagement, engage more. What words am I twisting? Where did you say it was anything more detailed than that? What behaviour that people "can't control alone" are you talking about?)
I did not and I am telling you I do not believe that it is that simple. You do not need to waste time arguing against your incorrect interpretation of my comment. If you need me to say I could have phrased it better, sure, I could have phrased it better. But I am now telling you exactly what I mean and think so we don’t need to do this song and dance.
For emphasis: I do not think it is simply/exclusively “chemical imbalance.”
But why do you think it is at all "chemical imbalance" when that doesn't seem to be an actual thing? What evidence convinced you? What measurements were taken on a human brain to diagnose the imbalance?
We can nitpick terminology all day but at the end of the day for you to assert that this is purely about perspective is patently absurd and I’m not going to let you distract from that fact. There are medical realities that impact people. There are external factors. There’s more to depression then recalibrating “how bad things actually are.”
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.
> 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.
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
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.
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".
> 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.
> "Our brain chemistry is not stable through our life!"
Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry". It's not like your stomach, liver, kidneys, <organs> suddenly stop working after you lose your job or your life partner and we say it's both inexplicable and because of a deficit of "body chemicals" and nod agreement with each other that "body chemistry isn't stable" through a lifetime.
These are just unsatisfyingly crappy non-explanations.
And quick attempts to assume that Doctors, Neuroscientists, Psychiatrists, Psychologists must have a better detailed knowledge of brain chemistry and I'm just falling for nonsense seems to find that they actually don't, and they don't agree that "brain chemistry" is a good explanation, and it can't be measured in a patient, and the idea isn't strongly supported by evidence, and even the mechanism of action of "drugs which correct brain chemistry" isn't agreed on, and when given to people to "correct brain chemistry" it often doesn't make the problem that was blamed on brain chemistry go away.
> "there very well may be genes that control; how much fear someone experiences when riding a roller coaster."
I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further. There probably are many genes which affect how much fat bodies store, or burn, or food cravings, or what constitutes hunger, or production of various leptins and grehlins and insulins and stomach acids, but that doesn't mean "I'm obese because of my genetics" is any kind of explanation at all. Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation. Downe's Syndrome is a good use for genetics as an explanation. "I have a macro-scale set of vaguely related behaviours, symptoms and body effects and no clear cause, it's my genetics" isn't.
Even if you have sequenced your genome, and have some specific gene that is associated with extra fat storage, genes can be turned on and off through a lifetime by behaviours and environment. Having a gene from birth doesn't mean it's being expressed and is therefore causing a specific problem, or that the problem can't go away and can't be fixed. ( https://www.cdc.gov/genomics-and-health/epigenetics/index.ht... )
> "The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if you are too afraid to ride a roller coaster you should take xanax."
I agree with this. Society likes assuming everyone is the same. Imagine if we collectively noticed that Adrenaline gives people "a burst of strength" and decided that daily exercise, individual strength training plans, gym visits, were all too much bother and that ageing adults were suffering from "an imbalance of Adrenaline" and when they struggle to carry their massive haul of groceries in from their car they should carry an auto-injector of Adrenaline to help their chemical deficiency.
> Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry".
Ohhh, leg chemistry, good choice! You know that leg "chemistry" is control by neurotransmitter release, yes? So you must have never heard of Familial Periodic Paralysis then. Let me tell you what happens with that, because it happened to me while taking Seroquel. Familial Periodic Paralysis is also called Hyperkalemic periodic paralysis and is due to mutations in the gene that encodes the alpha-subunit of the skeletal muscle sodium channel (SCN4A).
"The paralytic attacks are characterized by decreased muscle tone (flaccidity) more marked proximally than distally with normal to decreased deep tendon reflexes. The episodes develop over minutes to hours and last several minutes to several days with spontaneous recovery.
Some individuals have only one episode in a lifetime; more commonly, crises occur repeatedly: daily, weekly, monthly, or less often. The major triggering factors are cessation of effort following strenuous exercise and carbohydrate-rich evening meals. "
Look at that! Their muscles stopped and stared working again!
And yes, this happened to me while taking seroquel because it lowered my potassium so much it affected my nervous system.
Any good psychiatrist will tell you that they have no idea what is going on. But that does not mean neurotransmitters cannot be changed and that they do not effect behavior.
> I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further.
As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?
>Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation.
I have my hair color, height, skin color, all the physical traits from my parents, so why do you think the brain is not physical as well? Or or adrenal system? The brain is effected by genetics, this is true as has been shown clearly as a risk for schizophrenia. I have no idea why people think our mood, which is dictated by our thoughts which are created and sensed by our brain, which is a physical organ, does not have anything to do with genetics and neurotransmitters.
and then you go on to talk about epigenetics, like that matters by genes don't? Do you know that genes control the epigentic response? Genes like DNMT1? So people with differences in DNMT1 will have different epigenetic responses?
> I agree with this. Society likes assuming everyone is the same.
So how are we different? nature AND nurture. Genes AND environment. I agree the solution to these problems are wrong, but your solution are just as bad as the ones your are prescribing.
Listen, there are times when our neurtranmitters are supposed to be different, like when we are in pain or when some one dies. But some people, like me, have these changes regardless of the situation and we can like them to other environmental factors like diet, sunlight, weather, etc.
I could tell you whey and why I think am so sensitive to the world but I doubt you would listen, because no one listens, because everyone knows.
Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".
Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).
They allow me to function. I've gone through various dosages of various types to find the ones that work best for me, but they have never stopped working. They also allowed me to stick with CBT therapy, and after 20 years my therapist told me I didn't need him anymore ("Call if that changes").
Your second paragraph reveals a biased motive behind your opinion.
I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?
Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.
> The last thing that your doctor wants is giving you pills so you go away
Except for all the doctors who do want just that.
> Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick"
While such patients exist, I don't believe they're a global majority, and the group of patients who want the exact opposite, more time rather than "quick", is the bigger out of the two.
Literally a few comments down from this one:
> N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
> I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.
Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.
"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"
Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.
It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.
Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.
The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.
>people want easy fixes that do not require any change in habits
Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.
The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.
Its easy to say anything. Doing the correct thing is not always easy. I think your last statement is woefully outdated. The current zeitgeist is lack of agency. Its like collectively many of us have shifted from an internal to an external locus of control. This is due to a variety of reasons, a big one of which is the internet empowering people to make themselves feel insignificant due to unhealthy scale. I'd write a book if I continued, but that's the just of it, I suppose.
> I have the impression that's exactly what people do in the USA?
It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.
you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.
Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).
I've been off and on them for years, usually my doctors seem to prefer if I'm off them and indeed treat them more as short term "stabilizers" so that my brain has a bit more space to deal with things.
This has been true across two countries (Scotland, Hong Kong) and multiple doctors, with a third country's (China) doctor suggesting I try out sleeping tablets for a few weeks - and only giving me a very limited supply of them - to try out instead.
I wonder if the "here take these" is a predominantly American phenomenon due to the weird incentives around health care costs (I'm being genuine here - maybe it's predominant in other countries too, I honestly don't know!)
> The hate on antidepressants is not because they're not effective,
But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.
The "hate" on antidepressants is mostly from a place of "The kids are taking pills for things that aren't diseases and just need to get out more" and other stupid takes about how "back in my day we didn't have this much mental illness", which is why the hate is maintained even for things like ADHD medications which are so thoroughly proven scientifically that they are one of the best proven treatments humans have access to for any disease.
Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.
The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.
We just don't really have much in terms of better treatments because we know so damn little about depression.
The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.
Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.
Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".
The lingering roots of Calvinism in the US cause us all kinds of problems.
"You were born broken because god made you that way, don't make yourself better, and hurry up and die" permeates huge parts of our culture. It's why lots of other cultures look at us and what we do with relative confusion.
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.
I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.
The easiest way to deal with horrible trauma is to prevent said trauma in the next generation.
What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.
And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.
> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.
I wish people would stop saying this.
Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.
If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.
And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.
No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).
I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.
(I also added a small dose of Buspar to help with the sexual side-effects.)
If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.
For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.
I was diagnosed a while back with a chronic neurological disorder. One that has a heavy effect on my mood and can conversely be triggered by my mood. The underlying cause is scientifically proven to be physiological. I lack a specific neurotransmitter due to inactive cells in my hypothalamus.
For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).
While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.
Every time I have a yearly physical, my GP will ask if I have feelings of depression.
I know this road leads to SSRIs at the very least, so I always reply in the negative.
The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.
I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.
> I know this road leads to SSRIs at the very least, so I always reply in the negative.
Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.
To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.
N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
Likely the office was getting a kickback from the supplier for writing that prescription. This is shockingly common in the US. A straight cash payment is prohibited, but it's easy to work around that legally and provide equipment or "compensate" some other expense.
Crazy. I hear such wild horror stories with doctors. I'd never return to a doctor like that, sorry you had that experience. Still, this feels like a case where the lesson is "get a new doctor" not "lie to one" but I understand that circumstances can make that a pain.
Agreed. A friend of mine is a primary care doctor, and it's remarkable how often people come in for depression and after examination and labs it turns out their depression is heavily influenced by other issues, especially low testosterone or hypothyroid. A lot more people have issues with these than most people realize. There have also been people he has seen who were reporting depression, often where nearly every anti-depressant had been tried, where getting treatment for ADHD massively improved their case and was life changing. As much as people like to hate on Adderall nowadays, for people with ADHD it is miraculous.
Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.
I am in that case, low testosterone and hashimoto (hypothyroid), ADHD and big Scolioses. Last weeks I am dealing with insomnias, and had to take pills to sleep and it seems my parasympathic system is in alert mode for years, stress, divorce, ex-kid and older kid, etc.. I stopped SSRI after 21 years for 5 months and its probably causing my insomnias, the brain was not used for missing serotonine and brain don't stop thinking, loop, alert mode.
I am doing several blood analysis with a functional doctor and lyme may be around or was in the body, and so many other things. I was thinking I had lucky gut, but seems negative..
I did get my Vit D up to 65 and I seems to be issues with ADH hormone since kid and probably that makes dehydration. It's a fucking nightmare..
I may only see a testosterone replacement as a solution maybe..
>often where nearly every anti-depressant had been tried, where getting treatment for ADHD
This is actually a somewhat difficult diagnosis to make, especially when diagnosing adult ADHD without the user documenting and bringing in a well defined log of their behavior (and possibly another person to point out things they don't know about themselves).
>ADHD is a highly heterogeneous disorder with a significant comorbidity rate.
Is thing that you read about in literature around it. And even more common than that is the comorbidity of all the above symptoms, that is ADHD and depression + more in autism.
You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:
1.) It's killing my libido
2.) It's too strong
For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.
And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!
Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.
Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.
All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.
There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.
YMMV for sure - I was on an SNRI (Cymbalta) for a few months as an attempt to eliminate nerve pain. It all but destroyed my ability to climax both during and for maybe 6 months after getting off of it.
The brain zaps were also hell if I was even like an hour later than usual to take it
Why do you think SNRIs wouldn't have sexual side effects? They still inhibit the reuptake of serotonin just like SSRIs. That's the part that causes (certain) sexual side effects.
Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.
Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.
I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.
> I’m just always astonished at “have you tried not being depressed?”
There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"
It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.
Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.
That was my experience with ADHD. In retrospect, I clearly struggled with it my entire life, with it starting to cause problems around middle school age. I started getting treatment a couple years ago and it was like someone flipped a light switch. Wait, this is what it's like for everyone else? They can just decide to start doing a necessary thing before it becomes a crisis?!
In before "of course things are easier when you're taking stimulants!", which is another dumb thing I hear too often. I feel basically nothing from taking Adderall, and not in the least stimulated or more alert or more awake or anything. I can just concentrate on boring things afterward.
>in the US I think because of our hyper individualist culture.
Calvinism.
There's been a number of papers written about how pervasive Calvinistic ideas are in the medical community. This tracks with the New England area of the US pumped out the most doctors while medicine was 'growing up', and protestant christianity was the most common form there. When you view the creation of the US medical system with that view many of our screwed up systems make sense. A lack of willpower is a failure of man to be in touch with god, and not a problem a doctor should solve.
> I just realised I have the impression that's exactly what people do in the USA?
How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.
We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.
Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.
> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.
I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.
I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”
And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"
Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.
The tl;dr is that our understanding of the brain and mood disorders kind of sucks.
It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.
It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.
For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.
after being prescribed Mirtazapine, then Trazadone I realized I don't think I've had restful sleep as long as I can remember. I need a sleep study done probably but until that the quality of life from taking something that has virtually no negative side effects for me is insane.
meanwhile people are like "just take magnesium or melatonin lol"
Nobody should take this as medical advice, but from my own experience, nothing has made a bigger difference in my sleep quality than supplementing with magnesium glycinate. I didn't even start taking it for that purpose - I was taking it for something else and quickly noticed that it made the quality of my sleep significantly better. The only side effect from it is that sometimes I have strange dreams (not nightmares or anything, just odd).
Everyone should check with their doctor, but it's an inexpensive supplement and the effects (if any) show up pretty quickly, so IMO it's worth a shot.
The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.
> The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo.
^ citation needed
What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?
I believe that is indeed what they meant. The perception of being given a remedy is very powerful indeed, especially for issues ultimately linked to the mind.
That placebos can work should not be seen as undermining the severity or pain of the depression, but rather underline the power of tricking the mind into improvement.
> The hate is (among other points) because they are only arguably, marginally, better than placebo
Only true for some. Inarguably, well-proven false for others.
Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.
From reading internet comments you’d think so, but your experience is more typical than anything.
Depression is deceptively common. As a consequence, SSRI use over a lifetime is also more common than most would assume. Any drug will come with negative side effects for some portion of its users. Multiply that by the high number of people who have ever taken an SSRI and it starts to become obvious why there are so many Internet anecdotes about SSRIs not working.
Meanwhile, most people who take SSRIs successfully aren’t going around and advertising the fact that they’re on psychiatric medications. There is less stigma now than there was in the past, but it’s still not something most people like to broadcast to the world. For patients on long term SSRIs in stable states, the SSRI is just a routine thing they take in the background and don’t really think about. There’s no reason for it to come up in conversation.
To add to this discussion as someone who had above experience this winter, after (literally) years of mood fluctuations, fatigue and brain fog.
I have started taking SSRI after a harder-than-usual body collapse, and after no matter what I did my mood hasn't improved for a month. Regular running, meditating, writing, crafting, coding etc were my antidote to my mood swings but this time it didn't work. Started taking SSRI and continue doing all this things, and I was reborn.
My therapist said that a big chunk of why i am feeling better is also because I kept doing things that are good for me. That she sees with a lot of her patients that they think a pill will magically change the situation. It doesn't work on itself, you need to show up and do things that release serotonin in your body.
But seriously, unbelievable, years of frustration and friction in my life disappeared and I have never felt better.
I didn't even know I had it, but when I was diagnosed, my psychiatrist was very concerned and made a point of encouraging me to keep in touch, making sure I worked through things and engaged with the problem. I initially thought something like "I'm fine, just a little down here and there, I wonder if this person is inventing work for themselves?"
Same with anxiety. I would have told you something like "I'm not an anxious person at all. I don't even know what that's like, though I can sympathize with people who suffer with it". As it turned out, I was suffering pretty severe anxiety. In retrospect it's as clear as day, but at the time it was just... The way life was.
The thing is, all of my assessments remarked that I demonstrated relatively high self awareness and openness. My experience being diagnosed with ADHD and depression made me seriously concerned for people who 1) can't afford this process and support, and 2) will just continue to grind like I was, living half-dead without knowing it can be any other way.
I suspect there are a ton of these people—I think I notice them quite often—and I was arguably accidentally pulled from that stupor and would likely still be there, unaware, if it weren't for a chance encounter that caused me to think slightly differently about the possibility of having ADHD.
“God, I see what you’re doing for others, and I want that for me.”
I had a very similar experience, except it killed my libido, so I chose to endure the suffering of Winter rather than live with emotional numbness.
Still, I strongly recommend it for people flirting with the abyss. It was life-changing for me while I was raising an autistic 2yo during the pandemic.
> I had a very similar experience, except it killed my libido
Did you, as well as the other people seconding this, have any libido left in the first place? I got on Sertraline because I was depressed, and it actually brought my libido back, by virtue of just bringing me back to a better emotional baseline.
All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.
I have switched to lamotrigin, it helps to balance mood as I had bad mood in months with less sunshine. Lamotrigin is not an antidepressant, previously it was used for epilepsy stabilisation but now it is prescribed for mood swings. (This is not a medical advice.)
It is still prescribed for epilepsy. I am actually hoping for some medication stories if anyone/someone they know has ADHD and epilepsy. It's for a juvenile, but your stories can be for any age. Or pointers to any resources about the combo.
Speaking from personal experience, people react to different SSRIs differently. I took a popular one that had significant side effects without a whole lot of benefit, and so I stopped it and didn't try anything else for 10 years. Then I spoke to a psychiatric nurse practitioner who suggested trying several others until we found something that worked for me. I had (incorrectly) assumed that if you had e.g. sexual side effects from one SSRI, that you'd have them for all. That is not the case.
I spent $300 on high lumen output light bulbs. 28 200W equivalent LED bulbs and 2 LED corn bulbs. Just a TON of light. Depending on severity either run it all day (late January and February tend to be the worst months), but even 10 minutes in the morning helps substantially. Just a lot of light. You can get hung up on high CRI and full spectrum but just do it badly first, then if it works worry about perfecting the setup. I just kept buying more bulbs and as I bought, I felt better and better.
i'm sorry this happened to you, this was of the reasons i held off trying them for so long. ubiquitous indeed, also on this front I got lucky...
please people, take my post for what it is: anecdotal evidence. SSRIs can basically give you any possible side effect, including destroying your libido.
I have no experience about antidepressants myself so please excuse my stupid question.
When I hear people say "it killed my libido" I always think about the fact that hyper-sexuality can be a trauma response, and if your body is healing the hyper-sexuality is most likely also reduced.
It's like when you have a disease and then read the side effects of a medication and notice that a lot of the side effects are basically also something that can happen when your overall condition is improving but still some people report them as adverse effects and then these are added as side effects to the package label.
For example you take antibiotics but bacteria can have toxins in their body, and when the bacteria disintegrate you get more sick from the released toxins. It's called the Herxheimer effect: https://en.wikipedia.org/wiki/Jarisch%E2%80%93Herxheimer_rea...
When I started methyl-B12 supplementation I also had inflammation in sinuses for weeks but it was just from my immune system starting up again and being able to attack long-standing inflammation. Someone else would've put "fever", "headache" and "stuffed nose" onto the side effects medication label of methyl-B12.
I didn't read their comment as insinuating libido is 1:1 to hyper-sexuality. I read it as: "consider if you have a libido, and depression, you may also be hyper sexually."
The situation is PersonA has determined they need an anti-depressant. So one thing is 'wrong.' It stands to reason that they may be using sex as a painkilling mechanism. After all, sex feels great. When the anti-depressant kicks in, the body may determine it doesn't have to use that painkilling method anymore, hence, the decreased libido. It doesn't mean having a libido is bad, it means that the person potentially was overdriving it.
That is not what this was. You have been firing your fireplace, now you put on a sweater and you suddenly don't want to fire so much. Maybe that's not bad, but a return to normal. That was the proposition. Is it true, who knows. Case by case question.
Hi, author of the blog post here! Thank you for sharing your experience with antidepressants, I'm really glad it worked for you & made your life better.
I did mention the following at the end of the "antidepressants" section, but reading your comment convinced me to move it further up. The intro now reads:
> The "standardised effect size" of antidepressants on depression, vs placebo, is around 0.4. (On average; some people respond much better or much worse.)
Also, I wasn't expecting my article to do well on Hacker News; thank you everyone for the comments & critiques! I'll edit the blog post as I go along, to refine it in response to your comments.
My personerino let me be ridiculous and fawn a bit, and tell you that you're one of my internet heroes.
Don't take it as criticism, more of a personal take on figuring out what antidepressants do for me. Furthermore, since posting that parent comment I've converted my vit. D dose to IUs and I realised i'm only taking 800 IUs daily. So a thank you for clueing me in on that, and who knows what happens if I up that. Maybe you were right all along and all i DID need was a heroic dose of vitamin D. (... thats what she said)
Thank you for the blog post! I live in New England and always had the winter blues, always just assumed it was because of the weather but never acted on it.
About a week ago, there was a reddit post claiming it's actually geographically impossible for anyone where I live to produce enough Vitamin D naturally from the sun alone, due to the shorter days and lower angles throughout the day. I had no idea.
Thank you! I relate; I live in Montréal, close to New England, with similar climate. The current UV Index for Montréal is... 0. And the current UV Index for Boston is... 0.6. (1.6 later today)
I can't find a rigorous academic source right now, but the top web results all say we need at least UV Index 3 for our skin to be able to make enough Vitamin D. I guess summer may work for us, in the Montreal/New England area, but other than that, yeah, you and I will need to get Vitamin D from diet and/or supplements. And fish is expensive, so supplements it is.
I had disk issues in my lumbar spine that caused nearly unbearable pain and terrible quality of life. Tried everything: PT, OTC painkillers, epidurals, massage, nothing worked. Was prescribed pragabalin and duloxotine. Duloxotine is an SNRI that also treats nerve pain. That combination helped some but I was sleeping 11+ hours per day and generally felt like my head was in a complete fog, was pretty much useless with work. I had been trying to avoid surgery but finally had 2 procedures in 2024 that helped immensely. Weaning off those 2 drugs was no fun: sweating constantly, anxious, headaches for about 2 weeks. Extremely happy I went the surgery route and stopped those meds. I can't imagine living day to day feeling like that.
Duloxetine was indeed a beast to get off of. It got so bad that I would open the capsules and count the number of beads to taper as slowly as possible. It was hell
SSRIs saved my life. No exaggeration. They might be overprescribed, only effective is some individuals, and they certainly have their share of side effects, but they're still the gold standard treatment for clinical depression and anxiety.
It takes a 10 min talk with a doctor to get antidepressants around here. Perhaps a test which looks like multiple choice score of symptoms with some weights.
I had an old gf receive two different drugs each with terrible side effects. To me it looked as poison.
I decided that I would rather hurt myself myself than fuck with my brain chemistry this way.
During the dark northern Winters I lack vitamin D (your doctor can measure this using a blood test). The symptoms are some physical issues and probably something that can be described as light depression which goes away if I remember to take the vitamins.
We are all different. Some people might need anti-depressants. I just need some vitamins.
If a drug has an 1% chance of 100% effect, it will look pretty weak in those studies.
IMO it's pretty clear that depression is a symptom of many independent issues, so it's really lame that we don't have a more accurate way of diagnosing it.
The goal is to tackle it in every way. The medicines are supposed to be supportive and not the solution. More often than not people treat it as a solution.
Thats why they are eventually tapered and discontinued once you are able to be on your own.
As someone who tried citalopram escitalopram and sertraline, along with venlaflaxine and fluvoximine, I would suggest doing a pharmacological test for psychiatric medications.
I am an intermediate metabolized for the first three and the ones I was on most long. It did not suit me and made my orgasms go from ‘wtf’ to ‘that’s it?’ And they are still not normal 2 years after discontinuation.
I am still depressed and anxious to the point of serious consideration of these medicines to save myself, but you can save yourself the experimentation by doing a simple test and avoiding those medicines.
Anxiety depression panic attacks are something I wish more people studied along with sexual health.
That’s B3 for nerve and dna repair if I understand correctly.
I notice a difference after eating non vegetarian food but since I also have IBS, my absorption can be a hit or miss.
A very balanced and nutrient rich diet with good sleep and exercise is the start to mental health recovery. People often forget how important all this is.
for ibs: no coffee, milk (any milk), vegetable oils, wheats, soy, or anything from USA :D and no sugar or alco
then slippery elm and probiotics, d-vitamin + c-vitamin.
fasting, intermediate is also helpful.
add berries and yes, beef meat and lots of greens.
with strict diet ibs goes better.
I finally went and got diagnosed at age 46 for what had been an childhood-onset issue in retrospect. All the signs were there: inability to start work until enough challenge or novelty or a state of crisis had come about, etc. When I spoke to friends about considering treatment, they said they thought of me as a hyperfocus kind of person. But they didn't see how many support systems I had put in place to function normally, how I saw others around me just doing things while I had to work myself up to start and then keep checking and double-checking for the silly inattentive mistakes I knew from experience I would keep making.
I've had a meditation practice for a long time and it has helped with anxiety but it hasn't really helped with getting started on tasks, especially those perceived as boring. I even had to psych myself up to sit down and start meditating, even though I knew I would enjoy it.
I didn't know until a year or two ago that non-stimulant medication existed to treat ADHD. I always thought it was only Adderall and the like, and I couldn't risk anything that would ramp my anxiety up, or take additional treatment for the anxiety with SSRIs because I have severe hemophilia and any additional risk of bleeding from SSRIs was an untenable proposition.
After sitting on the idea for some time and just hoping that I could fix it with more meditation, I finally decided to see a psychiatrist. The doctor suggested Atomoxetine, but said it doesn't work for most people and even then takes 3-4 weeks to take full effect. I started on the absurdly low dose of 10mg/day for the first month to be sure it wouldn't cause additional bleeds. By day 3 I could see a huge improvement in my working memory and ability to perform tasks. It gave me insomnia for a bit but I would wake up at 3 AM, sit down happily to work and write the best code I've written in years. I could not believe the difference it made. There were quite a few side effects initially but I was willing to put up with them because of how smoothly my brain was functioning. I became a nicer person to deal with. I felt this sense of possibility and freedom that I haven't felt since my 20s. My only regret is not having done this sooner.
So yeah, please don't avoid medication based on internet reading.
Similar. I was on stimulants as a kid and hated them as they did nothing but make me feel high then taper off leaving me exhausted. Nevermind the total loss of appetite. Later on as an adult I obtained adderall from a friend and experimented with it and it seemingly worked for a few days but it never stopped the intrusive thoughts or help with the anxiety. In fact all I did was chase a high with cup after cup of coffee when coming down. That put me off to meds for a long time.
More recently I was on a vacation where I took mushrooms and had a nice trip. Two days later at work I felt very relaxed driving in and sat at my desk BUT something was wrong, my head was dead quiet (the GP explained this exactly like I would.) So quiet that for a second I had a bit of panic as I thought something was wrong. Then something wonderful happened: I realized I was able to just do my work. There was no stress, no worry, no nothing. Just a calm quiet confidence to get the job done. Best day of my life.
After that I called a mental health center and connected with an ADHD specialist who has been working with me. I am also on Atomoxetine myself and while it has not brought me back to that zen head space it brings me close enough. My only gripe is at a higher dose it gives me sensations in my head. However, I learned that eating a proper breakfast helps a lot as I was taking it on a near empty stomach. Overall my life has been slowly improving and I feel more confident at work.
> So yeah, please don't avoid medication based on internet reading.
Same for me with buproprion. Night and day difference. Made me wonder how different my life would be if I had been diagnosed appropriately when I was a kid.
I do wonder if being highly functional and feeling capable is normal though, like as a species it seems almost dysfunctional to happily plow through 8 hour workdays and bills and appointments and all the little bureaucracies we have to navigate. Sometimes a little voice screams "Run to the woods!" when I sit down and look at a long todo list for the day, but with Adderall I can generate some semblance of enjoyment from ticking off the boxes.
Granted our world is what it is, and we are mostly helpless to enact large changes. Finding some kind of peace with reality is probably better than bashing your head against why you don't fit into it well.
When you're depressed, you're in a hole that's too deep to get out of.
The SSRI basically shovels stuff from the top of the hole to the bottom of the hole so your head is above ground level. You are still in the hole though and you need to climb out of it.
Tangent… but for sweaty feet, try a ski boot dryer!
You can get them for $50… they dry out my shoes which makes them last a lot longer before they get so smelly I have to throw them away. Plus, who doesn’t like warm shoes in the morning?
That, and there are some creams called Sweat Block or whatever you can rub on your feet which reduce sweating. Those work as well.
Also try wearing merino wool socks. It seems counterintuitive to put wool on your sweaty feet, but they're quite comfortable and they help you avoid that "clammy feet" feeling when you are sweating in cotton socks. They also don't develop odor the way that cotton does.
I had severe SAD to the point of having a mental break where I told my wife I was flying that very day to Miami to get away from the cold. I didn’t end up flying to Miami, which is likely why I’m still married…
So I ended up spending $300 on LED bulbs, both corn bulbs and 200W equivalent, bought some 7-Way splitters for my ceiling fan so it’s holding 28 light bulbs (people have joked I have a “biblically accurate ceiling fan” because it’s so bizarre looking, like a weird glowing biblical angel), and get about 10,000 lux in my home office now. As a bonus, I don’t have to run a space heater in my home office (since I only need it in winter, I’d have been using that electricity anyway via a space heater). Solved the issue completely for me.
The things that keep me away from SSRIs are the potential for addiction and not being able to take psychedelics.
I had a friend on SSRIs not tell us they were on them when they hit a DMT vape pen at a party years ago and they got serotonin syndrome. Had I known I would have warned them not to.
It's more "dependency" than "addiction". No one's waking up jones-ing for another hit of their SSRI. Dependency works well because some people are dependent on it like I am dependent on glasses/contacts.
Yeah, that's fair, there's not really a loss of control so dependency is probably the better term. Still, if you go off of them I've seen people get rocked with physical symptoms. I really try to avoid anything that would have such an affect on me physically.
Whatever the word, getting off of them is not fun. It took 6 months after getting of Paxil to stop feeling like I was being dropped down an elevator shaft at random times day and night.
Thank you for saying this, I wholeheartedly agree. Antidepressants have an excessively bad reputation.
I'm sure they have their problems too on occasion, but for me the decision to start taking Escitalopram was one of the best things I've ever done.
The side effects were totally negligible compared to the benefits.
I've stopped taking it a year ago or so and... it's basically cured me.
I'm not saying antidepressant are a literal pharmaceutical cure for depression, but in my case it simply put me in a position mentally to change habits and patterns of thinking in a sustainable way.
My only regret is not doing this 10 years earlier; the poor reputation contributed to that.
Same story here, but different drugs. Every year Nov to Mar means no lapses whatsoever in diet, exercise, sleep, supplements, clutter, lighting otherwise the SAD will seep in and erode me. I tried udosing ADHD meds this year and suddenly subsistence is easy and I have gas left in the tank for worthwhile things.
I feel like I speedrun Maslow's hierarchy of needs.
No anhedonia so far this year and my creative output is at all-time high. Hope that helps someone get over their own biases about prescriptions.
Bessel van der Kolk also mentions in his excellent book "The Body keeps the Score" that the effect of antidepressants is correlated with the source of the depression. If the depression is a comorbidity from early childhood trauma then antidepressants are limited due to trauma-related reshaping of how the brain is organized. Cases like yours or those that a related to traumatic experiences as an adult are more the result of a shallow neurochemical imbalance which antidepressants are able to impact beneficially.
I’m glad to hear that. Another frame is that your depression turned out to be “math hard” rather than bodybuilding hard [0]. Your disciplined, methodical approaches were steady applications of effort, whereas what you actually needed was easy to implement but hard to envision.
They've been losing ground to placebo in more recent research.
Plus, most of the more serious side effects take a lot more time to manifest than the typical length any given patient remained in the older clinical trials that secured FDA approval and grounded the official manufacturer literature.
I am glad we have these tools, but I suspect they are vastly overused, and patients not well informed.
Same I am in outstanding physical health and my diet / exercise is excellent. Taking Lexipro has made a massive improvement on my emotional bandwidth. I take vitamin D / fish oil and bits of other supplements. At least for me no question this medication even at a 10mg dose has made a major positive impact.
Similar story for me, but with Bupropion (Wellbutrin). None of the SSRIs/SNRIs worked for me, spent years trying different medications, Wellburtin was finally the one that worked, and oh man what a difference.
They do for me too. Alcohol gives me a huge downer the next day but the party itself is amazing so I just waste the day after with a pillow over my head.
And I hate strict rules and rituals, I love chaos. So that also gets me down. I often stay up till 6am (the parties I mentioned above only start at midnight)
So yah it might make some people better but for me the times I break it are the ones that are exceptionally good.
I had a similar experience except instead of antidepressants it was when i started taking Adderall as an adult. A sense of peace and serenity in my mind that I had never felt before, it was almost overwhelming.
I had pretty much the same reaction after two days of taking it.
Took a while longer to get the dose right so that my anxiety also mostly disappeared, but the difference in quality of life it made for me is hard to put into words.
10 mg a day, down from 20 but that made me feel wired, like I ate a bunch of 9V batteries for breakfast. Big pupils, trouble sleeping, manic thoughts, the works.
Thanks. Ever try Saffron extract standardized to crocin content (typically 2-3% crocin, dosed at 20-30 mg/day)?
One meta-analysis showed an antidepressant effect size around 1.2-1.6 , and unlike pharmaceutical antidepressants, saffron with standardized crocin has no well-documented or commonly reported withdrawal syndrome in clinical studies or reviews.
> This just goes to show that for me, they're extremely effective.
I am not so convinced. Perhaps your case was simpler, but people can feel chronic depression. They may take some drugs to modify that, but what if the external factors won't change? You can see this issue for some people who have a disease that only gets progressively worse. I think we can not unify all this as "dislike on antidepressants" as a one-size-fits-all formula.
To cherry-pick a quote from a review of SSRI studies:
>the magnitude of symptom reduction was about 40% with antidepressants and about 30% with placebo.
That tells me that antidepressants have some effectiveness, but placebos work shockingly well. You can give someone a sugar pill with no medical properties whatsoever, and a good portion of people will recover, likely crediting the pill for their recovery.
and then the effects wear of. You just feel "normal" or the same as before.
I used to take ssri meds too. It was nice in the beginning.
Stopping was a nightmare, I needed to taper down foe like half a year..
Yeah, I have an extremely bright lamp designed to tread SAD that I sit, or well used to sit, in front of every morning. Daylight responsive led strip in my home office. And a pair of glasses with blue LEDs for on the go. It did... 10%? of what citalopram eventually did for me.
Have you tried more light? Like, a lot more light? Like, getting a light meter and aiming for 10-20,000 lux in your room? This blog was a good start for me.
Thanks for the reply. Does the citalopram completely obviate the need for the extra lighting or do you find there is still a benefit to having the daylight lighting too?
I've stopped caring for my various lamps. I turn on the bright panel out of habit while working at my desk... but I don't feel "drawn" to it as before. I'd, for example, set my phone to the highest brightness in a dark room to motivate myself to get out of bed, or at least get to the light switch. Now I don't care, I just get up.
And I can look at the dark world outside the kitchen windows in the morning and not feel oppressed. It's just a lack of light, no menacing presence.
As someone that falls on the side of “depression is real and antidepressants can help” it is very clear that there are people in this thread that need to hold their tongues because they know not of what they speak. (Not you OP)
There are some forms of depression that you cannot think or act your way out of. If you haven’t experienced that, I promise that you do not understand what it is like. You cannot really understand unless you have experienced it. Your opinion on it is irrelevant, and frequently offensive.
The same is true for people that say that antidepressants are mostly placebo. They are not. When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Yes, I understand that other therapies are also effective, and that some people are non-responsive to some drugs.
Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.
Edit: I understand that the placebo effect is still an effect. My point is that there are a lot of people being incredibly dismissive of real lived experiences and outcomes on a VERY serious issue.
As a counterpoint, I experienced such severe negative symptoms after taking SSRIs that I had to be hospitalized for months. Medical treatment is not without its risks. I would always advise trying NPIs before drugs.
I don't in any way mean to discount adverse affects, or negative experiences. Those are just as valuable points. People should be aware of the risks when they take any pharmaceutical, and there are doctors who will happily prescribe these drugs without educating the patient or themselves about downsides and alternatives.
My point is that a lot of the commenters here are saying some variation of "have you tried being happier?" and "these drugs do nothing". Both of which are absurd to the point of offensiveness to people who have gone through it, in the same way that it would be absurd (and offensive) to claim that these drugs have no possible downsides and a negative reaction is placebo.
There are indeed some form of serious depression that are non-responsive to psychotherapy alone. Those are however not the norm. Dr. David D Burns, practising psychiatrist and author of the book Feeling Good: The New Mood Therapy has written a whole chapter in it on the appropriate use case and effectiveness of anti-depressants today. (If you are considering using anti-depressants, I urge everyone to get the latest revision of his book and read that chapter). He believes anti-depressant has its use during treatment but also shares studies that suggest modern psychotherapy, like Cognitive Therapy which he advocates, has now begun to surpass the effectiveness of anti-depressants in "curing" depression in the long-term.
A particular point he makes about depression in it is insightful: Although depression is conventionally viewed as a medical illness, research studies indicate that genetic influences appear to account for only about 16% of depression. For many individuals, life influences appear to be the most important causes.
I was incapable of the compassion you're talking about until I had a bad shroom trip and felt some horrible, hard-to-describe anxiety the next morning. It was some of the worst hours of my life until my serotonin system rebalanced itself.
I'm not saying it's the same thing as depression or regular anxiety, but it gave me tremendous perspective on how bad these conditions can be and you just don't have the ability to "shake it off" when things are unbalanced.
Maybe that's how my wife feels when she's off the meds. Shit. Now imagine having a douchebag by your side second-guessing your pain. Never again.
The good thing is it isn’t necessary to know how someone else feels to have compassion.:)
It’s enough to accept you don’t understand the other person‘s thought process and stop trying to tell them what they are thinking. You don’t need to fix things, you just need to listen and not make them justify or explain themselves to you.
Doing nothing is better than doing the wrong thing.
This comes from my own personal experience. I can’t relate to people on an emotional level. Every relationship is processed with deliberate, logical action. If I love a friend, I need to figure out what would change their internal state so they can experience that love.
From the outside, this looks like I can relate on an emotional level.
Precisely. That's what I took from the experience as well. If that's so hard and I had no idea about it until now, maybe there are other things that I don't know, and some that I will never learn, and I should tread lightly.
> The same is true for people that say that antidepressants are mostly placebo. They are not.
In fairness, anti-depressants are a lot of drugs. The article gives a list. 23 of them seemed to be better than placebo, 19 of them were much less clear.
> When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Lexapro made me feel like I was randomly being dropped down an elevator shaft for 6 months after I stopped taking it. I’m glad it worked for you, and am not minimizing that, but these medications have a side effects profile a mile long and should be a therapy of last resort in my opinion.
The problem with antidepressants are that while we know, more or less, what they do, we don't know why they work for some and not for others. Escitalopram (Lexapro) was a vast improvement for me over Citalopram. Then it plateaued and a year later, left me anhedonic. Tried an SNRI that would give me brain zaps every day a few hours before my next dose and it was horrendous to quit using. It also messed with my ability to meditate for a long while. Basically, I could put myself in a mental state that would trigger the same kind of painful brain zaps that withdrawal from the SNRI caused.
I can't go so far as to say it saved my life, but I'm part of that cohort of 10% of men who develop postpartum depression. Taking a small dosage of Lexapro had zero side effects for me and helped me deal with not just the anxiety and depression I was experiencing but also a lot of pre-existing anxious behavior that I didn't even realize was abnormal.
Huge quality of life improvement. 10/10 would medicate again.
A: The same is true for people that say that antidepressants are mostly placebo. They are not.
B: When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Are placebos unable to save lives?
Not claiming antidepressants are or are not mostly placebo, and don't mean to minimize the pain of depression in anyway. I just don't think whether or not they saved a person's life is an indication either way. The placebo effect is real, right? As in the subject actually gets better after taking it.
> Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.
This is the internet, friend. I wish you the best, but maybe don't put too much hope into that one. I think you'll have better luck cultivating the ability to be comfortable having your own beliefs while others have different (possibly wrong!) ones.
When you do this, you're just accusing people of having no real evaluative power about their own experience. It's pointless, and it's not really an opinion.
Placebo-controlled RCTs show that some people react well to antidepressants with major variation from person to person.
Maybe I wasn't being clear, since I didn't mean to accuse anyone of anything.
I'm not disputing that someone had the genuine experience of antidepressants saving their life. I'm asking if that precludes antidepressants acting as a placebo.
In other words both things can be true: antidepressants saved someone's life and antidepressants can act as placebo (even in the case where they saved someone's life). And notice I'm saying "can be true". I'm not saying they are true, cause I have no idea.
This is a logic question, not some kind of moral attack.
This is my first year, doc told me to wait until at least march, April to start talking about tapering. I have zero symptoms in summer, so I'm inclined to get off them outside the darkest months... we'll see how bad the discontinuation syndrome hits.
Re "citalopram" and "SSRI lottery I guess"...in fact, citalopram is not a true SSRI and in fact no SSRI is only an SSRI as they also on, at increasing doses, many other neurotransmitters like norepinephprine and Muscarinic acetylcholine receptors.
However, citalopram specifically has a big effect on the histaminegma the sigma-1 receptor. I will focus on the sigma-1 receptor:
Never heard of it? Yeah, don't be ashamed, it is the biggest secret in depression. In fact they are finding that many "SSRIs" are sigma-1 agonists, even prozac.
It tunrs out that Sigma receptors modulate glutamatergic dysfunction in depression, and glutamate, being excitatory, well, you can. make your assumptions from there.
It seems the main function of the Sigma-1 receptor is Calcium release. And calcium ion channels are one of the most studies ion channels in mood disorders. By increasing calcium release you increase neuronal activity, hence, the uplifted mood.
It is too bad that the sigma-1 receptor is just starting to be studied and there is limited evidence of how omega-3 and Vitamin D effect it. But I do know that Vitamin D has a huge effect on SLC6A4 (SERT).
I have Schizoaffective Disorder Bipolar Type (disabled) and have been on no less than 14 types of meds. I knwo how they work better than my psychiatrists, which I why I no longer take them. I also know my genetics which gave me clues to what is happening in my body. Now I eat a mostly seafood diet and my needs for meds has mostly vanished. I am still an odd old fellow, but at least I am not ranting in the streets or trying to kill myself anymore.
Meds saved my life, but a diet high in Omega 3, D, and a bunch of other things has removed so much suffering from my life, more than any medication has.
Yes. Made me manic. You know we make niacin in our own bodies, from tryptophan, down the kynurenine pathway. Sine many of the enzymes that are in this pathway need B6 and B2, being low in these may lower endogenous niacin in the body.
Yah. Measuring the effects of these drugs with a single effect size number is ridiculous. They work exceptionally well for some people (myself included). It seems as well that SSRIs work much more reliably on anxiety disorders than on depression.
Getting on them can be a ball ache (or entirely painless; escitalopram was easy on and easy off, Wellbutrin was a nightmare to get on, but also easy off), but entirely worth a shot for anyone symptomatic.
> I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.
Yes, you did. Had the same medication and got tremors and stiffness so bad I thought I had early-onset Parkinson. Could hardly unlock the door without dropping the keys five or six times. Fortunately, it ceased when I stopped the SSRI.
Have you tried SAD lamp light therapy? But not those lamps you get on amazon or other marketed SAD lamps, those are a scam. Just buy a 2 floodlights that are pretty powerful, say 100 watt each. Works like a charm. 15-30 mins a day its all it takes
I experienced this but ended up getting off of them after developing some back/hip issues but I didn’t think it was related, it wasn’t until I quit the citalopram that my shoulders were suddenly relaxed and the hip “looseness” or constant need to be adjusted back into place went away, like everything tightened back up, it is really strange, then I looked up how SSRIs can impact this and even bone healing, decided I couldn’t risk my body falling apart.
something's fucking my hydro balance. i've done my fair share of psychedelics, and i have to keep drinking water on shrooms too. i dont know, something highly idiomatic haha. i also sweat more in other places, but my feet are the moistest. right now i just change socks often, it's hardly a debilitating side effect...
I'm guessing you can afford spending $300 on light therapy glasses.
Disclaimer: I'm not a doctor, but saw 4 seasons of dr. House. Moreover, few hours of Huberman Lab on sleep and light and most importantly, this episode of Additude Mag Podcast on curing SAD and ADHD day-rhytm shifting with light glasses: https://www.youtube.com/watch?v=fu4mLgkNc6I
What happens in the seasonal affective disorder season is the sunlight pattern diverges from 6-18 that we evolved with. Without daily reminder of getting enough sun (or sun-like) light at the 6 o'clock⁰, your body clock will drift.
It can start by feeling groggy instead of refreshed in the morning, even if you've slept enough. And can escalate into loosing the will to do anything or even live.
No wonder. You're still an animal. You need to be fed, put to bed, etc. at a specific time. If you try to make your body sleep during the day, and eat and work during what body expects to be night, you won't really sleep and won't really live/work. Enough of not really sleeping and not really living - you mess up your body, your gut biome, your hormonal balance and your brain chemistry. You kind of should get depressed when you do it.
You can steer your body clock with light. Most of us do it, by exposing ourselves to strong (strong enough it won't matter if it includes blue wavelength or not).
But you can do it consciously (and in a way good for you) by putting on light therapy glasses (I'm using Lumiere 3¹, and they are not the only ones, find your own) at 6⁰ everyday, or right after you wake up if you're trying to readjust your rhythm. Or if you have time and want to save $200, use a stationary lamp and just sit in front of it doing nothing. I don't have the time. When readjusting, small doses of melatonin (0.5mg) 1h before sleep will accelerate body clock shift.
But don't listen to me, if you have SAD, you should really listen to that ADHD experts episode.
I feel for you, struggling with that stuff for a long time. Vit D, fish oil (lot of). All lights at home set to reduce intensity after 18. Strict going to bed routine. Still sleep poorly once in a while, but can do things in winter again. Hope it will help :)
0: choose whatever suits you. With small doses of melatonin and discipline in using light glasses you can even flip day and night. Just stay consistent, good farmer always feeds his cows at the same time.
1: at the time of buying ( fall '25 ) they were cheapest and best overall in norway. Solid build, ok battery, can have them on during yoga using attached rubbers and kind of can have them over glasses. Mine are very large and have blue light filter, but I manage 20min without eyeglasses. Medical certificate. Few leds, holo strip, battery and some plastic - my inner Scrooge says it's not worth $285, but everything else was worse and more expensive.
I just spent $300 on LED light bulbs. Especially if you have an older house the sockets are all wired up for incandescents so you can just split the socket and run 7 bulbs per socket, I have 30 light bulbs, including two 200W corn bulbs and the rest are “100-200W equivalent”
Hi, author of the blog post here! Yes thank you for catching this awful typo, it's fixed now! I did write "4000 or 5000 IU of Vitamin D" everywhere else in the article -- main text, conclusion -- just my luck that the one place I mess up is right at the very start.
(Do not take 5000 mg, that's 200,000,000 IU. You'd have to chug dozens of bottles per day)
Colon Blow: "It would take over 30,000 bowls. [ a giant pyramid of cereal bowls shoots up from under the man, who yells in terror as it rises ] To eat that much oat bran, you’d have to eat ten bowls a day, every day for eight and a half years."
More often written as 200,000 IU as 5000mg of D3 is not written as 5,000,000mcg
The author simply (and terrible mistaking) typed [mg] instead of [UI] in the first paragraph: if readed entirely, the author correct this typo in every other sentence
Still it needs proof reading and definitely a BIG WARNING that anyone who reads the article should first talk with their doctor before trying any "recommendations". Some of these "recommendations" could literally kill someone.
I bought the once weekly 50,000IU bottle on Amazon and am currently taking 4 a day and I am ignoring all growing signs of vitamin D toxicity because I read this guys blog and never once ever decided to consult another source, including later paragraphs in that same blog because there was no warning. Without a warning, you should blindly follow all medical advice you read online.
That is that pathway to death you are worried about?
I was going to say, wouldn't following through on this mistake require you to not just spend a ton of money on pills but also take tons of them a day? I'd like to think this would give even the dumbest of people pause just because of the practicality aspect.
If you don't have an underlying condition it is way better to get the Vitamin D from the sun in 10-30min increments per day after which you are saturated for the day. Overdose is not possible via the sun (excluding sun burns of course).
> A single, optimal sun exposure session might produce the equivalent of 10,000 to 25,000 IU from a supplement, but it will not keep increasing with more time in the sun. That's your max per session.
"In Scotland, we only get enough of the right kind of sunlight for our bodies to make vitamin D between April and September, mostly between 11am and 3pm."
And in Norway we often don't see the sun during certain months, due to it only being up for a few hours in the middle of the day (when we're working). And even if I was outside I would be covered in clothes.
We have a saying here to take cod liver oil all months ending with R (in Norwegian that's September to Februar) to get both omega 3 and the vitamin D.
In winter, even on a sunny day, only tiny fraction of your skin is exposed to sun. 10-30 min of sun when you are wearing tshirt and shorts is much different from 10-30 min of sun when you are wearing long sleeves, gloves, and a scarf.
It's not really the exposed skin that's the issue. At higher latitudes the ultraviolet (UVB) gets scattered by the longer path through the atmosphere and so even if you were naked you still wouldn't be getting enough.
Check local/national advice. In many places it is officially advised to take vitamin D supplements, especially in winter or if you have a darker skin tone.
Your suggestion sounds a bit detached from reality of many people.
In many countries it is physically impossible to get enough vitamin D from the sun, even if you go out naked.
Also did you ever notice that the cheap apartments in many places are facing north and do not have a balcony, and of course do not have a private garden? Now you are reduced to going to a park which in the "cheap" areas is also not a good spot to chill for 30 minutes.
I would argue to do both in the winter, since sunlight has other benefits than just Vitamin D synthesis, like mitochondrial health and better circadian signaling for better sleep quality.
Isn't the oral intake pretty much negligible anyway? I remember getting a vitamin d supplement in a syringe (to be put on bread, from a physician) containing a very large dosis.
I'm not stating the dosage is wrong. Looks like it is anyway.
Oral has felt very effective for me. I take a daily supplement that has roughly 100% of the recommended daily dose of everything. I split it in half.
For D3, it is 25mcg / 1000 IU / 125%
After splitting in half it's 12.5 mcg / 500 IU / 62.5%.
I take with some fat-containing food to allow ir to absorb which is usually breakfast (yogurt, some nuts, some kind of fruit, oats), and it's a night and day difference in my mood (how easily I can control my temper if already agitated, how easily I brush off annoying stuff, takes the intensity off of my reactions and mood during conversations).
I did a blood test before starting, and if normal is between 30 - 70, I was at 10. Dr prescribed megadose of D2, followed by daily D3, but I skipped on the megadose and went straight to D3 -- makes me wonder if a megadose would build up my stores since D is fat-soluble and make it so I could miss a day and not notice.
All of the above is anecdotal from me, a self-professed cave dweller, but it's been a couple of years now, and I still notice the difference. Also, what I heard from people in Boston is that 90% of them are on a vitamin D supplement. My friend from there laughed at me when I was raving about it, saying "yeah, literally everyone here is on it".
Source? There have been many articles on HN showing the RDA to be ~10x too low (something like 5,000 IU) and that the daily safety limit to be significantly higher than that (something like 30,000 IU).
Edit: for clarity I am not saying it is impossible to overdose on oral tablets, but rather that with most tablets 400 IU to 1000 IU and the safe limit so much higher than these, it seems like it would be extremely unlikely for someone to be taking 30+ tablets daily. Not impossible, but not easy either.
> Source? There have been many articles on HN showing the RDA to be ~10x too low (something like 5,000 IU) and that the daily safety limit to be significantly higher than that (something like 30,000 IU).
First: the RDA and the safety limit are not the same, and an RDA in a country being too low does not mean that the maximum safe dose is wrong.
And it certainly does not mean that there is a higher risk in under-dosing than overdosing when taking the RDA (which already includes recommendations for supplementing if you spend most of your time indoors).
I'm not a scientist, so I only know what physicians told me and what's explained in news publications or by consumer advocacy non-profits.
Here are a study (which I didn't read) and the NHS's advise on Vitamin D toxicity:
> Most cases of vitamin D toxicity resolve without serious complications or sequelae. However, in some instances, severe hypercalcemia can lead to acute renal failure requiring hemodialysis. Cases of permanent renal damage due to vitamin D toxicity are rare.
Which sounds good, but I don't think it supports that there is no risk of oral Vitamin D overdose.
The first link makes the problem sound like it can happen to anyone, but then when you tease out the details;
* Toxicity resulting from lack of monitoring is frequently seen in patients requiring high doses to treat ailments like osteoporosis, renal osteodystrophy, psoriasis, gastric bypass surgery, celiac, or inflammatory bowel disease.
* Patients who are on high doses of Vitamin D and taking inadvertently increased amounts of highly fortified milk are also at increased risk for vitamin D toxicity.
* According to the latest report from America's Poison Centers (APC), there were 11,718 cases of vitamin D exposure recorded in the National Poison Data System. More than half of these cases were in children younger than 5 years.
* The clinical signs and symptoms of vitamin D toxicity manifest from hypercalcemia's effects.
* Clinical management of vitamin D toxicity is mainly supportive and focuses on lowering calcium levels.
* Isotonic saline should be used to correct dehydration and increase renal calcium clearance.
A lot of those point to people drinking too much milk! (enriched milk)
* People with osteoporosis thinking "I better drink more milk for strong bones" when they are already on supplements/medicine.
* Kids drinking lots of milk and presumably not drinking any water - hence the dehydration.
PS: There are a lot of people out there that don't drink any water, and stick to juice or milk or soda, etc. They are not always fat, but that doesn't mean they don't have issues.
I've read the article by now and I like it. It's balanced, more so than the comment section made me think.
And my takeaway is not that everyone should be taking 10k IE, but it's a great reminder to be more consistent in taking my Vitamin capsules in winter.
I'm still standing by my point that it's "easy" to overdose on Vitamin D. Like the article already mentions, one should remember possible kidney issues and not take insane doses of it.
What the recommended daily intake should be, I don't know.
The whole reason I'm commenting on this is I used to take one of the "top" antidepressants on this list.
And I am a skeptic of antidepressants, that doesn't mean I deny all positive effects in people who are prescribed them, of course.
For what it's worth, it's also easy to overdose on Venlafaxine. It's still considered safe.
Just an example to make clear that my comment was not a critique of taking Vitamin D in general.
I don't find the article's main point surprising though. That's the reason I'm taking Vitamin D, too. Doesn't mean that it's impossible to overdose, and this point is also important, because many people still think that it would be impossible to take too much of an vitamin or mineral. Thankfully, high-dose Vitamin A / retinol supplements are not as widespread.
Why would you not be able to overdose orally? It's not like it stops absorbing past a certain dose, and there is such a thing as too much (especially if vitamin k2 is lacking)
That's a bit of a non-sequitur, isn't it? The debated point is how oral intake as a delivery method can pan out specifically (and its limits), not the dosage limits of Vitamin D in general. Think consuming a drug vs injecting it.
It may not be that crazy in fact, unless it's prolonged. Don't take 30k/day for several months without supervision, but doing that for a single month is unlikely to harm you if you start from deficiency. Some people may need even more than that.
In any case, keep your blood levels in check. It's cheap and easy. There are even services you can order to have your blood sample taken at your home.
That’s a large enough error that it calls the rest of the writing into question, in my opinion.
Also, be careful taking 5000 IU/day of Vitamin D. I did this for a few months and it was enough to send my blood levels over the top of the range, even in winter.
Too much Vitamin D is not good for you. The supplement fans have gone too far in recommending too high of dosages. My doctor said she’s seeing a lot of people with excessively high Vitamin D levels now that it has become popular.
It's usually pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
> It's pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
No, that’s literally what I was doing when I reached the excessive range: 5000 IU/day in winter with an indoor job.
This commonly repeated idea that everyone is deficient and you can’t overdose on 5000 IU/day is wrong.
> Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
Literally what I did.
Every time I explain this online it seems like the supplement people ignore what I wrote and just parrot the same “5000 IU/day and everyone is so deficient you can’t overdose” myth.
> No, that’s literally what I was doing when I reached the excessive range:
That doesn't make it easy for most people. In my case it was barely enough to move the needle, but that's not how it will be for most people either.
> you can’t overdose on 5000 IU/day is wrong
Of course you can (though it would usually have to be really prolonged to actually cause you troubles, and even then it's mostly due to calcium rather than vit D itself). The vast majority of people won't, but you don't know whether you're in that group or not until you test yourself.
> Literally what I did.
That's good, but my post obviously used plural "you" as a general advice.
(BTW. There's no evidence of toxicity below blood level of 150 ng/ml, but there are many guidelines that consider levels way below that, such as 50 ng/ml, as "too high" already)
> A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L.
> This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
> ...
> Since 10 000 IU/d is needed to achieve 100 nmol/L [9], except for individuals with vitamin D hypersensitivity, and since there is no evidence of adverse effects associated with serum 25(OH)D levels <140 nmol/L, leaving a considerable margin of safety for efforts to raise the population-wide concentration to around 100 nmol/L, the doses we propose could be used to reach the level of 75 nmol/L or preferably 100 nmol/L.
According to the internet, it is way higher, probably over 9000.
Edit because the comment might be to shallow for HN: I sympathize with the struggle against depression and, after first-hand experience, share the skepticism against the widespread prescription of antidepressants and the methods of evidence presented for it.
Very serious and important topic.
Regarding Vitamin D, I am also supplementing in the Winter, but I have not read the article, which says it has an estimated reading time > 10min. I use one 1000IE (0.025mg according to the package) tablet a day max.
I'll bookmark this discussion page to read TFA later maybe.
I was taking 2x2000 IU with almost no sun exposure and then did bloodwork. My level was 77.8 ng/mL. The lab's reference ranges listed 30-50 ng/mL as optimal, 50-100 as high, over 100 as potentially toxic, and over 200 as toxic.
I don't know why this is downvoted, I had a very similar experience a while back. I took 4000 IU/day for about 4 months, insignificant sun exposure and ended up at 60 ng/mL (lab listed normal range as 30-40).
My starting levels were unknown but I assumed they were low given my usual sun exposure and some low-energy symptoms (which resolved a couple of weeks after I started taking it). I discontinued VitD then and now I only take 1000 IU/day in the winter.
You got it backwards, it would be more beneficial in areas with few hours of sun for darker skin folks, since they do not absorb as much Vitamin D as fair skin folk do.
That comparison doesn't work. Only 10-20% of the vitamin D we intake is delivered through food and the body cannot process more sourcing from food. Even if you take more you will not benefit in an unlimited way, processing more. The skin is much better at generating/making/doing it.
The skin is definitely much better, but a higher than "recommended" dose is definitely (anecdata) effective at bringing up and maintaining the measureable Vitamin D3 level in your blood if you are under the recommended range. It's an important metric to track in your regular blood tests.
No, it's to make it easier to dose different kind of biologically active substances. They can have significantly different "recommended weight to eat of this per day", IUs make that sort-of comparable and easier to remember.
The usability issue with IUs is that people are used to scales measuring weight and containers measuring volume, but an IU is different for each substance.
Another issue is insulin syringes are labeled in "insulin units," which hapless folks reasonably assume can be abbreviated "IU."
If you are measuring out a certain number of IUs, and your calculator or formula hasn't asked you which substance you're working with, you're gonna have a bad time.
IU was correctly used everywhere else in the article except that one place with the mistak, so the LLM didn't hallucinate a correction, it correctly summarized what the bulk of the article actually said.
Only recently again I read in the newspaper, that most products are overdosed. There is a typical number that the vitamin D products usually show, and in the article it said, that only up to 800 IU is safe, and everything above is an overdose. There are many products out there with 2000 UI or maybe even more. Beware.
EDIT: Wow, the HN-local doctors at it again. Imagine getting downvoted for sharing information from newspaper article (and honestly labeling that info as such), that probably was written by someone consulting medical professionals. But hey HN will know better!
> An adult in a bathing suit exposed to 1 minimal
erythemal dose of ultraviolet radiation (a slight pinkness to
the skin 24 h after exposure) was found to be equivalent to
ingesting between 10,000 and 25,000 IU of vitamin D
(Fig. 6).
Doesn't say 30 minutes, but it may be 30 minutes depending on your skin colour and the local strength of the sun.
I think the OP's interpretation of this is wrong. Just because someone was found to have an equivalent of ingesting so and so much, after UV radiation, doesn't automatically imply that it a good idea to ingest any amount of vitamin D. Ingestion is different from exposing skin to UV/sun. The paper probably doesn't state, that ingesting that much will make a person absorb that much from that ingestion, nor does it state, that ingesting some equivalent amount will be safe and without side-effects.
So the paper may be well researched or whatever, but the interpretation of it is questionable.
I can't make any assesment on the quality of the paper as that is far outside my expertise, but as far as I can tell from a quick skim it does indeed make the claim that recommendations for supplements should be significantly increased.
From the abstract:
> The safe upper limit for children can easily be
increased to 2,000 IU of vitamin D/day, and for adults, up
to 10,000 IU of vitamin D/day has been shown to be safe.
The goal of this chapter is to give a broad perspective about
vitamin D and to introduce the reader to the vitamin D
deficiency pandemic and its insidious consequences on
health that will be reviewed in more detail in the ensuing
chapters
The full article is available on researchgate[1]. Direct link to PDF [2].
EDIT: I just looked up the author, Michael F. Holick. Apparently he is one the people who identified calcitriol in 1971. I know appeal to authority doesn't prove anything, but it might be prudent to at least consider his findings.
So? What's your claim here? Are you claiming that our skin works the same way as our digestive system? That would be a ridiculous claim. And fyi, many people get a proper sunburn, if they stayed in the sun for 30 min straight without protection, at least in summer. So your 30 min statistic doesn't really tell us anything about something being healthy or not.
What you have given is rather a comparison, that doesn't stand up even the slightest scrutiny, and an improper citation. I am not gonna read a whole paper on a whim. Cite properly, with proper hyperlink, and at least a page number, and I will consider looking at it.
I would like to, but I cannot, since it is a region-local newspaper that comes as actual paper, that only has a paid online offer, to which I have no access, nor could I post a link to that. If I went through recent paper form newspaper, I could get a photo of the text in German, but then I would (A) need to spend that time, and (B) need a place to upload pictures, without having to make an account, and only then get back to you with a link. To be honest, I am too lazy to do that, just to justify a comment on HN.
That's not unreasonable, but then you also didn't really "cite" your source. Even without photographing the paper, giving the name of it, article title, or author would go a long way.
I think the downvotes are harsh btw and in general HNers have gotten too reflexively downvoting IMHO.
Just Google it. There's tons of research on this so I don't know why I need to provide a specific link when this is common knowledge.
But also here is something to think about: your body will produce more D3 than that by being in the sun for just several minutes. So if you consider such a low dose of D3 an overdose then you better steer clear of the sun!
> But also here is something to think about: your body will produce more D3 than that by being in the sun for just several minutes. So if you consider such a low dose of D3 an overdose then you better steer clear of the sun!
This is another superficial statement, that displays shallow-at-best understanding. Staying in the sun and producing via the skin, and intake via food are 2 separate pathways. You cannot just make wild assumptions about one of those pathways from stuff you know about the other pathway.
And actually: Yes, you shouldn't stay in the sun for too long without proper protection. Having the sun shine on your skin is not some inherently healthy thing. It too comes with acceptable dosage and overdose. Symptoms of overdose are commonly known as getting a sunburn.
You can find scientific papers on a lot of search engines, not only Google.
The problem with that is, that you still need to know how to interpret any results and statements within the supposedly scientific papers. If you are not a statistician, you might overlook methodology mistakes. If you are not an expert in the matter of the paper, you might not realize some side condition, that makes some statement or result of the paper irrelevant for your individual situation.
It's unbelievable crazy what the author suggests, even say "10,000 IU if you're feeling daring / have darker skin / live in less sunny climates.".
Just a simple look at the side effects of high dosages:
Safety and side effects
Taken in typical doses, vitamin D is thought to be mainly safe.
But taking too much vitamin D in the form of supplements can be harmful and even deadly. Taking more than 4,000 IU a day of vitamin D might cause:
Upset stomach and vomiting.
Weight loss and not wanting to eat.
Muscle weakness.
Not being able to think clearly or quickly.
Heart rhythm issues.
Kidney stones and kidney damage.
Hi, author of the blog post here! Thanks for your concern. I do still stand by my claim, since more recent peer-reviewed studies have shown that up-to-10,000 IU is safe. As written in the post:
> McCullough et al 2019 gave over thousands of patients 5,000 to 10,000 IU/day, for seven years, and there were zero cases of serious side effects. This is in line with Billington et al 2020, a 3-year-long double-blinded randomized controlled trial, where they found "the safety profile of vitamin D supplementation is similar for doses of 400, 4000, and 10,000 IU/day." (though "mild hypercalcemia" increased from 3% to 9%. IMHO, that's a small cost for reducing the risk of major depression & suicide.)
So why then does Mayoclinic, etc, all say 4000 IU is the limit? I think because policy is decades behind science (this happened with trans fats), and also policymakers are much more risk-averse. (this is why in California, thanks to Prop 65, up until ~2018, there used to be a warning in every coffeehouse that coffee causes cancer.)
But thanks to your comment, I will edit the intro to note what the official max safe dose is, and that more recent peer-reviewed research shows it's too low!
To my understanding Vitamin D is regularly underdosed. Several points:
1) There are lots of studies that correlate Vitamin D production with sunlight exposure. For example, https://pubmed.ncbi.nlm.nih.gov/20398766/ this one lands on 1/4 of a MED = 1000 IU. Of course now we have a MED definition problem, but we're roughly talking single digit numbers for a white person in midday sun in NYC to reach 1/4 of a MED.
2) If you also supplement with Magnesium, a lot of your side effects go away. Vitamin D3 depletes Magnesium absorption.
FWIW just anecdotally I took 160,000 IU per day for a few months along with 800mcg to 2mg of K2 MK-7 and about double the suggested amount of magnesium citrate. I slowly titrated up to that amount over a few months. I am not suggesting anyone else do that as I had a specific purpose slow action TPA when combined with many protease so to speak but just my own experience I did not have any of those issues. I don't know how they came up with them so I figure they are just guessing like they did with the toxic level of selenium which has a funny back story. I am back down to 5000 IU a day. Years later still none of those issues. But that is just me.
I did have one issue related to magnesium however. If I did a very high dose of magnesium taurate and a couple of other chelated forms I would have trouble catching my breath after physical exertion similar to chronic high doses of iodine. Not the end of the world but it was unnerving.
Don't anyone else do what I do. I experiment on myself more than scientists experiment on mice minus the whole dissection bit. I am just continuing some experiments from the 1900's but as I understand it AI will be learning all of those soon. Fascinating stuff really.
Hi, I'm the author of the main blog post. Just wanted to say that's a fascinating experience, 160,000 IU a day! I mean, I'm not going to try that, but that's good to hear that 5,000 IU/day for years has been working fine for you. Thanks for sharing!
I respond well to magnesium oxide and magnesium citrate in capsules but the chelated magnesium gives me heart palpitations or makes them more frequent if I am already having them. I hadn't noticed shortness of breath since the palpitations would have outweighed that.
It depends on the person, as a sample size of one I was on 5,000IU and my levels were still on the low end (almost still deficient), and my calcium levels were still safely on the low side as well. Ultimately people should be getting their levels checked before and after to see exactly what the effect on them is
Be careful - many studies in the Vitamin D meta-analysis *enrolled patients already taking antidepressants.* [1] Reporting effect sizes without specifying "on which population?" is misleading.
(As an aside, Cohen would be the person not to tell you to assign qualitative values to effect sizes. They are as arbitrary as any other threshold used by working statisticians.)
EDIT – that is, please don't draw the conclusion that you can substitute supplements for antidepressants. The meta-analyses don't seem designed to examine that hypothesis, and I doubt anyone would ever participate in a such a trial. In general (and as a working biostatistician), I would be very, very, very cautious applying estimates of average effect to myself, you, or any other individual person in a field as murky as psychiatry. That's why even the stingiest American health insurance plans still have an incredibly large range of antidepressants in their formularies.
Hi, author of the blog post here! Thanks for bringing this up -- it wasn't my intention to say one should replace antidepressants with vitamins (the conclusion even says "(Don't quit your existing antidepressants if they're net-positive for you!)", but you're right that the intro may give that impression. I'll edit the intro to say you can stack, not substitute, regular antidepressants.
> many studies in the Vitamin D meta-analysis enrolled patients already taking antidepressants.
Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
Table 1 of the meta-analysis ( https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ) shows the raw sub-group analysis. There were 9 studies on patients using antidepressants, 13 on patients who weren't, the rest were Mixed or Not Reported (...how do 6 studies just not report that?) Anyway,
Effect size of Vit D for people on antidepressants:
−0.54 (−0.85, −0.23)
Effect size of Vit D for people NOT on antidepressants:
−0.28 (−0.40, −0.16)
Both negative. Weirdly, the effect of Vit D seems to be a bit stronger for people on antidepressants, but the difference isn't statistically significant at the p<0.05 level (P subgroup difference is 0.23)
(As for why those effect sizes, -0.54 & -0.28, are lower than what I (and that meta-analysis itself) report, -1.82, that's because the majority of RCTs for any group used far less than 5000 IU. Table 2 in that paper shows the effect (with 95% CI) for various dosages.)
I'll lightly edit my blog post to emphasize stack them, don't substitute. Thanks again for your comment!
> Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
I think the point here is that such a study selects for people where their antidepressants are already known not to work very well for them, or they wouldn't be interested in participating.
Based on your own citation, this is untrue. The citation you have linked is a meta analysis of 31 trials, many of which specify no medication use at recruitment.
You are however correct about population being important (which is a big reason meta analyses can be very useful).
I saw a thing from HealthyGamerGG youtube[1] that he said one of the things about depression is that it causes/influences one to avoid the things that would make their life less depressing.
eg just to paint the picture: you're depressed so you don't get out of bed, therefore you don't go do your workout, therefore you lack endorphins and look in the mirror and see squishy, you're sad about how squishy you are and so you get more depressed. You're more depressed so you also don't do your dishes, when you do get out of bed you are depressed you feel like a slob and you're squishy, so you get more depressed...
Whereas adding anti-depressants, and other virtuous cycle things like vitD/O3, exercise et al. Give the boost necessary to _make your life less depressing_ ...
So if you know someone who's depressed, it might be helpful to help them make their life less depressing too. (in addition to all the best medical advice!)
[1]- he's a real Dr... Dr. Alok Kanojia (Dr. K), a Harvard-trained psychiatrist (MD, MPH) specializing in modern mental health
Careful, he is also a believer in Ayurveda[1]. Which basically basically categorizes people into different elements like fire and water and then tries to change their diet and habits to match their elemental style or something. You can hear him talking about it here [2]. Kinda reminds me of Humorism [3]. Dr. K seems like a nice enough guy but don't get too lured in by the "Harvard-trained" credentialism.
I agree there's nuance, but he's way above the "has a webcam and yeti blue" bar that most of youtube falls under, that was my point in putting his credential up. Not to rise him to a perfect status, but to not allow him being on youtube to fall to the minimum bar of youtube.
Definitely agree. He sometimes says things that sound interesting or true, but for the most part I believe he is full of it.
The field of psychology is barely removed from charlatanism anyway, having a diploma from Harvard doesn't change that.
I found this to be the case. Tried Sertraline for a while, gave me headaches and made me feel sick. Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped. I also felt quite an extreme uptick because I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood. I suspect one of the main reasons my mental health declined was due to the lack of Omega 3.
Disclaimer, not saying vegans should stop being vegans, just make sure you find a good supplement, and make sure you understand the difference between EPA/DHA Omega 3.
All my nutrient numbers improved when I became vegan because nearly every one in the US/UK is deficient in VitD, Omegas and B12.
Fortunately today’s vegan communities are much more aware of this so I started taking these supplements right up front and all my blood markers improved dramatically since when I consumed meat/dairy.
It’s annoying to hear some push back against this when it’s as simple as taking relatively safe supplements (just make sure you talk to a doctor, and not a social media influencer, about how much you should take, and if you get a chance to regularly check your bloodwork don’t miss out).
My cholesterol improved massively, but over time, a few, such as Omega 3 suffered. But those were ultimately my own fault, wasn't managing it properly. So, I'm absolutely not suggesting there's an issue with veganism, this isn't really why I fell out of it. So I do want to stress I wasn't suggesting people should steer clear of Veganism, just something to be mindful of. Oh, and my cholesterol immediately shot back up again when I stopped being a vegan. So, swings and roundabouts with every diet/lifestyle, I guess!
Why did you become a vegan if apparently even non-vegans are deficient in B12? Do you supplement B12? Since B12 is mainly found in meat, and B12 deficiency is irreversible.
why do you think the reason for them becoming vegan has something to do with B12 levels? likely they became vegan for different reasons, became much more aware of the importance of B12 and started taking a supplement.
every vegan should supplement b12, so they probably do too
> Fortunately today’s vegan communities are much more aware of this so I started taking these supplements right up front and all my blood markers improved dramatically since when I consumed meat/dairy.
Yeah but that sentence does not refer to why the person switched to being vegan, the first one does. In any case, let us not beat the dead horse there. :P Supplement B12 and it is fine.
No sentence referred to why they became vegan. Their nutrient numbers improved when they became vegan. This happened because becoming vegan moved them from a group who didn't know they needed supplements to a group who knew they needed supplements.
> In any case, let us not beat the dead horse there.
Possibly, deffo would have been a big factor. Anecdotally though, I forgot to take these supplements for a while recently, just got out of the habit, and definitely felt worse again for a bit. But, could have been a coincidence/something else
I think they meant their vegan diet didn't naturally have Omega 3 in it if they didn't take supplements; not that they couldn't take the supplements once they realised it.
Yeah I took that for a while, and did slightly improve things. Only problem I had at the time was those were super expensive in the UK. Maybe that's changed now
> Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped
I would bet that 95% of that improvement or more was due to the exercise.
Your anecdote is common: People start taking Vitamin D or fish oil as part of a bigger plan to have a healthier lifestyle and then they attribute success to the pills, not the lifestyle changes.
Possibly, but anecdotally, I went through a period of forgetting to take them again recently, and definitely felt worse again. Sleep started suffering, felt lower energy again. But, could have been a coincidence/something else entirely
> I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood
I see your disclaimer, but just for more context, vegans can get Omega 3 without taking pills per se. Flax seeds are an excellent source. I often add a spoonful to a bowl of oatmeal or as a pancake topping along with fruit sauce and granola.
Most people can’t chew flaxseeds effectively, so they grind them first or swallow them whole. (They are tiny.) Nutrition experts do recommend grinding them first to release the fiber and the beneficial fatty acids. Flaxseeds are helpful for constipation and may lower cholesterol as well.
Ground flaxseed goes rancid easily, however, so it should be kept in the freezer until you are ready to use it. If you buy it ground, you wouldn’t have to use the blender or coffee grinder to break those seeds up before you have breakfast.
Flax seeds are a very tedious and inefficient way to get omega-3 as a vegan, particularly because they contain ALA, a short chain omega-3, which our bodies are extremely inefficient at turning into long chain fatty acids.
Funny - I feel the opposite about chia. Soaked and plumped is when I hate them. Dry on salads/etc. or just submerged in an active bowl I'm eating is when I like them most - the crunch adds texture to what I'm eating.
With depression it is important to find the cause of it.
You might be depressed because you life objectively sucks. Then you symptoms are good and healthy and a signal to make changes in your circumstances.
You might actually have a good life but still feel depressed because there is a chemical imbalance in your brain. (Very simplified). That is when drugs come in.
It might be just a seasonal thing and you need to go outside more and take some supplements.
You might have some other undiagnosed issue. You might have ADHD, autism and other things that cause you to struggle and develop depression as a side effect.
So find out what works and what doesn't work for you.
The problem with the "your life objectively sucks" option is when you end up too depressed to actually bother doing anything and just give up. That's another case where drugs can help.
Objectively in the sense that there are actual causes in you life that distress you and cause your symptoms instead of thinking your life is shitty because you are depressed. Of course being able to determine if it is your depression talking or if things are objectively bad isn't easy and people often need outside help from a therapist for that. Plus it isn't really clear cut in practice.
On a sidenote, I know that knowing that it is "just your depression talking" is also a pretty hard pill to swallow and not always helpful. Personally I have a lot of fears that I know are irrational but that doesn't make them any less real.
And even if your problems are external, sometimes you need to focus and your inner self first, find some strength and help so you can tackle the external problems later. But for other people "working on yourself" can be avoiding the actual problems they need to work on.
I don't think that's true. I think that just shows how disconnected we are.
We tell ourselves that we must have "better lives" than say a native american in the year 1000AD, but there's no reason to think that.
I think odds are that maybe the native american was happier -- having a small group that you spend time with outdoors every day, getting extensive exercise, having a clear sense of purpose, eating healthy fresh food every day, never once thinking about politics or bills or global warming. I bet they liked their life more than a depressed divorced accountant in our modern society, even if we have more material wealth or health access.
I guess there are different types of "life sucks" that can or cannot contribute to depression, my current understanding is that a lot of it depends on whether you feel you have some control over the situation or if you think you have absolutely no power over it
According to Victor Frankl (psychiatrist concentration camp survivor, author of Man's Search for Meaning) being in a shitty situation without any control over it isn't necessarily bad. Humans can still be mentally okay in the face of extreme unavoidable suffering like in the camps. The key thing is that you need to have some purpose / meaning in life (often a loved one or dependent).
Isn't people in the past had less control? There were dying from infections and not only had no vaccines and drugs they didn't understand how infections are spread. They also suffered from various natural disasters not having a protection a modern civilization gives us.
I don't know enough about how people lived in the past but I would tend to agree with you that they might have had less control than us on many things. But what I meant was that it depends on how much control you *think* you have rather than the control you actually have.
So I think a lot of it is about perception, in 100 years time people might wonder why we weren't all depressed because we had a life expectancy of "just" 80/90 years, but for us it's just normal and expected
> You might be depressed because you life objectively sucks
The problem with this that to a bad situation different people react differently - some trying to do what they can to improve the situation or at least don't make it worse and some give up and let situation to slip and become worse and worse (becoming a self fulfilling prophesy). It's not a choose one makes I think (it's likely a biological predisposition) but the difference is still exists.
People prone to depression genuinely believe the main (only) reason for a depression that the life sucks and as a result they avoid medical help and don't do anything which could help them.
This stuff is complex. There are no magic potions or hacks that work for everyone. No amount of positive thinking can fix physiological issues that you have because of some underlying condition. But it's quite possible to create new issues as a side effect of being depressed, stressed, chronically exhausted, etc. So, working on those issues is probably smart.
And each of those things can be caused by physiological issues as well. You might feel stressed because you don't sleep well. You might sleep poorly because you suffer from e.g. sleep Apnea. Which in turn might be because of a mix of physiological and other reasons (diet, weight, alcohol abuse, etc.).
Or you might be working too hard, which makes you stressed and causes you to lose a lot of sleep. Different causes that have similar results. Including long term physiological results. Your brain can actually get damaged if you chronically abuse it or neglect it. Many "between the ears" type problems are actually physiological.
Root causing your issues enables you to deal with them properly instead of fighting the symptoms.
Anyway, I take vitamin D and a few other things. Getting yourself checked out regularly once you hit middle age is a good idea. There's a lot of stuff that is long term lethal that a checkup can detect early. And some of it is fixable. I have the usual cardio vascular challenges that many people struggle with because of a combination of genetics, age, and life style. And indeed a vitamin D deficit.
I was also recommended to consume more omega-3 as well. Eat salmon. Work some flax/chia seeds in your breakfast. I put flax seeds in my yogurt and use it as a thickener in sauces as well. You have to grind it to dust for it to get absorbed properly. Dirt cheap and it doesn't mess with flavor/texture too much. I keep a jar of ground flax seeds in my fridge. Takes 2 minutes to top it up every 1-2 weeks or so with some freshly ground seeds.
But I'm also aware that me being a stressed startup founder has health consequences that a few pills and suplements won't fix for me. I need to actively make sure I get my rest and sleep. I deal a lot better with stressful situations when I'm well rested. And I seem to be better at avoiding getting in to those as well. And I feel happier. Sometimes the best thing I can do for my company is having a proper weekend or going to bed early enough that I can get my 8 hours of sleep. You can survive on 4 hours (been there done that), for a while. But most people are not at their peak performance if they do that. And it's not good for you to work yourself to exhaustion all the time.
That's the sorta standard socially accepted way of thinking about this. but uh... to a lot of people it doesn't ring quite true.
For example: if your life objectively sucks, why aren't you doing anything about it? Some people whose lives suck fix their lives, and other people get depressed and do nothing; what's the difference? And: all of us know somebody who appears to have a good life and therefore their depression is presumably a chemical imbalance thing but if you're being honest the vibes in their life are a bit off, actually, like you can tell they're not really getting everything they need out of it, that they're clearly good at masking (for example people who are clearly not thriving in their relationships) .... in which case sure medication could help but you can't shake the feeling that facing the reality of their life would help a lot more.
However! Questioning this stuff becomes a bit of a moral minefield. "Believing" in the chemical imbalance theory is part of why it's medically helpful. If your life has sucked for years and you could find no way of fixing it and then SSRIs helped, then you basically need to believe that it really was a chemical imbalance, because believing that it might not be threatens to take away the thing that's making your life work. So much so that I would bet at this point there are already readers of this comment who are ready to angrily reply to my preceding paragraphs, because the model I just described threatens their existence. (If so, wait a sec and read the rest...)
On the flip side, for some people not believing in the chemical imbalance model for some particular case might be important. Maybe they want to feel responsible for their life being bad, so they will be motivated to do something about it, and being happy due to drugs would make them feel complacent and okay with years passing by at a shitty job or something. Or picture someone whose parent has gone their whole life unable to take them seriously as an adult, which as a result means the child and parent have a bad relationship, and then picture the parent complaining about depression and taking medication for it. This can be really infuriating: the child thinks about the parent, "your life sucks because of the tension created by not treating people around you with respect, and you're so incapable of recognizing this even when it's told to your face regularly that you're taking drugs to feel better despite not fixing the problem". Now ascribing depression to medical problems seems like avoidance, and having people write off your frustrations and say that you're just depressed and need to take a drug for it is frustrating.
Just saying: the two narratives really get tangled up. I don't really know what to do about it, but I do think that some harm is done by harping on the concept of a "chemical imbalance". A lot of the issue is avoided if you just think of the drugs as helpful but don't choose any model (with its moral implications) for what exactly it is they're helping with. Just treat them as a tool for making you feel better.
Also, I suspect that people who have an intuitive aversion to mental health drugs are probably way overindexing on that intuition. I definitely did this for a long time, as did some friends I knew growing up. Turns out whatever your issues you can sometimes just deal with them sooner than later if you accept that doctors might be onto something. (Actually I think the reason people get stuck avoiding medication for so long is precisely that they feel like they're not allowed to be skeptical of them... which makes them kinda plant their feet in the ground and refuse to be open to it. That's kinda why I'm typing this long comment, to tell anyone reading that it is a reasonable thing to feel. And now that you know that maybe try them anyway..?)
The first thing I would do in case of depression is to make sure that the patient's energy levels are good and that mitochondria and other energy-related biochem phenomena work as expected.
I know first-hand that low energy-levels and lacking energy production mechanically lead to depression.
Also, look at how people (children also) experience the world and their relationships and their stresses when they are tired (or even just hungry) compared to when they are fit...
Fix those, and the depression might be gone.
This is not bashing against anti-depressants, they play their role to. But in some cases, energy-management is key.
Thank you for the comment. This is not in my area of expertise, so I hope you can clarify - how does one test that "mitochondria and other energy-related biochem phenomena work as expected"?
Chris Masterjohn is a noted quack. He takes bits of actual science and research and weaves them together into narratives that make it sound like he has everything figured out with his unique protocols, but it doesn’t hold up to actual scrutiny. People spend years following his ever changing protocols without getting anywhere (beyond placebo effect and a large bill for supplements)
I know I won’t convince the parent commenter but hopefully I can convince other readers not to go down this road or invest any money in anything related to him.
Pure ad hominem FUD. “This guy sometimes disagrees with scientists employed by the government, don’t listen to him!”.
The technical details are beyond my understanding but I’ve heard from a PhD in the field that Masterjohn’s understanding of metabolism is second to none. Whether his protocols work or not is certainly a case by case matter (like any health protocol), but he always appears to substantiate it with well-cited lines of argument, and is willing to engage with interlocutors.
As for spending years with changing protocols without getting anywhere besides spending lots of money, well that can be said for people with complex issues who go the institutionally approved route as well. It isn’t discrediting in its own right that a protocol didn’t work for some.
> A 2014 systematic review concluded that vitamin D supplementation does not reduce depressive symptoms overall but may have a moderate benefit for patients with clinically significant depression, though more high-quality studies were determined to be needed.
The meta-analysis cited in the article is from 2024 and specifically mentions the Shaffer et al. 2014 review cited by Wikipedia as being low quality:
> Some of the available reviews, owing to the limited number of trials and methodological biases, were of low quality (Anglin et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al., 2014).
Therefore what to do? I have seen these Hacker News vitamin D ads appear every few months for the past 15 years, or so. I always seem to have a vitamin D deficiency, so it reminds me to take supplements. I take them for a few months, hoping to see a change, but I don't feel any benefit. Then, I forget to take the supplements until the next time I see an ad. How to know if they're actually doing something useful?
Remember when HN had an entire year of articles about how we should all be on microdoses of various hallucinogenic and psychoactive substances for "peak performance"?
Good times.
HN is as bad at medicine as it is at everything else.
No, I was here just for the year in which they ended COVID with vitamin D. With the weekly (n=5) articles garnered with blog posts from randos swearing by it...
If you're not in the respective fields it can be pretty difficult to distinguish good from bad research. I am not able to do so.
If you (or your close ones) don't suffer from depression, then I guess it's best to ignore it until scientific consensus has formed. That will for sure show up on wikipedia. As far as I can see as a layperson there is a lot of correlation with Vitamin D that breaks down in interventions and Vitamin D is recommended mostly for babies and elderly people. On the other hand I see Vitamin D pushed as a miracle drug not unlike Vitamin C used to some decades ago and regular reports of overdosing of supplements leading to organ failure.
If you're suffering from depression, you should talk to your doctor. They will be able to help you to weigh potential benefits with risks
Can I just add: In addition to this, if you struggle with anxiety or have some sort of ADHD, then try cutting out caffeine entirely. Not just switching to "decaf" (which isn't), but cutting out tea and coffee, and switching to an alternative like Barleycup.
Doing this has had a massive positive effect for me, and combined with decent nutrition and daily exercise, has been wonderful.
Agreed, anyone that already struggles with something like this should quit caffeine. My life is so much better off of it, but I struggle to stay off of it because I'm addicted to the 2hr productivity boost vs the all-day steadiness when you're not on caffeine.
Things that improve for me were: No sense of urgency for every single thing. Significantly improved confidence. Word things better and speak better in general. No hard crash later in the day. All my scattered thoughts become cohesive. No more random heart palpitations.
All of these likely got better due to the overall effect of decreased anxiety and not making ADHD worse. I'm not myself when on caffeine. Nikola Tesla quit all caffeine/other stimulants for a reason.
The silly thing is that when I drank caffeine, the hit from it would make me overcreative. Yes, I might do more, but it probably wasn't what I was supposed to be doing - I'd pursue some new and exciting thing with tremendous fervour, before realising later that it was a load of nonsense.
Going to argue here, this is wildly bad advice. Decaf practically has no caffeine, it has 2-7 mg from what I can tell which is less then chocolate. 2-7mg is like impossible to notice and might aswell be water with how little there is.
My advice was along the lines of saying, in the 1950s, "give up all cigarettes, not just 'low tar'". Potential straw man here, but surely you wouldn't call that "wildly bad advice".
My comment was predicated on the belief that we wildly underestimate the negative effects of caffeine, as well as its activities at lower doses.
Downside with going completely off caffeine is you get so tired and unfocused and it lasts for ages.
I tried doing this for almost a full year, and while the improved sleep and generally improved mood was fantastic, and even toward the end it was so much harder to get any focused work done.
I think my average level of useful focus is just simply higher with caffeine. I was off it for three years, which is well beyond the time it would take to lose any tolerance, but never really reverted back to the same level of focus that I get with caffeine.
I'm not sure my overall focus over time is higher with caffeine, but it does allow me to nudge more of it into the useful part of my day. However I'm a fast metaboliser of caffeine, and it doesn't impact my sleep at all, so could be that there's a genetic component to one's experience here.
Some stimulants are a treatment for ADHD. Caffeine is not one of them, and whilst there are suggestions it can act as a short-term treatment for some people, it's not recommended.
I did the same thing and experienced the same effect.
I'd add that my ability to sleep naturally was negatively affected as side effect of medication. I tried a various combos to induce sleep and found the best solution to just be... exercise.
No caffeine, exercise, sleep lead to a significantly reduced anxiety and more.
I am in the middle of trying this out. When I first stopped caffeine I had better sleep and very vivid dreams every night. I also feel better as I think coffee was making my stomach too acidic which was causing me other indigestion problems, not to mention that coffee was nuking my teeth as well with acid.
Im on week 3 of no coffee now, I will maybe give it a month or two more to make a judgement call if I want to continue with coffee or not.
It is unfortunate as I really enjoy coffee, but it causes some issues for me with anxiety and stomach problems.
This is not true. Caffeine is not necessarily helpful for ADHD. It has a different mechanism of action from ADHD stimulants. They are not interchangeable. Not all stimulants help ADHD.
Also there’s a growing trend of diagnosing every focus problem as ADHD when many patients might have focus problems secondary to another condition like anxiety. It’s sadly all too common to find someone who believes they have ADHD due to TikTok self diagnosis or even a lazy doctor’s diagnosis but their core problem is actually anxiety. For these people, stimulants of any kind can actually worsen focus even if then provide a short term perception of helping due to the energy boost.
Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee.
I’m quite sensitive to caffeine, yet I can drink green tea all day without noticing much effect, while even a light coffee or a caffeine pill is clearly noticeable. I can also drink tea before going to sleep without any problems.
> Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee
You can absolutely get high doses of caffeine from tea if you really want to. It comes down to the type of tea, how much is used, and how strong it’s brewed.
There is nothing special about tea that breaks the rules of caffeine. It comes down to the content of the leaves, quantity, and extraction into water.
> while even a light coffee or a caffeine pill is clearly noticeable
Caffeine pills generally have really high dosages, FYI. Even light coffee drinkers can be caught off guard by how much caffeine is in a typical off the shelf caffeine pill.
> There is nothing special about tea that breaks the rules of caffeine.
There's definitely something special, just poorly studied: typical "how much caffeine is in X?" tables show tea having caffeine levels similar to coffee, but I never feel the same effects.
> Caffeine pills generally have really high dosages, FYI.
I use 200 mg tablets split into quarters for doses of 50–100 mg. Yet, they produce a much milder curve than coffee (which I no longer drink) and, as a side effect, cause no gastrointestinal side effects!
Quick search shows various infographics: green tea at 20–35 mg, black tea at 45–50 mg, espresso at 45–75 mg, and instant at 60-80 mg on average. The day I feel anything close from a cup of black tea to what I get from an instant coffee or a quarter of a pure caffeine pill, I might start trusting those numbers, but for now I see them as nonsense that tries to present as science.
There are also other ingredients in coffee and tea that may affect caffeine's effect (L-theanine in many teas for example). Same with energy drinks, these will have a different effect even when the same caffeine intake is the same due to presence of taurine.
i thought that the mechanism in green tea is that it has l-theanine that helps with caffeine jitters/spikes. a bunch of people drink coffee + theanine which gives a much calmer high.
I cut coffee for over 6 months, and one of the most significant thing it did for me is that, when I resumed, I noticed that caffeine actually helped me feel more awake and alert (while I didn't notice any effect when taking a lot of it before stopping cold-turkey)
Can you describe what else you tried? Other supplements? Any other non-food/supplement techniques like journaling, breathing, etc.? Any therapy and other similar human interventions?
After all those - is it / was it still the case that cutting caffeine drove the best outcome?
Not OP but I'll share my experience. For me, I have to quit caffeine for those to even become an option. Otherwise I get my short burst of productivity then everything shuts down after and I don't want to do a thing, everything feels "impossible" or like it doesn't matter at all.
Things like journaling / breathing / etc calm the nervous system while caffeine stimulates it. I would say caffeine is counterproductive to those practices.
I briefly quit caffeine once but it as well before any realization of anxiety. So, hard to extrapolate forward from that experience.
What feels different to me (compared to you) is this: sometimes I'll drink 2 cups of coffee in the morning and be awake but useless. Sometimes totally productive. Caffeine in some form is there - recently sometimes substituting coffee for a Celsius.
I am OP, and I can confirm exactly this line of thought. Once I had given up caffeine, I was able to start using methods like Pomodoro and Eisenhower grids, and they actually worked.
How long would you say it takes to feel the effects after switching? I did this a couple of years ago and as far as I remember the only real effect was my energy levels were more stable.
I gave it maybe 2-3 months and decided it's not worth it.
I think some of the positive effects are very quick (better sleep) whereas others take longer to materialise. My wife commented after maybe 2-3 years that I had become much more organised. I think that happened because I came off caffeine and then adapted over time to having a different brain chemistry, so I learned techniques to organise myself that I wouldn't have stuck to had I carried on consuming caffeine.
Very true! I recently found out that i am extremely sensitive to caffeine, and one cup at 6 pm makes me unable to fall asleep at night until 4 am. Trying to cut off the caffeine entirely now.
I wish I could cut down on my caffeine intake to help my ADHD. Unfortunately, I already have basically zero caffeine intake (apart from diet coke sometimes)
As someone from the Middle East, just thinking about not drinking coffee makes me lose my will to live. It’s like asking me to wear sunglasses on a cloudy night.
The quality of the coffee depends on the technique used (and who does it). Yes, most decaf coffees suck, but there are some very good you can find. For example, Arpeggio [1] is for me and few people I know the best of all Nespreso coffees. In specialized coffee bars you can get amazing decafs.
At this point, I mostly avoid prescribed medications and don't take very many things at all regularly. Mostly because I've had some of the worst interpretations of the side effects of most medications I've ever been on. These include hospitalizations and side effects I'm still dealing with years after (looking at you Trulicity/Ozempic)...
I'm usually able to reason or force my way through depression and the like, but have had a few deep bouts in my life. The medications have ranged from ineffective to building a tolerance quickly, to just plain worse than the symptoms being treated. Nothing like missing your highway exit multiple times back and forth because you get lost "in" the drive on medication, or having 140 browser tabs open and losing 5 hours of work time.
Everyone is different. I am amazed at how much western society has so many hormonal issues that come down to the lack of quality or appropriate fatty acid intake and a lack of something as simple as more outdoor/sun time. I think the "low fat/cholesterol" advice for most of the past half century combined with the increase in snacking and junk foods have been massive disservices to humanity as a whole. I wouldn't be surprised if some of the effects are multi-generational in the making either.
My physician prescribed Vitamins D and B12, so a quality Omega 3 is the only supplement I currently purchase.
After an absurd amount of trial and error with every over-the-counter, trendy supplement over the last couple of decades (and lord only knows how much money), these are the only ones that seem to make a subjective difference on my quality of life and an objective difference in my bloodwork.
can vouch for a diet high in fatty fish along with supplementation of D3 + cofactors (K2, A, magnesium, zinc, copper, boron). sample size of one but noticeably improves mood and energy levels.
recent evidence [0] suggests there's not much of a link between serotonin and depression, and therefore the effects of SSRIs are either placebo or an as of yet unexplained mechanism of action. IMHO it seems much more likely that modern lifestyles (excessive screen time, poor diet, lack of socialization, no connection to nature, no spirituality, etc) have more of an effect than serotonin levels.
> due to some quirk of evolution, Omega-3, -6, and -9 are the ones biological life uses most. As far as I can tell, there's no specific reason they're all multiples of 3. Probably just a coincidence.
This curio bothered me as well. I didn't yet get a fully satisfying explanation for this either.
It shows dependencies of the process onto several very specific molecular machines we call enzymes.
(main pathway, handling saturated fatty acids)
° Acyl CoA dehydrogenase -- removes 2 hydrogens from carbons immediately after the carboxylic head, forming a π-bond (double-bond) between the α-β carbons;
° Enoyl CoA hydratase -- adds water as H-OH to that α-β carbons π-bond;
° 3-hydroxyacyl CoA dehydrogenase -- converts the added -OH hydroxyl group to =O keto group;
° β-ketothiolase -- grabs the two keto groups, and snips off 2 carbons from the chain, carrying them off in bound form as a molecule of acyl-CoA;
(unsaturated side-branch)
° Dienoyl CoA reductase -- collapses two neighboring π-bonds into one;
° Enoyl CoA isomerase -- converts cis- to trans- variants, making them compatible with Enoyl CoA hydratase. Pathway continues from there.
These, when viewed as a set of combinators, seem perfectly sufficient to metabolize any fatty acid chain. Their chemistry reads pretty straightforward — and it must deal with cis/trans isomerism shenanigans, with neighboring π-bonds, with odd/even parity of the carbon chain. But it apparently handles all that!
Besides catalysis (combustion of the acids for energy), the two other paths for consumed fatty acids are excretion, and laying them into cell walls and membranes. These two paths aren't selective; they mostly don't care about the length of the chain, and where which π-bonds occur in it, if any.
So this must imply, that the "quirk of evolution" lives somewhere on the anabolic (synthesis/production) side of fatty acids; definitely not on the catabolic side.
I can only provide anecdotical evidence, which is ... not evidence, really.
Within my peer group of people on the spectrum (which very often comes with a depression, which is logical) we've discussed Vitamin D studies for years. And multiple of us decided to give it a try for a couple of months. And neither those who tried it INSTEAD of an SSRI, nor those that took both (SSRI + D) could report any measurable difference.
I have a theory on why is that: It is known that low levels of Vitamin D is one likely cause for depression - in Northern Europe, where during winter time people do not get enough sunlight, that correlates very clearly with the suffering of depression.
But potentially it simply does not work the other way round: I moved to near the equator, and I therefore basically have sunlight shining out of my butt, but still am depressed. It makes sense that in this case Vitamin D makes no difference at all.
In summary my theory would be: Vitamin D only has an effect on a depression that was caused by a lack of Vitamin D.
To many people without relevant expertise give medical advice online.
I remember a similar case with levelsio who was advocating people to take melatonin and discussing how much grams is good vs bad. When I said that people shouldn't take medical device from someone who was successful in building web apps, he blocked me.
And better than taking pills for the former, add hemp hearts or flax seeds to your cereal. One serving of hemp hearts has 10 grams of protein and 12 grams of Omegas 3 and 6. Flax seeds are lower in protein but an even better source of Omega 3 in particular.
Never going to advocate against eating whole foods if they taste good! But beware, the ALA omega 3 fat in flax and plant sources is not the DHA and EPA omega 3 fats used by animal cells, and so it's not as potent as what's in fish.
The main problem with ALA is that to have the good effects attributed to omega-3s, it must be converted by a limited supply of enzymes into EPA and DHA. As a result, only a small fraction of it has omega-3's effects — 10%–15%, maybe less. The remaining 85%–90% gets burned up as energy or metabolized in other ways. So in terms of omega-3 "power," a tablespoon of flaxseed oil is worth about 700 milligrams (mg) of EPA and DHA. That's still more than the 300 mg of EPA and DHA in many 1-gram fish oil capsules, but far less than what the 7 grams listed on the label might imply.
Also, beware of omega 6 fats. Seed oils (corn, soy, canola) used in commercial food products are incredibly omega 6 dominant in terms of polyunsaturated fat content. Consequently, the ratio of omega 3 to omega 6 fats we consume has plummeted as food production has industrialized. Omega 3 fats are precursors to generally anti-inflammatory signaling compounds, whereas omega 6 fats are precursors to pro-inflammatory signaling compounds. The bias in fat intake leads to more pro-inflammatory signaling in the body, and a lot of alt health types have alleged this is a major causative factor in the obesity epidemic.
This is important for depression, because chronic brain inflammation as a cause of depression was one of the going hypotheses at least a decade ago when I last looked into all of this. Upping omega 3 intake is an intervention that can address chronic inflammation, which is potentially why it improves some cases of depression.
Pretty much nobody in the west needs more omega 6s these days. I hear even farmed salmon eat primarily corn and soy based feeds these days, meaning their fat ratio is skewed much more heavily toward omega 6 than wild salmon and fish.
I'm not an expert, but I've done a bunch of reading on this previously, and also skimmed the article which also mentions some parts of this.
First, when taking omega 3 supplements, you generally care about increasing the ratio of omega 3 to omega 6. Hemp hearts have much more omega 6 than omega 3, so they're not very effective for improving the ratio.
Second, hemp hearts contain ALA, while what you generally want to improve is EPA and DHA (this is also covered in TFA). The body can convert ALA to EPA and DHA, but it's not efficient.
So all in all, if Omega 3 for the article's stated benefits is what you want, this is not the way. I recommend looking into eating more fish, or if you want a vegan route, algae-based supplements. [0] is a decent source from the NIH about foods and their Omega 3 content, split by ALA/EPA/DHA.
The ratio of Omega 6 to 3 needs to be below 4:1 to be a good source of Omega 3, and hemp hearts are at 3:1, so they're listed as a good source of Omega 3.
Flax seeds are even better just for Omega 3 at 1:3, but hemp hearts have other benefits, like more protein, which is why I called them out. That said, I eat a fair amount of flax seeds as well.
Just to reiterate, both of those (hemp hearts and flaxseed) only contain ALA, while what you're generally looking for is EPA and DHA. TFA also explicitly mentions it's only talking about EPA.
This is not to say that they're unhealthy of course.
EDIT: see the sibling comment by code_biologist, it's much more comprehensive than what I've written.
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial https://pubmed.ncbi.nlm.nih.gov/30541089/ "Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
So it might well be that general deficiency in Vitamin D is caused by the deficiency in magnesium status. This would also be an explanation why we see Vitamin D deficiency in sunny Africa: https://theconversation.com/think-vitamin-d-deficiency-is-no...
"Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being."
Anecdotally, I've been taking a 5,000 IU vitamin E supplement this winter. Seattle area, indoor desk job, I am a vampire. It does seem to help, I would rate it as going from a C to a B grade. I'd prefer not to use antidepressant medications to fix a problem that for me is mostly caused by living at a different latitude than I grew up in.
Do be aware that not all vitamin E supplements actually contain the dosage that they are labeled at, and that inclues both no-name brands and some big name brands. I'm having trouble finding a good reference on google due to AI and SEO pollution. But I recall Nature Made was labelled accurately and that is what I buy.
My wife on the other hand has struggled with life-long anxiety/depression even when living in Atlanta. For her a fairly low dose of lexapro enables her to live her life like a normal person. We wish we could get her mother to give it a shot for a few weeks, as she now can see a lot of similarities in both their personality traits that were affected by a life of untreated anxiety.
We also have cat that would probably have been put down for fear-biting of people and attacking our mild and mellow dog until we got his aggression under control with kitty prozac. I kid you not, it's a transdermal fluoxetine cream we put in his ear each day. Without the constant anxiety stimulus in the way, his real personality came through and he is actually very sweet. To me at least. Still bites my wife, but not hard anymore, just enough to keep her alert.
>caused by living at a different latitude than I grew up in.
or society in its current incarnation. its an underexpressed opinion that maybe depression is a justified reaction to ... life, as humans across a lot of earth in 2026.
The only problem here is that "going from an F to a C in mental health" is vastly different than "going from a C to an A." It's very well known and well documented that antidepressants have very little effect on mild depression compared to say, exercise, but that F grade of depression tends to be a different beast with different causes.
That's not to suggest that exercise etc isn't great, just that society has come a long way in destigmatizing mental health and just being like "oh just take fish oil" to someone dealing with that kind of depression, either through shitty genes or childhood trauma or whatever, can be really harmful.
Vitamin D toxicity is absolutely real, causes hypercalcemia, and can occur even at the 4,000 IU dose. I would really recommend you be getting regular bloodwork done if you go beyond that. Here’s a fun podcast on a case study. https://www.barbellmedicine.com/podcast/episodes/episode-381...
As a neurologist I cannot be persuaded. Their is a huge placebo and confounding component in the spectrum stress-depression. There are syndromes where AD drugs make wonders, literally saving lives, and others where they are useless. But taking 150000 IU of vitD per month definitely doesn't have the effects it promises.
You might want to take magnesium with Vitamin D, because taking vitamin D depletes magnesium. Not sure if it's strictly necessary, but if you're already low on magnesium it might be an issue. I once got tinnitus (which lasted a few months) when supplementing Vitamin D, the only explanation I've figured is that my magnesium was very low, which can cause tinnitus. Might be something else too, who knows.
One flaw in this analysis is that the source he cites for antidepressant effectiveness didn't include tranylcypromine (or any MAOI class drugs), which the STAR-D trial found was one of the most effective antidepressants.
(The STAR-D had a cumulative remission rate of 67%, I don't know how to convert that to the format he used)
Otherwise I agree that vit D and omega 3 are underrated for depression, it would be interesting to see if they have a cumulative effect with antidepressants.
Unlike the commenter, I didn’t suddenly turn into a chess grandmaster, but I did notice that my winter blues didn’t show up this year, the first time in a decade!
How many people have depression without vitamin D deficiency? And how many people have vitamin D deficiency, but no depression? Are there any studies about that?
For a single time fix (“rewire brain to be healthy again”) you need psychedelics (psilocybin has seen multiple studies where its effect is way better than psychopharmacological drugs). A single dose can make you healthy for a year to come, potentially also for life as you’re no longer a potential victim to it ever again.
I have seasonal affective disorder and was taking a medication that sort of helped, but was causing mood swings if taken even slightly out of rhythm, increased my blood pressure, and was just generally not that effective, but it was better than nothing. Last winter I switched to vitamin D (it was already uncovered in blood tests I had a deficiency, which is what turned me onto it - when I started taking it, I felt a lot better) and omega 3 and I won't go back. I wish someone had told me a decade ago, probably would have saved a lot of damage to my organs (another reason I got off of it)
This made me think of Pauling (https://en.wikipedia.org/wiki/Linus_Pauling) who was a famous scientist and big proponent of high-dosage C-vitamin. He claimed it could cure everything from a cold to heart disease and cancer. Later studies did though not find any benefit of high-dosage C-vitamin and that potentially had a higher risk of prostate cancer. Pauling died of prostate cancer.
Try NSAIDs. Depression is a set of emotions. Emotions affect the body. I thought to try NSAIDs to deal with the physical discomfort. That partially shutdown the feedback loop of mood -> body discomfort -> reinforcing mood.
There are studies that show this is an effective intervention.
I used to have very rough winters. Despite the fact that I ate well and was outside 2+ hours every day. I got my blood tested and I had very low vitamin D, two tiers below normal. This was the first winter being on Vitamin D, and my energy and hunger levels stayed normal. I never crashed or had extreme hunger or trouble sleeping.
Getting Vitamin D from food is a fools errand, and since sunscreen and protective clothing slow vitamin D from the sun drastically, it's in most people's best interest to get it tested.
You may consider that you have a dust mite allergy. If you have any of: chronic coughing, frequent sickness, eczema, or IBS then that is even more evidence this is your problem.
Vitamin D is toxic (and ultimately fatal) at high doses, which is why the 'suggested' dosages of between 400IU and 1000IU are so conservative. You may need more, but you should get a blood test.
THIS. And not just for Vitamin D. Not everyone absorbs / metabolizes / excretes vitamins or minerals in the same way. Learning whether or not you're an outlier can be done either the safe way, or the dangerous way.
I used to take a supplement with 10k vit D units. Made by a reputable company here in Europe.
I did a blood test for vit D metabolites (oh 25 or something). It turned out I was deficient.
The doc gave me 8k units as a prescription drug. In theory weaker. After 2 months I was no longer defiecient (kinda borderline). After 4 months the doc decided to go down to 4k iu.
Now I wonder why some experts are telling people to take 10k iu? Is it because the supplements are crap and contain 10% of what they claim? (I've been taking vit K as well)
I think the general idea is that the stats labs use to decide what is normal is not necessarily ideal, and like everything else will vary per person.
Too much Vitamin D3 can be toxic, so doctors are reluctant to tell you to go over published guidelines. but if you don't have other issues, and stick to what you can get OTC from a normal vitamin brand and follow the instructions, you're probably safe. There was a story a while ago about a woman who died from too much D3, but it turned out she was taking a whole bottle's worth every day for years.
Before you start taking crazy amounts (or any amount) of vitamin D just get a blood test. It's simple. As part of my insurance I can get a bunch of different blood tests, but I did have to pay about $50 extra to add the vitamin D test.
Based on the test I was just a tad under where I should be and so now I am taking 800 IU per day. I may stop in the summer when I get more sun.
I read somewhere that too much vitamin D has similar effects as too little (permanent hair loss, anemia, etc) but that may have just been on a blog similar to the linked blog on this submission.
(Note: my own real therapy is to do what is fun. That is, humour. This can occur via social interaction; it can also happen to some extent by studying human behaviour via ... youtube videos! There are some surstromming videos that are just epic display of human behaviour. If aliens ever arrive here, I'll show them the Top 3 videos there. Either they will laugh too - or flee from this strange planet.)
Several people in my family have a MTHFR gene mutation that screws stuff up, including causing problems with anxiety+depression. But a simple B12 shot every couple of weeks does wonders.
I’ve personally found meditation, exercise and healthy food intake are more effective for self regulation and coping with tough emotions over medication and supplements.
Each human being is unique, as is the recipe for sustained positive metal health.
I think it’s helpful to consider and experiment with different ideas and strategies.
I strongly disagree there is one single solution that can provide significant lift for a large population.
I was an RA at the RAND Corp who put together literature reviews for mental health interventions like this. The Vitamin D result is implausible. If true it would be the biggest breakthrough in the history of psychiatry.
The largest N study (N=18,353; more than half of the entire 31 study sample) included is https://jamanetwork.com/journals/jama/fullarticle/2768978, which found: "Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group...and the placebo group."
The highest dose study (100,000 IU/week) included is https://pubmed.ncbi.nlm.nih.gov/30532541/, which found: "...the treatment response or BDI scores did not differ significantly between groups."
The paper/supplementary materials doesn't include a simple table of the depression outcomes for the 31 included studies, which is a glaring omission.
I think someone just messed up here. Maybe missed a decimal place?
Chia is awesome for making pudding out of random liquids. I have to restrain myself from eating a batch of coconut milk cinnamon chia pudding in a single sitting.
A useful way to look at the effects of vitamin d and omega-3s: supplementation isn't really a hack, it's more that their removal is a handicapping of our "normal" state. Our evolutionary conditions would have been more rich in both of those things. Also see light exposure during the day, proximity to green space, etc.
I had sleeplessness that eventually led to depression and gastritis. I took medication for two years to recover. The root cause was a vitamin D deficiency my level was 8 ng/mL, which was far below the required range. There was a period when i was only able to sleep with medicines. Now coming back to normal life.
I would add that the issue with Omega-3, is the imbalance between Omega-3 and Omega-6. It turns out that many of the food products have been manufactured with Omega-6 rich oils and that is causing some issues.
One can ingest Omega-3 supplements, try to eat foods rich on that fatty acid or reduce foods with lots of Omega-6 in order to restore that balance.
These are always tricky, vitamin D deficiency and low fat diets clearly cause depressive symptoms.
Does that mean vitamin D treats depression in general?
When most people talk of depression they aren't even using talking about major depression.
We live in a world that in many ways is comfortable but crushing. Is that depression? Or just harmful levels of understandable unhappiness? Are they different?
Before anyone goes out and overdoses on Vitamn D (since lots of multiple vitamin include too much), see this article on toxicity from too much Vitamin D
Juxtaposing with the quoted passage from the post: “Because vitamin D is potentially toxic, intake of [1000 IU/day] has been avoided even though the weight of evidence shows that the currently accepted [limit] of [2000 IU/day] is too low by at least 5-fold.” --https://www.sciencedirect.com/science/article/pii/S000291652...
It cites a study about vitamin D toxicity where the range of cumulative intake causing it was identified to be 2.2 million - 6.3 million IU. When you take 6000 IU daily for a whole year you only reach the lower end of that range, and you definitely shouldn't do that without checking your levels somewhere in between. Taking it for a few months may get you above the recommended blood levels, but is very unlikely to cause issues unless you started with very high levels already (which you most likely did not).
Toxic levels of vitamin D can be life threatening, so do keep your levels in check, but you won't get there unless you really try, so if you can't get out of the bed to have your blood tested just start taking it and check it after 3 months when things get hopefully easier for you. Just make sure to get the number of zeros in the dose right.
Hey OP, kudos for being so engaged in the discussion + making edits and not just firing the link off and then going AFK. Makes the comments more interesting and (I think) the actual work better.
> So why are all the official sources still so paranoid about Vitamin D
It is fat soluble vitamin, together with A, E and K. That in itself makes in more risky in terms of overdose. I didn't hear of any cases outside kids eating jars of vitamin gummies but it does happen.
Precision Medicine is the way, and maybe we will get there one day Too many effective agents are averaged away because the population for whom it is effective is just a subset of the population with the targeted symptom.
I would take these articles about vitamin D with a grain of salt, there is a big vitamin D supplement and testing market and most of the studies about the miracles of it are dubious at best
Please talk to a doctor if you're curious about this instead of following this advice. Megadosing vitamins and supplements comes with risks not addressed by the author.
I eat so much vitamin d and omega 3 i should be shitting fish shitting sunshine... and yet, cold baltic winters with only a few hours of sun still make me depressed.
> Zolpidem (“Ambien”) has effect size around 0.39 for getting you to sleep faster. Ibuprofen (“Advil”, “Motrin”) has effect sizes between from about 0.20 (for surgical pain) to 0.42 (for arthritis). All of these are around the 0.30 effect size of antidepressants.
...
> Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875.
As for why, read his essay I guess. But I wouldn't take at face value the interpretation of effect sizes in the original article.
(I also couldn't say why the effect size of vit D and Omega-3's is so large, although per Scott Alexander's article if fewer people drop out of the treatment group, that should increase the effect size, so maybe the relative tolerability of the treatments is part of the story?)
> The twisted kink is caused by the hydrogens being on opposite sides, hence "trans". (And yes, if they're on the same side it's "cis". Latin was a mistake.)
can only say, if you have depression or mental problems: NIACIN. not the niconinamid or whatever which is a scam.
do not drink alco or smoke! kidneys will suffer.
The article even states that nothing here is written in certainty. It’s just pure speculation. No, fish oil and vitamin D do not have a larger effect than SSRIs for depression.
Not to say they don’t help, but it’s asinine to state that nutrients are a replacement for selective serotonin reuptake inhibitors, whose sole purpose is to help with depression, and has been designed by an army of scientists, researchers, psychologists, psychiatrists.
To add another data point: 4,000 IU (two Kirkland capsules) daily keeps my Vitamin D levels at the high end of the reference range. I also take six Kirkland fish oil capsules which happens to hit the 1,500 mg DHA+EPA target suggested in the article.
Honestly, Costco supplements are hard to beat since they're both USP certified and are usually the cheapest.
Here you go HN commenters. Last month when I made the observation that "from what I've read recently, I've started to get the impression that the explosion in mental health problems (depression, autism rates etc) has more to do with the western diet than genetics"[0]
Y'all called me MAHA and down voted me into the negatives. Please, insult your own analytical ability by doing the same here. This time I'll just revel in your ideologically confined science denial this time.
A study proposing that diet can affect the expression or severity of some autism-related behaviours is not the same thing as claiming “80% of what people consider autism is actually just the western diet's effect on normal brain chemistry."
Except depression rates are rising at similar or worse levels in other places too, including sunnier/tropical regions and the ones with "better" diets.
The main instigator of depression is still societal as the postmodern era is pushing everyone into seclusion and addicting them to constant individualized dopamine hits, increasing the miserable effect on one's chronic mood and exacerbating one's self-consciousness about it.
I started back on Vitamin-D and Omega-3 (with extra EPA & DHA) about 2 months ago or so. Sadly, I don't feel much of a difference, but I believe the potential harms are quite minimal, so I am going to maintain supplementation for the purposes of self-experimentation.
It took me more than 3 months to get to the lower edge of the desired range with my blood level on about 8000 UI daily. There was no instant improvement, it takes time.
then it would suggest why depression gets worse in colder and less sunny part of the year. That even has its own name - Seasonal Affective Disorder (SAD).
Over the last few months, I’ve increasingly come to believe that depression is not caused by a chemical imbalance. After trying ten different antidepressants with no success, I found far greater improvement by changing my patterns of thinking.
The amount of people in this thread rejecting behavioral health as a legitimate science/field and calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense. Very sad to see.
> "calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense."
That's not what I was doing in my other comments that you replied to. If you have a knot, and imagine all the possible things you can do with your hands and body and tools in the universe and notice that to a first approximation none of them will untie the knot. Not hitting it with a spoon, not stroking your chin, not jazz hands, way more than 99.999% of possible movements will not untie it. Some of the things which won't work also include pulling yourself up by your bootstraps, "not being weak", "toughing it out". "just get over it". All those are no more effective than any other of the 99.999...% of things which won't work.
The things which will work are in a tiny space of things involving fingernails, needles, knot-eye-hand-feedback-loop and some understanding of rope and tangles. Or fire.
Just because fire will have a useful effect doesn't mean the knot is caused by an imbalance of fire and so you should keep burning your fingers for the rest of your life as "the cure" for knots. The way to untangle a knot is to develop the focused, pointed, targeted skills of untangling knots. And (I argue) the way to untangle negative thoughts is not by powering through them, toughing them out, positive mental attitude, fortitude, being strong, manifestation, dreaming big, just getting over it, or crowbarring your mood up with sledgehammer drugs to an 80-billion neuron network for the rest of your life, or anything else of the millions of other concepts one could do or imagine doing - except the focused, pointed, feedback-loop skills of untangling negative thoughts wielded by a particularly good therapist or by yourself.
Whether you develop such a thing by therapy training, meditation, prayer, Stoicism, biofeedback systems, luck, intuition... I suspect there are multiple ways which are effective that can be developed through multiple approaches, but not many. And "I tried thinking my bad thoughts away and it didn't work so it must be genetic" is not one of them.
Your body makes Vitamin D when in sunlight. Could it be that sunlight - and the whole being outdoors situation - is the thing that helps rather than vitamin d levels?
There's a research that winter sunlight in northern latitudes just does not convert precursors to vitamin D. Even when it's shining, no matter how long you are outside.
Interesting point, there is at least one theory out there which says that neither sunlight nor Vitamin D is necessary if an individual is really healthy. The ones that feel better on the Sun and/or Vitamin D are people who are at least mildly unhealthy and it's of form of addiction where the individual ought to keep taking something to just not feel miserable.
Vitamin D and Omega-3 are the two supplements that consistently appear to be super powerful in small studies and then fail to do anything significant at all in larger studies.
Pause for a moment and consider the mere plausibility of the claims in the first few paragraphs: The effect size for antidepressants is 0.4, but the effect size for Vitamin D is 1.8? Are we to believe that Vitamin D supplements have an effect size 4.5X larger than antidepressant drugs, and nobody noticed this massive discrepancy until now?
Effect size is also a favorite metric in this vein of supplement-over-pharma writing because it’s so commonly misunderstood and it’s so easy to find small supplement studies that have outlier effect sizes.
To put it in context, even common OTC pain meds can have effect sizes lower than 0.4 depending on the study. Have you ever taken Tylenol or Ibuprofen and had a headache or other pain reduced? Well you’ve experience what a drug with a small effect size on paper can do for you.
Please be very careful when someone tries to tell you that supplements are miraculous and pharmaceutical drugs don’t work at all. I know too many people who delayed trialing SSRIs for years due to internet driven fears and lost many years of their lives to depression based on content like this. People with cabinets full of dozens of supplement bottles that were chosen based on studies, too. Then they finally decided to try real antidepressant medications and wished they’d done it sooner.
As much as I wish we could all just cure depression by taking a simple Vitamin D supplement that has 4.5X higher effect size than antidepressant drugs, this claim just isn’t passable.
Anecdotally, Vitamin D and B12 had more of a positive effect on my mental health than therapy or any of the half dozen prescription meds I tried.
Hiking has the biggest effect though.
I think maybe the problem is that therapists are diagnosing people, and psychiatrists are prescribing pills based on those diagnoses, but neither are ordering bloodwork to check for deficiencies. Which leads to a lot of people suffering from lack of basic health, and treating the symptoms with SSRIs that have withdrawl symptoms a million times worse than most of the problems they treat.
Now to your point, I seriously doubt that vitamin D will hold up against anti-depressants and therapy if we control for other health and quality of life issues. I just think there is a ton of misdiagnosis, and lack of root cause analysis in the mental health field, and health care in general.
> Hiking has the biggest effect though.
Keeping the mind busy with beautiful things and being physically exhausted can heal a lot of things.
Its like surfing on a big day - you are just too tired to be depressive afterwards. It feels like a weight blanket.
It's also endorphins. Natural drugs.
I don't have the energy to do all that when I'm down though. I hate all sports though I do like hiking (there's no team or competitive bullshit) but I'm too clumsy for it.
> Hiking has the biggest effect though.
I remember reading that pine trees give off a chemical that is a natural human bronchodilator.
One thought of why people love hiking, especially in piney woods, is that the chemical allows humans to process more oxygen which in turn helps them feel more "energized".
I point this out for two reasons:
1. It's a fascinating bit of trivie
2. It highlights that there are MANY confounding variables so it will always be tough to figure out the isolated impact.
I bought an E-Bike two years ago and it’s changed my life. I want to ride my bike all the time, and am counting down the days to spring. During the warmer months I run all the errands I possibly can with my bike instead of driving, and ride for pleasure often, going on multi hour bike rides. It’s just such a blissful feeling, and as I’ve gotten more fit I’ve been able to turn down the bike assist and built a lot of leg muscles.
I do understand there are many things that can make it infeasable to bike during winter, but if you miss your bike absolutely give it a try! I bike year around in Norway. Studded tires help tons, and that the city maintains the bike infrastructure during winter.
Getting an e-bike has got me out getting exercise way more than a regular bike ever did. Being able to dial my effort up and down pushes me further, quite literally in distance and fitness goals. I'm by no means fit and almost did a 5 hour 40 mile ride one day. I completely used up the battery in that time, my legs were cooked from the effort. I would have never attempted something like that on a regular bike unless I was fit.
Are you riding on roads or trails? How are you treated by other road users? I'm tempted by ebikes but live in semi-rural UK with very poor (and getting worse) road surface and lots of blind bends.
I largely ride on paved bike trails that are wholly separate from the roads, or suburban residential roads that have a Swiss cheese of bike trails interconnecting via parks. It’s never the fastest way, but there’s almost always a “safe way” to bike somewhere, due to a lot of effort by our city council. I’m more avoidant of the major roads, an elderly man was extremely close to me and my kid in her bike trailer when he made a right turn, I think I’d be more cautious if I didn’t have so many accessible ways to bike separate from the roads.
Oddly a lot of the “guys with road bikes wearing full gear” seem to just ride on the road anyway. I have no idea why, I’ve double checked the laws and I’m allowed to ride there.
I go on regular long walks and it is a huge help.
A few months ago I tried walking with a weighted vest, and my body and brain got completely shocked in a really good way. Wakes up everything. So that is in my mix now.
Walking with 20 then 40 lbs was a lot easier than I expected, and the results were much greater.
I will say that my LMHNP ordered a blood test for me during my ADHD evaluation. I live in the Pacific Northwest and had a serious vitamin D deficiency, apparently like everyone else who doesn’t supplement. also got me started monitoring my blood pressure.
I can definitely tell that the Adderall I was prescribed had an immediate, huge benefit. Not sure about the vitamin D.
But I really appreciated that he took a wide angle look at my health.
> Vitamin D and Omega-3 are the two supplements that consistently appear to be super powerful in small studies and then fail to do anything significant at all in larger studies.
That statement is broadly true for most outcomes studied, but specifically for depression the larger study results are pretty mixed.
VITAL (the heavily cited metastudy) shows no effect. https://pubmed.ncbi.nlm.nih.gov/32749491/
But there are other large metastudies like this one for Vit D (https://pubmed.ncbi.nlm.nih.gov/39552387/) and this one for Omega 3 (https://pubmed.ncbi.nlm.nih.gov/31383846/) that do show robust moderate effects.
I'm surprised that metastudies are inconsistent. Vit D and O-3 probably do have a large effect in a deficient populace (so, like, Seattle or landlocked areas respectively). Metastudies should be good at mitigating that (but I guess you can choose the studies that coincide with the outcome you want).
Either way, the conclusion to this whole debate is incredibly simple: get a blood panel done and go from there - it might not even be one of these that ails you.
> The effect size for antidepressants is 0.4
What the article states, then fails to take into account, is that is the mean effect size, and there is huge variation.
Anti-depressants are notorious for producing different effects for different people.
What that high variance means in practice, is for any anti-depressant, the people who get good results are getting a much higher effect than 0.4. And the other people move on to try something else.
So to keep comparing 0.4 directly to the effect of Vitamin D and Omega-3 directly is very misleading.
I believe presenting vitamin D supplements as effective in treating depression is kinda misleading. It's rather vitamin D deficiency that is super effective at making you miserable, but it's not the only thing that can do it to you. And since a lot of us are in fact deficient (and the threshold of being categorized as deficient may be placed too low too), it will appear as being quite effective overall, especially compared to other drugs that act on less common and poorly understood causes.
Thank you. Fixing a vitamin deficiency is an obvious benefit to physical health. But does it "cure depression"? To the extent that your depression was caused by vitamin deficiency, sure. But then didn't you just cure a vitamin deficiency? I'm sure a lot of things starting improving once your body starts getting proper nutrients after years of neglect! That doesn't indicate causality.
As far as we can tell, "depression" is a label we put onto a big bag of issues with similar symptoms, but that may require different interventions. Vitamin D deficiency may very well be or lead to one of those, and it definitely doesn't help when coexisting with something else either.
Hi, author of the blog post here! Thank you for writing in with your concerns. First:
> Please be very careful when someone tries to tell you that supplements are miraculous and pharmaceutical drugs don’t work at all.
I'll concede I unintentionally gave the tone that one should replace antidepressants with supplements, even though the conclusion specifically writes: "(Don't quit your existing antidepressants if they're net-positive for you!) you may also want to ask your doctor about Amitriptyline, or those other best-effect-size antidepressants."
I have now edited the intro to more explicitly say "you can take these supplements alongside traditional antidepressants! You can stack interventions!"
===
> and nobody noticed this massive discrepancy until now?
Researchers have noticed it for 13 years! From the linked Ghaemi et al 2024 meta-analysis ( https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ):
> Several meta-analyses of epidemiological studies have suggested a positive relationship between vitamin D deficiency and risk of developing depression (Anglin et al., 2013; Ju, Lee, & Jeong, 2013).
> Although some review studies have presented suggestions of a beneficial effect of vitamin D supplementation on depressive symptoms (Anglin et al., 2013; Cheng, Huang, & Huang, 2020; Mikola et al., 2023; Shaffer et al., 2014; Xie et al., 2022), none of these reviews have examined the potential dose-dependent effects of vitamin D supplementation on depressive symptoms to determine the optimum dose of intervention. Some of the available reviews, owing to the limited number of trials and methodological biases, were of low quality (Anglin et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al., 2014). Considering these uncertainties, we aimed to fill this gap by conducting a systematic review and dose–response meta-analysis of randomized control trials (RCTs) to determine the optimum dose and shape of the effects of vitamin D supplementation on depression and anxiety symptoms in adults regardless of their health status.
===
> even common OTC pain meds can have effect sizes lower than 0.4 depending on the study. Have you ever taken Tylenol or Ibuprofen and had a headache or other pain reduced? Well you’ve experience what a drug with a small effect size on paper can do for you.
I must push back: that's an effect of 0.4 plus placebo effect and time.
There's now RCTs of open-label placebos (where subjects are told it's placebo), which show even open-label placebos are still powerful for pain management. So, I stand by 0.4 being a small effect; even if you took a placebo you know to be placebo, you'd feel a noticeable reduction in pain/headache.
EDIT: Here's a systematic review of Open-Label Placebos, published in Nature in 2021: https://www.nature.com/articles/s41598-021-83148-6.pdf
> We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%) of OLP.
In other words, if the effect on antidepressants vs placebo is ~0.4, and the effect of a placebo vs no placebo (just time) is ~0.7, that means the majority of the effect of antidepressants & OTC pain meds is due to placebo.
(I don't mean this in an insulting way; the fact that placebo alone has a "large" effect is a big deal, still under-valued, and means something important for how mood/cognition can directly impact physical health!)
> Researchers have noticed it for 13 years! From the linked Ghaemi et al 2024 meta-analysis
You’re cherry picking papers. Others have already shared other studies showing no significant effects of Vitamin D intervention.
For any popular supplement you can find someone publishing papers with miraculous results, showing huge effect sizes and significant outcomes. This has been going on for decades.
With Omega-3s the larger the trial size, the smaller the outcome. The largest trials have shown very little to no detectable effect.
I think a lot of people are skeptical about pharmaceuticals because they see the profit motive, but they let their guard down when researchers and supplement pushers who have their own motives start pushing flawed studies and cherry picked results.
> In other words, if the effect on antidepressants vs placebo is ~0.4, and the effect of a placebo vs no placebo (just time) is ~0.7, that means the majority of the effect of antidepressants & OTC pain meds is due to placebo.
You keep getting closer to understanding why these effect size studies are so popular with alternative medicine and supplement sellers: They’re so easy to misinterpret or to take out of context.
According your numbers, taking Tylenol would be worse than placebo alone! 0.4 vs 0.7
Does this make any sense to you? It should make you pause and think that maybe this is more complicated than picking singular numbers and comparing them.
In this domain of cherry picking studies and comparing effect sizes, you’ve reached a conclusion where Vitamin D is far and away more effective than anything, placebo is better than OTC pain medicines, and OTC pain meds are worse than placebo.
It’s time for a reality check that maybe this methodology isn’t actually representative of reality. You’re writing at length as if these studies you picked are definitive and your numeric comparisons tell the whole story, but I don’t think you’ve stopped to consider if this is even realistic.
> You’re cherry picking papers.
I just picked the most recent meta-analysis I could find, which also specifically estimates the dose-response curve. (Since averaging the effect at 400 IU and 4000 IU doesn't make sense.)
> Others have already shared other studies showing no significant effects of Vitamin D intervention.
Yes, and the Ghaemi et al 2024 meta-analysis addresses the methodological problems in those earlier meta-analyses. (For example, they average the effects at vastly varying doses from 400 IU and 4000 IU)
> According your numbers, taking Tylenol would be worse than placebo alone! 0.4 vs 0.7
No, I understand this fine. Taking Tylenol would give you active medication + placebo + time, which is 0.4 + 0.7 + X > *1.1.* Taking open-label placebo is just placebo + time = *0.7* + X.
(Edit: Also, these aren't "my" numbers. They're from a major peer-reviewed study published in Nature, the highest-impact journal. I don't like "hey look at the credentials here", but I bring it up to note I'm not anti-science, see below paragraph)
===
Stepping back, I suspect the broader concern you have is you (correctly!) see that supplement/nutrition research is sketchy & full of grifters. And at the current moment, it seems to play into the hands of anti-establishment anti-science types. I agree, and I'll try to edit the tone of the article to avoid that.
That said, there still is some good science (among the crap), and I think the better evidence is accumulating (at least for Vitamin D) that it's on par with traditional antidepressants, possibly more. I agree that much larger trials are required.
> They're from a major peer-reviewed study published in Nature, the highest-impact journal.
No, the domain name is nature.com because it's in a Nature Publishing Group journal, Scientific Reports, which is their least prestigious journal.
It's a common mistake, and they do that on purpose, of course, to leverage the Nature brand.
It's also a mistake that implies a complete lack of familiarity with scientific publishing, unfortunately, which makes it a bit difficult to take your judgements regarding plausibility very seriously.
> It's also a mistake that implies a complete lack of familiarity with scientific publishing, unfortunately, which makes it a bit difficult to take your judgements regarding plausibility very seriously.
It's still peer reviewed, and as the sibling comment said, more applicable to this type of research. Also you now went from raising understandable objections to refusing the argument because it comes from a specific journal, which doesn't sound very scientific to me
You're right it isn't fair to reject someone's scientific argument just because they seem unfamiliar with how professional science works.
We shouldn't have believed the study more if it actually had been in Nature.
I don't think that's what I was saying, though.
The issue in this thread was about taking a step back and looking at the overall plausibility of the conclusions, taking together multiple studies.
I agree with the GP that the argument doesn't really pass the smell test.
That's still the main issue, and it is something that people who don't understand scientific publishing struggle understanding/doing, because they lack the intuition for how certain results came about.
It’s less prestigious because it doesn’t judge papers on novelty, only on technical accuracy. For incremental research like this, it is an appropriate choice. The lower prestige has no bearing on the accuracy of their findings.
Hello, there is another study that might be relevant to you
https://pubmed.ncbi.nlm.nih.gov/28768407/
> A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered
> ... This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter.
Thank you! I'll give this a read.
the larger the trial size, the smaller the outcome
I find this a bit surprising. Could there be something else affecting the accuracy of larger trials? Perhaps they are not as careful, or cutting corners somewhere?
Maybe. Those could be the case. But ignoring all confounding factors, this phenomenon is possible with numerical experiments alone. One of the meanings of "the Law of Small Numbers".
Basically, the possibility that the small study was underpowered, and just lucky...then the large studies with more power are closer to the truth. https://en.wikipedia.org/wiki/Faulty_generalization
Sure, could be just lucky. But if there are several successful small studies, and several unsuccessful large ones (no idea if this is the case here), we should probably look for a better explanation.
It does not require more explanation: publication bias means null results aren't in the literature; do enough small low quality trials and you'll find a big effect sooner or later.
Then the supposed big effect attracts attention and ultimately properly designed studies which show no effect.
No, the other way around. It's the combination of two well known effects. Well, three if you're uncharitable.
1. Small studies are more likely to give anomalous results by chance. If I pick three people at random, it's not that surprising if I happened to get three women. It would be a lot different if I sampled 1,000 people.
2. Studies that show any positive result tend to get published, and ones that don't tend to get binned.
Put those together, and you see a lot of tiny studies with small positive results. When you do a proper study, the effect goes away. Exactly as you would expect.
The less charitable effect is "they made it up". It happens.
Just my hypothesis, but I wonder if larger sample sizes provide a more diverse population.
A study with 1000 individuals is likely a poor representation of a species of 8.2 billion. I understand that studies try to their best to use a diverse population, but I often question how successful many studies are at this endeavor.
use a diverse population
If that's the case, we should question whether different homogeneous population groups respond differently to the substance under test. After all, we don't want to know the "average temperature of patients in a hospital", do we?
> If that's the case, we should question whether different homogeneous population groups respond differently to the substance under test.
In terms of psychological treatments, I am honestly in support of this. Many mental illnesses can have a cultural component to them.
> After all, we don't want to know the "average temperature of patients in a hospital", do we?
No, I don't think we do. Am I understanding you correctly?
A point I think is crucial to mention is that “effect size” is just standardized mean difference.
If a minority of patients benefit hugely and most get no benefit, then you get a modest effect size.
This is probably why this discussion always has a lot of people saying “yeah, it didn’t help me at all” and a few saying “it changed my life.”
I believe we should be focusing on more relevant statistical methods for assessing this hypothesis formally. Basically, using mean differences is GIGO if you assume you’re comparing a bimodal or highly skewed distribution to a bell curve.
That's an odd argument. If we are talking about a organ safe uncombined dosage of Tylenol or Ibuprofen being 0.4 then I think we are talking about the point just above placebo and bias where something barely has a real effect that should be hard to measure without a high power study. That's saying nothing useful with so few significant figures.
If antidepressants cost less than $4/1000 and acted as an antiinflammatory as their only common side effect then sure I'd consider replacing Ibuprofen as my pain placebo of choice.
> nobody noticed this massive discrepancy until now?
People constantly say you should do three things if you are depressed. Go outside (vitamin D), exercise and socialize.
Often times exercising occurs outside as well.
Because it's common to hate on antidepressants, I've always personally had a bias against them.
For the past 15-20 years, november thru february are basically a writeoff due for me due to seasonal affective disorder. Cold showers, exercise, no alcohol, strict sleeping rituals. Vitamin d. I can still sleep 11 hours and feel like reheated cat shit.
Enter citalopram. "It will take up to six weeks to dial in" they said. Within four days I felt like the inside of my head was designed by Apple in their glory days. My mind became an orderly, well lit, tastefully designed space... instead of a dimly lit crack den. I'm more emotionally available, no longer tired, less cranky. I felt cozy. I could cry with joy because I could finally understand emotionally why people like the Christmas season.
I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.
This just goes to show that for me, they're extremely effective.
The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists. Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. Most of the time however, it's more of a "here, take these indefinitely".
It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.
Luckily, sertraline was an almost instant cure.
I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.
The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?
I'm not an expert so maybe someone else can clarify further, but in relation to sleep medications I've heard that they should not be used for more than two weeks, or they can permanently fuck up your sleep cycle.
They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.
At least that's how it was a while ago. Maybe the situation has improved.
I used ambien for sleep and provigil for mindfullness (the go/no go packets) during long deployments in the military and it took me years to get back to anything normal after leaving the Army. These are very powerful medications.
> At least that's how it was a while ago. Maybe the situation has improved.
Fortunately it has. Orexin antagonists don't cause dependency and provide high-quality ("natural") sleep.
Bit off-topic, but melatonin taken at right doses appears to work very well. (commonly prescribed doses are 10-30x too much and likely cause tolerance). See the post https://slatestarcodex.com/2018/07/10/melatonin-much-more-th...
I’ve heard this before that common doses are unnecessarily high but why is that? Patents?
Rather, lack of. Melatonin is over-the-counter, generic, badly understood by the people taking it and dosed according to personal preference which means marketing it is all abouy big numbers. Bigger number on package = more sales.
The help aiding sleep is only one function for melatonin. The reason for higher suggested doses is due to its anti-oxident function. From personal experience melatonin needs to be paired with vitamin e to really clear out over night. I take vitamin e as I get into bed right before I take a melatonin sublingual. Another benefit of melatonin is that it upregulates our insulin receptors.
They’re considered dietary supplements and not medicine, so they’re not meaningfully regulated in the way meds are.
> why is that
Why buy 1mg pill when you can buy 100mg pill?
Even funnier is that often 0.25mg or 0.5mg is closer to the correct dose, and those sizes tend to be hard to find.
There actually is a condition that calls for extremely high (100mg+ doses), but it is a very rare thing, no one should ever consider that much without instruction from a doctor. But you'll find it right next to the normal <=5mg doses without any explanation.
The Natrol liquid isn't usually too hard to track down. They advertise it as 1 mg or 2.5 mg, but it's the same stuff, the bottle just direct you to take 4 or 10 mL respectively.
So 1ml (20 drops) would yeild an average dose of .25mg in that form.
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.
> 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.
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.
>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.
> Some cancerous tumors produce this hormone; therefore, elevated levels measured when the patient is not pregnant may lead to a diagnosis of cancer and, if high enough, of paraneoplastic syndromes. It is unknown however whether this production is a contributing cause or an effect of carcinogenesis.
Interesting.
Well, I don't think you'll be able to avoid testicle atrophy even if it minimizes it, but the important part is understanding the tradeoff. Particularly, that adding testosterone will cause changes throughout your entire body (including, for example, shortening life expectancy a bit), and that adding other hormones to the mix will likewise cause changes around the entire body and not just one single process or organ.
But it's your body, your life, your priorities and decision. I also wouldn't consider it a good decision health-wise to take steroids to get huge, but I have no problem with someone deciding that absurd bulk is their main goal in life and worth the tradeoff.
>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.
> Insulin for example is the opposite.
You're describing entirely orthogonal issues. In case of insulin resistance, your natural production is running full blast with demand exceeding supply because the consumer stopped caring about the hormone. In case of autoimmune disease, the natural production was killed - you can neither use nor lose what is already dead, and even if some capacity was left it will either soon be killed or atrophy under external insulin, but it will not be mourned.
So no I would say it is exactly the same - "use it or lose it" - but that does not mean that there is never a reason to manually overrule your body's attempt at homeostasis through direct manipulation. It just means that there is a very significant consequence to the process.
> 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.
As a somewhat sidenote, this is also why I dislike the idea of trying to classify people into "normal" and "divergent/atypical". In my eyes we're all normal people and an entirely normal aspect of being a human is that we all differ and have individually specific needs by virtue of being built by a trillion micro-meter sized workers, each with their own hand-copied version of the blueprint, only caring about the millimeter of you in their immediate vincinity and not really talking to any of the others.
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".
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/
Explain the no glasses part to me? I read the study you linked but in there they used opaque glasses.
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.
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".
I'm not telling it's a matter of perspective, my point is that I see no objective metrics to tell apart if the situation is bad so it's one expected to be depressed and when the situation is good (so only medication / therapy would help). And it makes discussions around this topic harder.
If its not just a matter of perspective and only medication can help, etc, then why do we call depression a "psychological" or "mental health" concern? Why isn't it just considered a neurological disease?
Not sure what your point is, many mental health concerns are caused by neurological diseases.
In case of depression in particular, it appears to be a label given to a big bag of various issues you may have causing similar symptoms.
Depression is increasingly starting to be seen as a neurobiological disorder as we learn more.
In my own opinion, we need to stop viewing "mental health" as a separate class of conditions from general/physical health. A mental illness is a health/medical condition just like any other and shifting our views and diagnostic criteria in that direction would do a lot to remove the stigma associated with mental illness.
Someone with depression has a chronic illness, not a temporary "it's just in your head" condition.
> I feel completely empty and find no joy in things.
Maybe the idea that we should find joy and feel full is wrong?
We are on a random planet circling a random star in an unfathomable Universe.
STOP looking for meaning and you are liberated. The quest for meaning by itself might be exhausting and makes you feel depressed.
Who said I'm looking for meaning? I'm not.
It's not as liberating as you might think. A joyless existence is either suffering or nothingness. A life without meaning, either internal or external, is one where nothing is meaningful with no motivation thus one of crippling catatonia til death.
All I can say is just that it doesn't feel good and if you can't feel good about anything, your calculus of your life inevitably leads to the conclusion that existence isn't worth it.
There is only one cure/hack for Nihilism or similar...
Go somewhere where you need to work physically you az off to afford daily food. You will be so exhausted eventually that: 1 you will not have any energy left for thoughts. 2 If you have any energy left, you will give it to angriness which will lead to other circumstances which are none related to find the meaning of life.
Ignorance may lead to happiness and friends :)
I think a lot of people are conflating depression with "bad thoughts". That's just one possible symptom, usually as a result of a combination of both anxiety and depression.
I didn't have anxiety, just depression. I rarely thought. I existed on autopilot. I was physically exhausted on a daily basis as a division 1 athlete in college. Often went days without eating either because I simply forgot to eat or forgot to make time for it between classes and training. Didn't change anything.
I think something people are forgetting is that motivation is either driving you toward something you want or driving you away from things you specifically don't want. A complete lack of motivation means I wasn't motivated to do anything to get something, but also I wasn't motivated to anything to avoid something either. I wasn't motivated to eat to avoid hunger pangs. I wasn't motivated to quit my sport to avoid routine physical exhaustion. Instead, my empty autopilot existence just freely acted on the expectations of those around me as a proxy for motivation.
Interesting reply thanks. I would say though, If I were programmed or a program or whatever you name it... I would realize the under statement:
If One can´t be happy with what One have now, One will never-ever be in any circumstances.
This is not your case certainly but is connected with the autopilot (meaning we don´t get to choose.
Yeah, most folk get the causation backwards. They think having meaning in life will pull you out of depression. It's the other way around. You have to get pulled out of depression to be able to find meaning in your life.
Realizing that some "chemical reactions" can change your destiny then further learning that when you want something, all the universe is bound to conspires in helping you to achieve it.
This one came out good :)
Depression and pessimism are not the same thing.
> 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?
> "There is no convincing evidence that depression is caused by serotonin abnormalities"
- https://www.psychologytoday.com/us/blog/insight-therapy/2022...
and
> "the etiology of depression is incredibly complex, the narrative that it is caused by a simple “chemical imbalance” persists in lay settings. We sought to understand where people are exposed to this explanation"
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11752450/
and
> "Onset of depression more complex than a brain chemical imbalance. It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals."
- https://www.health.harvard.edu/mind-and-mood/what-causes-dep...
and
> "Analysis: Depression is probably not caused by a chemical imbalance in the brain – new study"
- https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
(These are not thoroughly checked articles, they're the first few search results; however claims that depression is caused by a chemical imbalance ought to be able to show where that idea originated, how the imbalance is measured in patients, where that hypothesis is supported by evidence, why antidepressents don't fix depression in half of patients, and several more suspicious things).
I didn’t say it was simply that. You’re twisting my words and these studies to discount all of behavioral health.
Yes you did. No I'm not.
(I've written paragraphs and paragraphs thinking through some of my views in this thread. You wrote three words naming a thing which doesn't seem to exist. If you want more engagement, engage more. What words am I twisting? Where did you say it was anything more detailed than that? What behaviour that people "can't control alone" are you talking about?)
I did not and I am telling you I do not believe that it is that simple. You do not need to waste time arguing against your incorrect interpretation of my comment. If you need me to say I could have phrased it better, sure, I could have phrased it better. But I am now telling you exactly what I mean and think so we don’t need to do this song and dance.
For emphasis: I do not think it is simply/exclusively “chemical imbalance.”
But why do you think it is at all "chemical imbalance" when that doesn't seem to be an actual thing? What evidence convinced you? What measurements were taken on a human brain to diagnose the imbalance?
We can nitpick terminology all day but at the end of the day for you to assert that this is purely about perspective is patently absurd and I’m not going to let you distract from that fact. There are medical realities that impact people. There are external factors. There’s more to depression then recalibrating “how bad things actually are.”
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.
My point is that it's hard if not possible to objectively tell if the situation you are in is good or bad. And I'm not trying to deny anything.
So your point is explicitly off-topic to the subject matter (read the title above). Gotcha.
> 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.
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
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".
> 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.
> "Our brain chemistry is not stable through our life!"
Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry". It's not like your stomach, liver, kidneys, <organs> suddenly stop working after you lose your job or your life partner and we say it's both inexplicable and because of a deficit of "body chemicals" and nod agreement with each other that "body chemistry isn't stable" through a lifetime.
These are just unsatisfyingly crappy non-explanations.
And quick attempts to assume that Doctors, Neuroscientists, Psychiatrists, Psychologists must have a better detailed knowledge of brain chemistry and I'm just falling for nonsense seems to find that they actually don't, and they don't agree that "brain chemistry" is a good explanation, and it can't be measured in a patient, and the idea isn't strongly supported by evidence, and even the mechanism of action of "drugs which correct brain chemistry" isn't agreed on, and when given to people to "correct brain chemistry" it often doesn't make the problem that was blamed on brain chemistry go away.
> "there very well may be genes that control; how much fear someone experiences when riding a roller coaster."
I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further. There probably are many genes which affect how much fat bodies store, or burn, or food cravings, or what constitutes hunger, or production of various leptins and grehlins and insulins and stomach acids, but that doesn't mean "I'm obese because of my genetics" is any kind of explanation at all. Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation. Downe's Syndrome is a good use for genetics as an explanation. "I have a macro-scale set of vaguely related behaviours, symptoms and body effects and no clear cause, it's my genetics" isn't.
Even if you have sequenced your genome, and have some specific gene that is associated with extra fat storage, genes can be turned on and off through a lifetime by behaviours and environment. Having a gene from birth doesn't mean it's being expressed and is therefore causing a specific problem, or that the problem can't go away and can't be fixed. ( https://www.cdc.gov/genomics-and-health/epigenetics/index.ht... )
> "The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if you are too afraid to ride a roller coaster you should take xanax."
I agree with this. Society likes assuming everyone is the same. Imagine if we collectively noticed that Adrenaline gives people "a burst of strength" and decided that daily exercise, individual strength training plans, gym visits, were all too much bother and that ageing adults were suffering from "an imbalance of Adrenaline" and when they struggle to carry their massive haul of groceries in from their car they should carry an auto-injector of Adrenaline to help their chemical deficiency.
> Citation requested. Because, y'know, it's not like your leg muscles suddenly don't work from age 40-50 and then start working again and we say it's because of unstable "leg chemistry".
Ohhh, leg chemistry, good choice! You know that leg "chemistry" is control by neurotransmitter release, yes? So you must have never heard of Familial Periodic Paralysis then. Let me tell you what happens with that, because it happened to me while taking Seroquel. Familial Periodic Paralysis is also called Hyperkalemic periodic paralysis and is due to mutations in the gene that encodes the alpha-subunit of the skeletal muscle sodium channel (SCN4A).
https://www.ncbi.nlm.nih.gov/books/NBK1338/
"The paralytic attacks are characterized by decreased muscle tone (flaccidity) more marked proximally than distally with normal to decreased deep tendon reflexes. The episodes develop over minutes to hours and last several minutes to several days with spontaneous recovery.
Some individuals have only one episode in a lifetime; more commonly, crises occur repeatedly: daily, weekly, monthly, or less often. The major triggering factors are cessation of effort following strenuous exercise and carbohydrate-rich evening meals. "
Look at that! Their muscles stopped and stared working again!
And yes, this happened to me while taking seroquel because it lowered my potassium so much it affected my nervous system.
Any good psychiatrist will tell you that they have no idea what is going on. But that does not mean neurotransmitters cannot be changed and that they do not effect behavior.
> I will lump "genetics" in as another pet-hate unsatisfyingly crappy non-explanation that people tag onto whatever they want so they can stop thinking about it further.
As someone who, as an armature geneticist, helped design a genetic study for Stanford, can I say that I put more energy into thinking about these things over the last 45 years than you can even imagine?
>Or "I have this personality because my parents and grandparents had it, it's genetic" is an explanation.
I have my hair color, height, skin color, all the physical traits from my parents, so why do you think the brain is not physical as well? Or or adrenal system? The brain is effected by genetics, this is true as has been shown clearly as a risk for schizophrenia. I have no idea why people think our mood, which is dictated by our thoughts which are created and sensed by our brain, which is a physical organ, does not have anything to do with genetics and neurotransmitters.
and then you go on to talk about epigenetics, like that matters by genes don't? Do you know that genes control the epigentic response? Genes like DNMT1? So people with differences in DNMT1 will have different epigenetic responses?
> I agree with this. Society likes assuming everyone is the same.
So how are we different? nature AND nurture. Genes AND environment. I agree the solution to these problems are wrong, but your solution are just as bad as the ones your are prescribing.
Listen, there are times when our neurtranmitters are supposed to be different, like when we are in pain or when some one dies. But some people, like me, have these changes regardless of the situation and we can like them to other environmental factors like diet, sunlight, weather, etc.
I could tell you whey and why I think am so sensitive to the world but I doubt you would listen, because no one listens, because everyone knows.
Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".
Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).
They allow me to function. I've gone through various dosages of various types to find the ones that work best for me, but they have never stopped working. They also allowed me to stick with CBT therapy, and after 20 years my therapist told me I didn't need him anymore ("Call if that changes").
Your second paragraph reveals a biased motive behind your opinion.
I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?
> but rather that they're abused by psychiatrists
Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.
> The last thing that your doctor wants is giving you pills so you go away
Except for all the doctors who do want just that.
> Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick"
While such patients exist, I don't believe they're a global majority, and the group of patients who want the exact opposite, more time rather than "quick", is the bigger out of the two.
Literally a few comments down from this one:
> N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to). She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
> I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
>Also, prevention.
Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.
Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.
"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"
Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.
It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.
With that said, does anywhere have enough specialists to cover as many sessions as would be needed for as many people would seem to need it?
Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.
> like if we took sleeping pills every time we had trouble sleeping
Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.
Which knowing the side effects of Ambien is pretty bonkers.
I know zero people that have ever taken Ambien.
https://www.cdc.gov/nchs/products/databriefs/db462.htm
Seems like daily users would be less than 10%.
Yes, it is quite a statistical outlier for an entire family to be using it daily.
something weird is going on there, for sure.
The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.
>people want easy fixes that do not require any change in habits
Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.
The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.
Its easy to say anything. Doing the correct thing is not always easy. I think your last statement is woefully outdated. The current zeitgeist is lack of agency. Its like collectively many of us have shifted from an internal to an external locus of control. This is due to a variety of reasons, a big one of which is the internet empowering people to make themselves feel insignificant due to unhealthy scale. I'd write a book if I continued, but that's the just of it, I suppose.
> I have the impression that's exactly what people do in the USA?
It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.
you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.
Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).
I've been off and on them for years, usually my doctors seem to prefer if I'm off them and indeed treat them more as short term "stabilizers" so that my brain has a bit more space to deal with things.
This has been true across two countries (Scotland, Hong Kong) and multiple doctors, with a third country's (China) doctor suggesting I try out sleeping tablets for a few weeks - and only giving me a very limited supply of them - to try out instead.
I wonder if the "here take these" is a predominantly American phenomenon due to the weird incentives around health care costs (I'm being genuine here - maybe it's predominant in other countries too, I honestly don't know!)
> The hate on antidepressants is not because they're not effective,
But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.
The "hate" on antidepressants is mostly from a place of "The kids are taking pills for things that aren't diseases and just need to get out more" and other stupid takes about how "back in my day we didn't have this much mental illness", which is why the hate is maintained even for things like ADHD medications which are so thoroughly proven scientifically that they are one of the best proven treatments humans have access to for any disease.
Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.
The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.
We just don't really have much in terms of better treatments because we know so damn little about depression.
The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.
Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.
Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".
>The "hate" is not based in science
The lingering roots of Calvinism in the US cause us all kinds of problems.
"You were born broken because god made you that way, don't make yourself better, and hurry up and die" permeates huge parts of our culture. It's why lots of other cultures look at us and what we do with relative confusion.
Yeah in Holland too. I deeply despise our Calvinist roots. It's so depressing.
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.
I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.
The easiest way to deal with horrible trauma is to prevent said trauma in the next generation.
What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.
And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.
I don't know, people really suck.
> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.
I wish people would stop saying this.
Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.
If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.
And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.
No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).
I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.
(I also added a small dose of Buspar to help with the sexual side-effects.)
If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.
For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.
I was diagnosed a while back with a chronic neurological disorder. One that has a heavy effect on my mood and can conversely be triggered by my mood. The underlying cause is scientifically proven to be physiological. I lack a specific neurotransmitter due to inactive cells in my hypothalamus.
For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).
While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.
Every time I have a yearly physical, my GP will ask if I have feelings of depression.
I know this road leads to SSRIs at the very least, so I always reply in the negative.
The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.
I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.
> I know this road leads to SSRIs at the very least, so I always reply in the negative.
Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.
To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.
N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
Likely the office was getting a kickback from the supplier for writing that prescription. This is shockingly common in the US. A straight cash payment is prohibited, but it's easy to work around that legally and provide equipment or "compensate" some other expense.
Crazy. I hear such wild horror stories with doctors. I'd never return to a doctor like that, sorry you had that experience. Still, this feels like a case where the lesson is "get a new doctor" not "lie to one" but I understand that circumstances can make that a pain.
Agreed. A friend of mine is a primary care doctor, and it's remarkable how often people come in for depression and after examination and labs it turns out their depression is heavily influenced by other issues, especially low testosterone or hypothyroid. A lot more people have issues with these than most people realize. There have also been people he has seen who were reporting depression, often where nearly every anti-depressant had been tried, where getting treatment for ADHD massively improved their case and was life changing. As much as people like to hate on Adderall nowadays, for people with ADHD it is miraculous.
Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.
I am in that case, low testosterone and hashimoto (hypothyroid), ADHD and big Scolioses. Last weeks I am dealing with insomnias, and had to take pills to sleep and it seems my parasympathic system is in alert mode for years, stress, divorce, ex-kid and older kid, etc.. I stopped SSRI after 21 years for 5 months and its probably causing my insomnias, the brain was not used for missing serotonine and brain don't stop thinking, loop, alert mode.
I am doing several blood analysis with a functional doctor and lyme may be around or was in the body, and so many other things. I was thinking I had lucky gut, but seems negative..
I did get my Vit D up to 65 and I seems to be issues with ADH hormone since kid and probably that makes dehydration. It's a fucking nightmare..
I may only see a testosterone replacement as a solution maybe..
>often where nearly every anti-depressant had been tried, where getting treatment for ADHD
This is actually a somewhat difficult diagnosis to make, especially when diagnosing adult ADHD without the user documenting and bringing in a well defined log of their behavior (and possibly another person to point out things they don't know about themselves).
>ADHD is a highly heterogeneous disorder with a significant comorbidity rate.
Is thing that you read about in literature around it. And even more common than that is the comorbidity of all the above symptoms, that is ADHD and depression + more in autism.
You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:
1.) It's killing my libido 2.) It's too strong
For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.
And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!
Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.
Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.
All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.
There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.
YMMV for sure - I was on an SNRI (Cymbalta) for a few months as an attempt to eliminate nerve pain. It all but destroyed my ability to climax both during and for maybe 6 months after getting off of it.
The brain zaps were also hell if I was even like an hour later than usual to take it
Why do you think SNRIs wouldn't have sexual side effects? They still inhibit the reuptake of serotonin just like SSRIs. That's the part that causes (certain) sexual side effects.
Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.
Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.
I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.
> I’m just always astonished at “have you tried not being depressed?”
There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"
It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.
Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.
That was my experience with ADHD. In retrospect, I clearly struggled with it my entire life, with it starting to cause problems around middle school age. I started getting treatment a couple years ago and it was like someone flipped a light switch. Wait, this is what it's like for everyone else? They can just decide to start doing a necessary thing before it becomes a crisis?!
In before "of course things are easier when you're taking stimulants!", which is another dumb thing I hear too often. I feel basically nothing from taking Adderall, and not in the least stimulated or more alert or more awake or anything. I can just concentrate on boring things afterward.
What is that they say, if you have ADHD then ADHD medication doesn't act like a stimulant in the same way it affects non ADHD people.
>in the US I think because of our hyper individualist culture.
Calvinism.
There's been a number of papers written about how pervasive Calvinistic ideas are in the medical community. This tracks with the New England area of the US pumped out the most doctors while medicine was 'growing up', and protestant christianity was the most common form there. When you view the creation of the US medical system with that view many of our screwed up systems make sense. A lack of willpower is a failure of man to be in touch with god, and not a problem a doctor should solve.
Yeah some people pop a melatonin every night before bed
> I just realised I have the impression that's exactly what people do in the USA?
How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.
We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.
Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.
> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.
I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.
I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”
yep and it works too.
"Imagine if we took insulin every time our pancreas failed to properly process sugar."
> it's more of a "here, take these indefinitely"
And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"
> but rather that they're abused by psychiatrists
Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.
The tl;dr is that our understanding of the brain and mood disorders kind of sucks.
It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.
It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.
For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.
after being prescribed Mirtazapine, then Trazadone I realized I don't think I've had restful sleep as long as I can remember. I need a sleep study done probably but until that the quality of life from taking something that has virtually no negative side effects for me is insane.
meanwhile people are like "just take magnesium or melatonin lol"
Nobody should take this as medical advice, but from my own experience, nothing has made a bigger difference in my sleep quality than supplementing with magnesium glycinate. I didn't even start taking it for that purpose - I was taking it for something else and quickly noticed that it made the quality of my sleep significantly better. The only side effect from it is that sometimes I have strange dreams (not nightmares or anything, just odd).
Everyone should check with their doctor, but it's an inexpensive supplement and the effects (if any) show up pretty quickly, so IMO it's worth a shot.
I have sleep apnea. Get the study done ASAP. It's a home test, non-invasive. Will change your life if you have it.
The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.
> The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo.
^ citation needed
What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?
I believe that is indeed what they meant. The perception of being given a remedy is very powerful indeed, especially for issues ultimately linked to the mind.
That placebos can work should not be seen as undermining the severity or pain of the depression, but rather underline the power of tricking the mind into improvement.
Two papers that might be of interest to people regarding this topic would be Kirsch 2014 and Cipriani 2018.
And yes, agreed with argwhat.
> The hate is (among other points) because they are only arguably, marginally, better than placebo
Only true for some. Inarguably, well-proven false for others.
Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.
> I won the SSRI lottery I guess,
From reading internet comments you’d think so, but your experience is more typical than anything.
Depression is deceptively common. As a consequence, SSRI use over a lifetime is also more common than most would assume. Any drug will come with negative side effects for some portion of its users. Multiply that by the high number of people who have ever taken an SSRI and it starts to become obvious why there are so many Internet anecdotes about SSRIs not working.
Meanwhile, most people who take SSRIs successfully aren’t going around and advertising the fact that they’re on psychiatric medications. There is less stigma now than there was in the past, but it’s still not something most people like to broadcast to the world. For patients on long term SSRIs in stable states, the SSRI is just a routine thing they take in the background and don’t really think about. There’s no reason for it to come up in conversation.
To add to this discussion as someone who had above experience this winter, after (literally) years of mood fluctuations, fatigue and brain fog.
I have started taking SSRI after a harder-than-usual body collapse, and after no matter what I did my mood hasn't improved for a month. Regular running, meditating, writing, crafting, coding etc were my antidote to my mood swings but this time it didn't work. Started taking SSRI and continue doing all this things, and I was reborn.
My therapist said that a big chunk of why i am feeling better is also because I kept doing things that are good for me. That she sees with a lot of her patients that they think a pill will magically change the situation. It doesn't work on itself, you need to show up and do things that release serotonin in your body.
But seriously, unbelievable, years of frustration and friction in my life disappeared and I have never felt better.
Why were you getting body collapses?
> Depression is deceptively common
I didn't even know I had it, but when I was diagnosed, my psychiatrist was very concerned and made a point of encouraging me to keep in touch, making sure I worked through things and engaged with the problem. I initially thought something like "I'm fine, just a little down here and there, I wonder if this person is inventing work for themselves?"
Same with anxiety. I would have told you something like "I'm not an anxious person at all. I don't even know what that's like, though I can sympathize with people who suffer with it". As it turned out, I was suffering pretty severe anxiety. In retrospect it's as clear as day, but at the time it was just... The way life was.
The thing is, all of my assessments remarked that I demonstrated relatively high self awareness and openness. My experience being diagnosed with ADHD and depression made me seriously concerned for people who 1) can't afford this process and support, and 2) will just continue to grind like I was, living half-dead without knowing it can be any other way.
I suspect there are a ton of these people—I think I notice them quite often—and I was arguably accidentally pulled from that stupor and would likely still be there, unaware, if it weren't for a chance encounter that caused me to think slightly differently about the possibility of having ADHD.
“God, I see what you’re doing for others, and I want that for me.”
I had a very similar experience, except it killed my libido, so I chose to endure the suffering of Winter rather than live with emotional numbness.
Still, I strongly recommend it for people flirting with the abyss. It was life-changing for me while I was raising an autistic 2yo during the pandemic.
> I had a very similar experience, except it killed my libido
Did you, as well as the other people seconding this, have any libido left in the first place? I got on Sertraline because I was depressed, and it actually brought my libido back, by virtue of just bringing me back to a better emotional baseline.
All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.
> All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.
Wouldn't a "NOOP" be the opposite of a "Nope"?
Sorry for the pedantry, but this forum seems an appropriate place for this.
That's the point, killing an inexistent libido is a no-op
Ah, thanks for explaining!
I have switched to lamotrigin, it helps to balance mood as I had bad mood in months with less sunshine. Lamotrigin is not an antidepressant, previously it was used for epilepsy stabilisation but now it is prescribed for mood swings. (This is not a medical advice.)
It is still prescribed for epilepsy. I am actually hoping for some medication stories if anyone/someone they know has ADHD and epilepsy. It's for a juvenile, but your stories can be for any age. Or pointers to any resources about the combo.
Speaking from personal experience, people react to different SSRIs differently. I took a popular one that had significant side effects without a whole lot of benefit, and so I stopped it and didn't try anything else for 10 years. Then I spoke to a psychiatric nurse practitioner who suggested trying several others until we found something that worked for me. I had (incorrectly) assumed that if you had e.g. sexual side effects from one SSRI, that you'd have them for all. That is not the case.
I spent $300 on high lumen output light bulbs. 28 200W equivalent LED bulbs and 2 LED corn bulbs. Just a TON of light. Depending on severity either run it all day (late January and February tend to be the worst months), but even 10 minutes in the morning helps substantially. Just a lot of light. You can get hung up on high CRI and full spectrum but just do it badly first, then if it works worry about perfecting the setup. I just kept buying more bulbs and as I bought, I felt better and better.
Edit: this was the blog that gave me the idea, it comes up on hacker news a lot. https://www.benkuhn.net/lux/
Villazodone was created partly to address that. Once I switched to that, I had no libido-related issues again.
> except it killed my libido
Similar experience. Apparently pretty much ubiquitous with SSRIs
i'm sorry this happened to you, this was of the reasons i held off trying them for so long. ubiquitous indeed, also on this front I got lucky...
please people, take my post for what it is: anecdotal evidence. SSRIs can basically give you any possible side effect, including destroying your libido.
hm
I don't relate at all to the latter part of your question, so by process of elimination it must be the former :)
Libido can be supplemented with Wellbutrin. Works great, even better than before.
I have no experience about antidepressants myself so please excuse my stupid question.
When I hear people say "it killed my libido" I always think about the fact that hyper-sexuality can be a trauma response, and if your body is healing the hyper-sexuality is most likely also reduced.
It's like when you have a disease and then read the side effects of a medication and notice that a lot of the side effects are basically also something that can happen when your overall condition is improving but still some people report them as adverse effects and then these are added as side effects to the package label.
For example you take antibiotics but bacteria can have toxins in their body, and when the bacteria disintegrate you get more sick from the released toxins. It's called the Herxheimer effect: https://en.wikipedia.org/wiki/Jarisch%E2%80%93Herxheimer_rea...
When I started methyl-B12 supplementation I also had inflammation in sinuses for weeks but it was just from my immune system starting up again and being able to attack long-standing inflammation. Someone else would've put "fever", "headache" and "stuffed nose" onto the side effects medication label of methyl-B12.
Stupid question - why do you keep suggesting that having a libido equals hypersexuality?
Is this your trauma speaking, or do you automatically associate any sexual needs with a pathology?
You've done it twice in this thread alone.
I didn't read their comment as insinuating libido is 1:1 to hyper-sexuality. I read it as: "consider if you have a libido, and depression, you may also be hyper sexually."
The situation is PersonA has determined they need an anti-depressant. So one thing is 'wrong.' It stands to reason that they may be using sex as a painkilling mechanism. After all, sex feels great. When the anti-depressant kicks in, the body may determine it doesn't have to use that painkilling method anymore, hence, the decreased libido. It doesn't mean having a libido is bad, it means that the person potentially was overdriving it.
Thanks for reframing it. That's what I was trying to say.
I'm not whom you asked. But it's a resonable association for some cases.
But I understand that it would have been better to ask and not associate because it's a fraction of the cases.
If I told you that I often have a fire in my fireplace, it would be incredibly strange if you suggested that pyromania can be a trauma response.
Either OP is confused about what libido means, or has some kind of heavy shame around sexuality.
That is not what this was. You have been firing your fireplace, now you put on a sweater and you suddenly don't want to fire so much. Maybe that's not bad, but a return to normal. That was the proposition. Is it true, who knows. Case by case question.
Yeah, I agree with your sentiment.
Sex is awesome and liberating! Should be anything but shamed.
Hi, author of the blog post here! Thank you for sharing your experience with antidepressants, I'm really glad it worked for you & made your life better.
I did mention the following at the end of the "antidepressants" section, but reading your comment convinced me to move it further up. The intro now reads:
> The "standardised effect size" of antidepressants on depression, vs placebo, is around 0.4. (On average; some people respond much better or much worse.)
Also, I wasn't expecting my article to do well on Hacker News; thank you everyone for the comments & critiques! I'll edit the blog post as I go along, to refine it in response to your comments.
My personerino let me be ridiculous and fawn a bit, and tell you that you're one of my internet heroes.
Don't take it as criticism, more of a personal take on figuring out what antidepressants do for me. Furthermore, since posting that parent comment I've converted my vit. D dose to IUs and I realised i'm only taking 800 IUs daily. So a thank you for clueing me in on that, and who knows what happens if I up that. Maybe you were right all along and all i DID need was a heroic dose of vitamin D. (... thats what she said)
Aw, thank you for your kind words! I hope the extra D helps! ^_^
Thank you for the blog post! I live in New England and always had the winter blues, always just assumed it was because of the weather but never acted on it.
About a week ago, there was a reddit post claiming it's actually geographically impossible for anyone where I live to produce enough Vitamin D naturally from the sun alone, due to the shorter days and lower angles throughout the day. I had no idea.
Thank you! I relate; I live in Montréal, close to New England, with similar climate. The current UV Index for Montréal is... 0. And the current UV Index for Boston is... 0.6. (1.6 later today)
I can't find a rigorous academic source right now, but the top web results all say we need at least UV Index 3 for our skin to be able to make enough Vitamin D. I guess summer may work for us, in the Montreal/New England area, but other than that, yeah, you and I will need to get Vitamin D from diet and/or supplements. And fish is expensive, so supplements it is.
I had disk issues in my lumbar spine that caused nearly unbearable pain and terrible quality of life. Tried everything: PT, OTC painkillers, epidurals, massage, nothing worked. Was prescribed pragabalin and duloxotine. Duloxotine is an SNRI that also treats nerve pain. That combination helped some but I was sleeping 11+ hours per day and generally felt like my head was in a complete fog, was pretty much useless with work. I had been trying to avoid surgery but finally had 2 procedures in 2024 that helped immensely. Weaning off those 2 drugs was no fun: sweating constantly, anxious, headaches for about 2 weeks. Extremely happy I went the surgery route and stopped those meds. I can't imagine living day to day feeling like that.
Duloxetine was indeed a beast to get off of. It got so bad that I would open the capsules and count the number of beads to taper as slowly as possible. It was hell
SSRIs saved my life. No exaggeration. They might be overprescribed, only effective is some individuals, and they certainly have their share of side effects, but they're still the gold standard treatment for clinical depression and anxiety.
It takes a 10 min talk with a doctor to get antidepressants around here. Perhaps a test which looks like multiple choice score of symptoms with some weights.
I had an old gf receive two different drugs each with terrible side effects. To me it looked as poison.
I decided that I would rather hurt myself myself than fuck with my brain chemistry this way.
During the dark northern Winters I lack vitamin D (your doctor can measure this using a blood test). The symptoms are some physical issues and probably something that can be described as light depression which goes away if I remember to take the vitamins.
We are all different. Some people might need anti-depressants. I just need some vitamins.
If a drug has an 1% chance of 100% effect, it will look pretty weak in those studies.
IMO it's pretty clear that depression is a symptom of many independent issues, so it's really lame that we don't have a more accurate way of diagnosing it.
The goal is to tackle it in every way. The medicines are supposed to be supportive and not the solution. More often than not people treat it as a solution.
Thats why they are eventually tapered and discontinued once you are able to be on your own.
As someone who tried citalopram escitalopram and sertraline, along with venlaflaxine and fluvoximine, I would suggest doing a pharmacological test for psychiatric medications.
I am an intermediate metabolized for the first three and the ones I was on most long. It did not suit me and made my orgasms go from ‘wtf’ to ‘that’s it?’ And they are still not normal 2 years after discontinuation.
I am still depressed and anxious to the point of serious consideration of these medicines to save myself, but you can save yourself the experimentation by doing a simple test and avoiding those medicines.
Anxiety depression panic attacks are something I wish more people studied along with sexual health.
look my other comment for niacin
That’s B3 for nerve and dna repair if I understand correctly.
I notice a difference after eating non vegetarian food but since I also have IBS, my absorption can be a hit or miss.
A very balanced and nutrient rich diet with good sleep and exercise is the start to mental health recovery. People often forget how important all this is.
for ibs: no coffee, milk (any milk), vegetable oils, wheats, soy, or anything from USA :D and no sugar or alco then slippery elm and probiotics, d-vitamin + c-vitamin. fasting, intermediate is also helpful. add berries and yes, beef meat and lots of greens. with strict diet ibs goes better.
Similar story here but for ADHD and Atomoxetine.
I finally went and got diagnosed at age 46 for what had been an childhood-onset issue in retrospect. All the signs were there: inability to start work until enough challenge or novelty or a state of crisis had come about, etc. When I spoke to friends about considering treatment, they said they thought of me as a hyperfocus kind of person. But they didn't see how many support systems I had put in place to function normally, how I saw others around me just doing things while I had to work myself up to start and then keep checking and double-checking for the silly inattentive mistakes I knew from experience I would keep making.
I've had a meditation practice for a long time and it has helped with anxiety but it hasn't really helped with getting started on tasks, especially those perceived as boring. I even had to psych myself up to sit down and start meditating, even though I knew I would enjoy it.
I didn't know until a year or two ago that non-stimulant medication existed to treat ADHD. I always thought it was only Adderall and the like, and I couldn't risk anything that would ramp my anxiety up, or take additional treatment for the anxiety with SSRIs because I have severe hemophilia and any additional risk of bleeding from SSRIs was an untenable proposition.
After sitting on the idea for some time and just hoping that I could fix it with more meditation, I finally decided to see a psychiatrist. The doctor suggested Atomoxetine, but said it doesn't work for most people and even then takes 3-4 weeks to take full effect. I started on the absurdly low dose of 10mg/day for the first month to be sure it wouldn't cause additional bleeds. By day 3 I could see a huge improvement in my working memory and ability to perform tasks. It gave me insomnia for a bit but I would wake up at 3 AM, sit down happily to work and write the best code I've written in years. I could not believe the difference it made. There were quite a few side effects initially but I was willing to put up with them because of how smoothly my brain was functioning. I became a nicer person to deal with. I felt this sense of possibility and freedom that I haven't felt since my 20s. My only regret is not having done this sooner.
So yeah, please don't avoid medication based on internet reading.
Similar. I was on stimulants as a kid and hated them as they did nothing but make me feel high then taper off leaving me exhausted. Nevermind the total loss of appetite. Later on as an adult I obtained adderall from a friend and experimented with it and it seemingly worked for a few days but it never stopped the intrusive thoughts or help with the anxiety. In fact all I did was chase a high with cup after cup of coffee when coming down. That put me off to meds for a long time.
More recently I was on a vacation where I took mushrooms and had a nice trip. Two days later at work I felt very relaxed driving in and sat at my desk BUT something was wrong, my head was dead quiet (the GP explained this exactly like I would.) So quiet that for a second I had a bit of panic as I thought something was wrong. Then something wonderful happened: I realized I was able to just do my work. There was no stress, no worry, no nothing. Just a calm quiet confidence to get the job done. Best day of my life.
After that I called a mental health center and connected with an ADHD specialist who has been working with me. I am also on Atomoxetine myself and while it has not brought me back to that zen head space it brings me close enough. My only gripe is at a higher dose it gives me sensations in my head. However, I learned that eating a proper breakfast helps a lot as I was taking it on a near empty stomach. Overall my life has been slowly improving and I feel more confident at work.
> So yeah, please don't avoid medication based on internet reading.
This - 100%
Same for me with buproprion. Night and day difference. Made me wonder how different my life would be if I had been diagnosed appropriately when I was a kid.
Same for me with Adderall.
I do wonder if being highly functional and feeling capable is normal though, like as a species it seems almost dysfunctional to happily plow through 8 hour workdays and bills and appointments and all the little bureaucracies we have to navigate. Sometimes a little voice screams "Run to the woods!" when I sit down and look at a long todo list for the day, but with Adderall I can generate some semblance of enjoyment from ticking off the boxes.
Granted our world is what it is, and we are mostly helpless to enact large changes. Finding some kind of peace with reality is probably better than bashing your head against why you don't fit into it well.
> I could cry with joy because I could finally understand emotionally why people like the Christmas season.
SSRIs are known to induce a
https://en.wikipedia.org/wiki/Mixed_affective_state
I seriously messed up my life early on by not being able to recognize the difference between being happy and manic.
One of those manic symptoms was often feeling like crying out of joy, and another was feeling way more cognitively capable that I was.
I described SSRIs like this:
When you're depressed, you're in a hole that's too deep to get out of.
The SSRI basically shovels stuff from the top of the hole to the bottom of the hole so your head is above ground level. You are still in the hole though and you need to climb out of it.
Tangent… but for sweaty feet, try a ski boot dryer!
You can get them for $50… they dry out my shoes which makes them last a lot longer before they get so smelly I have to throw them away. Plus, who doesn’t like warm shoes in the morning?
That, and there are some creams called Sweat Block or whatever you can rub on your feet which reduce sweating. Those work as well.
Also try wearing merino wool socks. It seems counterintuitive to put wool on your sweaty feet, but they're quite comfortable and they help you avoid that "clammy feet" feeling when you are sweating in cotton socks. They also don't develop odor the way that cotton does.
You can also 3D print them: https://www.printables.com/model/194340-60mm-radial-fan-boot...
I had severe SAD to the point of having a mental break where I told my wife I was flying that very day to Miami to get away from the cold. I didn’t end up flying to Miami, which is likely why I’m still married…
So I ended up spending $300 on LED bulbs, both corn bulbs and 200W equivalent, bought some 7-Way splitters for my ceiling fan so it’s holding 28 light bulbs (people have joked I have a “biblically accurate ceiling fan” because it’s so bizarre looking, like a weird glowing biblical angel), and get about 10,000 lux in my home office now. As a bonus, I don’t have to run a space heater in my home office (since I only need it in winter, I’d have been using that electricity anyway via a space heater). Solved the issue completely for me.
The things that keep me away from SSRIs are the potential for addiction and not being able to take psychedelics.
I had a friend on SSRIs not tell us they were on them when they hit a DMT vape pen at a party years ago and they got serotonin syndrome. Had I known I would have warned them not to.
It's more "dependency" than "addiction". No one's waking up jones-ing for another hit of their SSRI. Dependency works well because some people are dependent on it like I am dependent on glasses/contacts.
Yeah, that's fair, there's not really a loss of control so dependency is probably the better term. Still, if you go off of them I've seen people get rocked with physical symptoms. I really try to avoid anything that would have such an affect on me physically.
Whatever the word, getting off of them is not fun. It took 6 months after getting of Paxil to stop feeling like I was being dropped down an elevator shaft at random times day and night.
Thank you for saying this, I wholeheartedly agree. Antidepressants have an excessively bad reputation.
I'm sure they have their problems too on occasion, but for me the decision to start taking Escitalopram was one of the best things I've ever done.
The side effects were totally negligible compared to the benefits.
I've stopped taking it a year ago or so and... it's basically cured me.
I'm not saying antidepressant are a literal pharmaceutical cure for depression, but in my case it simply put me in a position mentally to change habits and patterns of thinking in a sustainable way.
My only regret is not doing this 10 years earlier; the poor reputation contributed to that.
Same story here, but different drugs. Every year Nov to Mar means no lapses whatsoever in diet, exercise, sleep, supplements, clutter, lighting otherwise the SAD will seep in and erode me. I tried udosing ADHD meds this year and suddenly subsistence is easy and I have gas left in the tank for worthwhile things.
I feel like I speedrun Maslow's hierarchy of needs.
No anhedonia so far this year and my creative output is at all-time high. Hope that helps someone get over their own biases about prescriptions.
Bessel van der Kolk also mentions in his excellent book "The Body keeps the Score" that the effect of antidepressants is correlated with the source of the depression. If the depression is a comorbidity from early childhood trauma then antidepressants are limited due to trauma-related reshaping of how the brain is organized. Cases like yours or those that a related to traumatic experiences as an adult are more the result of a shallow neurochemical imbalance which antidepressants are able to impact beneficially.
>> "The Body Keeps The Score"
Such a great book. Highly recommended.
I’m glad to hear that. Another frame is that your depression turned out to be “math hard” rather than bodybuilding hard [0]. Your disciplined, methodical approaches were steady applications of effort, whereas what you actually needed was easy to implement but hard to envision.
[0] https://www.alexcrompton.com/blog/2017/05/26/hard-is-not-def...
I still think you should have tried eating a banana first.
They've been losing ground to placebo in more recent research.
Plus, most of the more serious side effects take a lot more time to manifest than the typical length any given patient remained in the older clinical trials that secured FDA approval and grounded the official manufacturer literature.
I am glad we have these tools, but I suspect they are vastly overused, and patients not well informed.
Same I am in outstanding physical health and my diet / exercise is excellent. Taking Lexipro has made a massive improvement on my emotional bandwidth. I take vitamin D / fish oil and bits of other supplements. At least for me no question this medication even at a 10mg dose has made a major positive impact.
Similar story for me, but with Bupropion (Wellbutrin). None of the SSRIs/SNRIs worked for me, spent years trying different medications, Wellburtin was finally the one that worked, and oh man what a difference.
> Cold showers, ... no alcohol, strict sleeping rituals.
I feel like doing those three things would make me feel like reheated cat shit, regardless of the weather outside.
They do for me too. Alcohol gives me a huge downer the next day but the party itself is amazing so I just waste the day after with a pillow over my head.
And I hate strict rules and rituals, I love chaos. So that also gets me down. I often stay up till 6am (the parties I mentioned above only start at midnight)
So yah it might make some people better but for me the times I break it are the ones that are exceptionally good.
I had a similar experience except instead of antidepressants it was when i started taking Adderall as an adult. A sense of peace and serenity in my mind that I had never felt before, it was almost overwhelming.
I had pretty much the same reaction after two days of taking it.
Took a while longer to get the dose right so that my anxiety also mostly disappeared, but the difference in quality of life it made for me is hard to put into words.
What dosage of Citalopram? 40 mg/day?
(Roughly equivalent to Lexapro 15mg/day; Saffron 30 mg/day if Crocin+Safranal properly standardized)
10 mg a day, down from 20 but that made me feel wired, like I ate a bunch of 9V batteries for breakfast. Big pupils, trouble sleeping, manic thoughts, the works.
I'm a small, generally sensitive guy so ymmv...
Thanks. Ever try Saffron extract standardized to crocin content (typically 2-3% crocin, dosed at 20-30 mg/day)?
One meta-analysis showed an antidepressant effect size around 1.2-1.6 , and unlike pharmaceutical antidepressants, saffron with standardized crocin has no well-documented or commonly reported withdrawal syndrome in clinical studies or reviews.
Imaging the number of people that this comment could inspire to get on SSRIs lol
I'm not saying it's a bad.
But I'm also saying there are no magic pills...!
> This just goes to show that for me, they're extremely effective.
I am not so convinced. Perhaps your case was simpler, but people can feel chronic depression. They may take some drugs to modify that, but what if the external factors won't change? You can see this issue for some people who have a disease that only gets progressively worse. I think we can not unify all this as "dislike on antidepressants" as a one-size-fits-all formula.
How do you know it was the SSRI?
To cherry-pick a quote from a review of SSRI studies:
>the magnitude of symptom reduction was about 40% with antidepressants and about 30% with placebo.
That tells me that antidepressants have some effectiveness, but placebos work shockingly well. You can give someone a sugar pill with no medical properties whatsoever, and a good portion of people will recover, likely crediting the pill for their recovery.
and then the effects wear of. You just feel "normal" or the same as before. I used to take ssri meds too. It was nice in the beginning. Stopping was a nightmare, I needed to taper down foe like half a year..
Thank you for your comment. I think that can help many people.
If it is SAD have you tried bright daylight balanced lighting?
Yeah, I have an extremely bright lamp designed to tread SAD that I sit, or well used to sit, in front of every morning. Daylight responsive led strip in my home office. And a pair of glasses with blue LEDs for on the go. It did... 10%? of what citalopram eventually did for me.
Have you tried more light? Like, a lot more light? Like, getting a light meter and aiming for 10-20,000 lux in your room? This blog was a good start for me.
https://www.benkuhn.net/lux/
Thanks for the reply. Does the citalopram completely obviate the need for the extra lighting or do you find there is still a benefit to having the daylight lighting too?
I've stopped caring for my various lamps. I turn on the bright panel out of habit while working at my desk... but I don't feel "drawn" to it as before. I'd, for example, set my phone to the highest brightness in a dark room to motivate myself to get out of bed, or at least get to the light switch. Now I don't care, I just get up.
And I can look at the dark world outside the kitchen windows in the morning and not feel oppressed. It's just a lack of light, no menacing presence.
As someone that falls on the side of “depression is real and antidepressants can help” it is very clear that there are people in this thread that need to hold their tongues because they know not of what they speak. (Not you OP)
There are some forms of depression that you cannot think or act your way out of. If you haven’t experienced that, I promise that you do not understand what it is like. You cannot really understand unless you have experienced it. Your opinion on it is irrelevant, and frequently offensive.
The same is true for people that say that antidepressants are mostly placebo. They are not. When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Yes, I understand that other therapies are also effective, and that some people are non-responsive to some drugs.
Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.
Edit: I understand that the placebo effect is still an effect. My point is that there are a lot of people being incredibly dismissive of real lived experiences and outcomes on a VERY serious issue.
As a counterpoint, I experienced such severe negative symptoms after taking SSRIs that I had to be hospitalized for months. Medical treatment is not without its risks. I would always advise trying NPIs before drugs.
I don't in any way mean to discount adverse affects, or negative experiences. Those are just as valuable points. People should be aware of the risks when they take any pharmaceutical, and there are doctors who will happily prescribe these drugs without educating the patient or themselves about downsides and alternatives.
My point is that a lot of the commenters here are saying some variation of "have you tried being happier?" and "these drugs do nothing". Both of which are absurd to the point of offensiveness to people who have gone through it, in the same way that it would be absurd (and offensive) to claim that these drugs have no possible downsides and a negative reaction is placebo.
If only I knew what an NPI was.
Non pharmaceutical intevention
There are indeed some form of serious depression that are non-responsive to psychotherapy alone. Those are however not the norm. Dr. David D Burns, practising psychiatrist and author of the book Feeling Good: The New Mood Therapy has written a whole chapter in it on the appropriate use case and effectiveness of anti-depressants today. (If you are considering using anti-depressants, I urge everyone to get the latest revision of his book and read that chapter). He believes anti-depressant has its use during treatment but also shares studies that suggest modern psychotherapy, like Cognitive Therapy which he advocates, has now begun to surpass the effectiveness of anti-depressants in "curing" depression in the long-term.
A particular point he makes about depression in it is insightful: Although depression is conventionally viewed as a medical illness, research studies indicate that genetic influences appear to account for only about 16% of depression. For many individuals, life influences appear to be the most important causes.
I was incapable of the compassion you're talking about until I had a bad shroom trip and felt some horrible, hard-to-describe anxiety the next morning. It was some of the worst hours of my life until my serotonin system rebalanced itself.
I'm not saying it's the same thing as depression or regular anxiety, but it gave me tremendous perspective on how bad these conditions can be and you just don't have the ability to "shake it off" when things are unbalanced.
Maybe that's how my wife feels when she's off the meds. Shit. Now imagine having a douchebag by your side second-guessing your pain. Never again.
> Maybe that’s how my wife feels
The good thing is it isn’t necessary to know how someone else feels to have compassion.:)
It’s enough to accept you don’t understand the other person‘s thought process and stop trying to tell them what they are thinking. You don’t need to fix things, you just need to listen and not make them justify or explain themselves to you.
Doing nothing is better than doing the wrong thing.
This comes from my own personal experience. I can’t relate to people on an emotional level. Every relationship is processed with deliberate, logical action. If I love a friend, I need to figure out what would change their internal state so they can experience that love.
From the outside, this looks like I can relate on an emotional level.
Precisely. That's what I took from the experience as well. If that's so hard and I had no idea about it until now, maybe there are other things that I don't know, and some that I will never learn, and I should tread lightly.
> The same is true for people that say that antidepressants are mostly placebo. They are not.
In fairness, anti-depressants are a lot of drugs. The article gives a list. 23 of them seemed to be better than placebo, 19 of them were much less clear.
> When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Placebos can also save people's lives.
The placebo effect is a statistical reporting effect. Not a physical effect.
Somaticizers absolutely will change their behavior in response to a placebo.
Lexapro saved my life
Lexapro made me feel like I was randomly being dropped down an elevator shaft for 6 months after I stopped taking it. I’m glad it worked for you, and am not minimizing that, but these medications have a side effects profile a mile long and should be a therapy of last resort in my opinion.
They have a half life and you cannot stop taking them cold turkey without these symptoms, your psychiatrist should help you ween off of it slowly.
At the time I was unemployed and didn’t have a car, not much the psychiatrist could do about my “dirt pooritis” symptoms.
The problem with antidepressants are that while we know, more or less, what they do, we don't know why they work for some and not for others. Escitalopram (Lexapro) was a vast improvement for me over Citalopram. Then it plateaued and a year later, left me anhedonic. Tried an SNRI that would give me brain zaps every day a few hours before my next dose and it was horrendous to quit using. It also messed with my ability to meditate for a long while. Basically, I could put myself in a mental state that would trigger the same kind of painful brain zaps that withdrawal from the SNRI caused.
I can't go so far as to say it saved my life, but I'm part of that cohort of 10% of men who develop postpartum depression. Taking a small dosage of Lexapro had zero side effects for me and helped me deal with not just the anxiety and depression I was experiencing but also a lot of pre-existing anxious behavior that I didn't even realize was abnormal.
Huge quality of life improvement. 10/10 would medicate again.
A: The same is true for people that say that antidepressants are mostly placebo. They are not.
B: When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.
Are placebos unable to save lives?
Not claiming antidepressants are or are not mostly placebo, and don't mean to minimize the pain of depression in anyway. I just don't think whether or not they saved a person's life is an indication either way. The placebo effect is real, right? As in the subject actually gets better after taking it.
> Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.
This is the internet, friend. I wish you the best, but maybe don't put too much hope into that one. I think you'll have better luck cultivating the ability to be comfortable having your own beliefs while others have different (possibly wrong!) ones.
When you do this, you're just accusing people of having no real evaluative power about their own experience. It's pointless, and it's not really an opinion.
Placebo-controlled RCTs show that some people react well to antidepressants with major variation from person to person.
Maybe I wasn't being clear, since I didn't mean to accuse anyone of anything.
I'm not disputing that someone had the genuine experience of antidepressants saving their life. I'm asking if that precludes antidepressants acting as a placebo.
In other words both things can be true: antidepressants saved someone's life and antidepressants can act as placebo (even in the case where they saved someone's life). And notice I'm saying "can be true". I'm not saying they are true, cause I have no idea.
This is a logic question, not some kind of moral attack.
Do you take the citalopram year round, then?
This is my first year, doc told me to wait until at least march, April to start talking about tapering. I have zero symptoms in summer, so I'm inclined to get off them outside the darkest months... we'll see how bad the discontinuation syndrome hits.
Here's hoping it goes well, whichever path you take.
Re "citalopram" and "SSRI lottery I guess"...in fact, citalopram is not a true SSRI and in fact no SSRI is only an SSRI as they also on, at increasing doses, many other neurotransmitters like norepinephprine and Muscarinic acetylcholine receptors.
However, citalopram specifically has a big effect on the histaminegma the sigma-1 receptor. I will focus on the sigma-1 receptor:
https://www.sciencedirect.com/science/article/pii/S134786131...
Never heard of it? Yeah, don't be ashamed, it is the biggest secret in depression. In fact they are finding that many "SSRIs" are sigma-1 agonists, even prozac.
https://www.frontiersin.org/files/Articles/1691987/fnins-19-...
It tunrs out that Sigma receptors modulate glutamatergic dysfunction in depression, and glutamate, being excitatory, well, you can. make your assumptions from there.
https://www.frontiersin.org/journals/neuroscience/articles/1...
It seems the main function of the Sigma-1 receptor is Calcium release. And calcium ion channels are one of the most studies ion channels in mood disorders. By increasing calcium release you increase neuronal activity, hence, the uplifted mood.
It is too bad that the sigma-1 receptor is just starting to be studied and there is limited evidence of how omega-3 and Vitamin D effect it. But I do know that Vitamin D has a huge effect on SLC6A4 (SERT).
https://www.nature.com/articles/s41598-020-79388-7
I have Schizoaffective Disorder Bipolar Type (disabled) and have been on no less than 14 types of meds. I knwo how they work better than my psychiatrists, which I why I no longer take them. I also know my genetics which gave me clues to what is happening in my body. Now I eat a mostly seafood diet and my needs for meds has mostly vanished. I am still an odd old fellow, but at least I am not ranting in the streets or trying to kill myself anymore.
Meds saved my life, but a diet high in Omega 3, D, and a bunch of other things has removed so much suffering from my life, more than any medication has.
(Also, if you want to get into the weeds of depression, you might wat to look at ATP and depression https://onlinelibrary.wiley.com/doi/full/10.1111/cns.14536)
have u ever tried niacin?
Yes. Made me manic. You know we make niacin in our own bodies, from tryptophan, down the kynurenine pathway. Sine many of the enzymes that are in this pathway need B6 and B2, being low in these may lower endogenous niacin in the body.
https://www.researchgate.net/publication/353319033/figure/fi...
Many people I know, when tested, were low in B6. That is more important to me than niacin.
For others who want to try this, taking too much B6 is associated with nerve damage - https://en.wikipedia.org/wiki/Megavitamin-B6_syndrome
From your link: "The common supplemental form of vitamin B6, pyridoxine, is similar to pyridine, which can be neurotoxic."
Vitamin B6 in p5p form is cheap and widely available alternative.
Yah. Measuring the effects of these drugs with a single effect size number is ridiculous. They work exceptionally well for some people (myself included). It seems as well that SSRIs work much more reliably on anxiety disorders than on depression.
Getting on them can be a ball ache (or entirely painless; escitalopram was easy on and easy off, Wellbutrin was a nightmare to get on, but also easy off), but entirely worth a shot for anyone symptomatic.
> I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.
Yes, you did. Had the same medication and got tremors and stiffness so bad I thought I had early-onset Parkinson. Could hardly unlock the door without dropping the keys five or six times. Fortunately, it ceased when I stopped the SSRI.
Have you tried SAD lamp light therapy? But not those lamps you get on amazon or other marketed SAD lamps, those are a scam. Just buy a 2 floodlights that are pretty powerful, say 100 watt each. Works like a charm. 15-30 mins a day its all it takes
I experienced this but ended up getting off of them after developing some back/hip issues but I didn’t think it was related, it wasn’t until I quit the citalopram that my shoulders were suddenly relaxed and the hip “looseness” or constant need to be adjusted back into place went away, like everything tightened back up, it is really strange, then I looked up how SSRIs can impact this and even bone healing, decided I couldn’t risk my body falling apart.
sweet feet seems so random, maybe some serotonin receptors down there? are they noticeably sweety?
something's fucking my hydro balance. i've done my fair share of psychedelics, and i have to keep drinking water on shrooms too. i dont know, something highly idiomatic haha. i also sweat more in other places, but my feet are the moistest. right now i just change socks often, it's hardly a debilitating side effect...
I'm guessing you can afford spending $300 on light therapy glasses.
Disclaimer: I'm not a doctor, but saw 4 seasons of dr. House. Moreover, few hours of Huberman Lab on sleep and light and most importantly, this episode of Additude Mag Podcast on curing SAD and ADHD day-rhytm shifting with light glasses: https://www.youtube.com/watch?v=fu4mLgkNc6I
What happens in the seasonal affective disorder season is the sunlight pattern diverges from 6-18 that we evolved with. Without daily reminder of getting enough sun (or sun-like) light at the 6 o'clock⁰, your body clock will drift.
It can start by feeling groggy instead of refreshed in the morning, even if you've slept enough. And can escalate into loosing the will to do anything or even live.
No wonder. You're still an animal. You need to be fed, put to bed, etc. at a specific time. If you try to make your body sleep during the day, and eat and work during what body expects to be night, you won't really sleep and won't really live/work. Enough of not really sleeping and not really living - you mess up your body, your gut biome, your hormonal balance and your brain chemistry. You kind of should get depressed when you do it.
You can steer your body clock with light. Most of us do it, by exposing ourselves to strong (strong enough it won't matter if it includes blue wavelength or not).
But you can do it consciously (and in a way good for you) by putting on light therapy glasses (I'm using Lumiere 3¹, and they are not the only ones, find your own) at 6⁰ everyday, or right after you wake up if you're trying to readjust your rhythm. Or if you have time and want to save $200, use a stationary lamp and just sit in front of it doing nothing. I don't have the time. When readjusting, small doses of melatonin (0.5mg) 1h before sleep will accelerate body clock shift.
But don't listen to me, if you have SAD, you should really listen to that ADHD experts episode.
I feel for you, struggling with that stuff for a long time. Vit D, fish oil (lot of). All lights at home set to reduce intensity after 18. Strict going to bed routine. Still sleep poorly once in a while, but can do things in winter again. Hope it will help :)
0: choose whatever suits you. With small doses of melatonin and discipline in using light glasses you can even flip day and night. Just stay consistent, good farmer always feeds his cows at the same time.
1: at the time of buying ( fall '25 ) they were cheapest and best overall in norway. Solid build, ok battery, can have them on during yoga using attached rubbers and kind of can have them over glasses. Mine are very large and have blue light filter, but I manage 20min without eyeglasses. Medical certificate. Few leds, holo strip, battery and some plastic - my inner Scrooge says it's not worth $285, but everything else was worse and more expensive.
I just spent $300 on LED light bulbs. Especially if you have an older house the sockets are all wired up for incandescents so you can just split the socket and run 7 bulbs per socket, I have 30 light bulbs, including two 200W corn bulbs and the rest are “100-200W equivalent”
Please do not take 5000mg/day of Vitamin D. The author confuses IU and mg which is very dangerous.
I also noticed that. Opened issue: https://github.com/ncase/blog/issues/4
Hi, author of the blog post here! Yes thank you for catching this awful typo, it's fixed now! I did write "4000 or 5000 IU of Vitamin D" everywhere else in the article -- main text, conclusion -- just my luck that the one place I mess up is right at the very start.
(Do not take 5000 mg, that's 200,000,000 IU. You'd have to chug dozens of bottles per day)
Let’s hope the LLMs haven’t picked it up yet and are suggesting it to everyone already. :)
Hi, I’m curious about medicine in general and I’m considering going back to school.
what formal education do you recommend so that I can better understand this data?
It’s clear you’ve dealt with anxiety before, but this analysis is super thorough!
And thank you for quickly fixing that mistake - that could have really harmed someone.
Colon Blow: "It would take over 30,000 bowls. [ a giant pyramid of cereal bowls shoots up from under the man, who yells in terror as it rises ] To eat that much oat bran, you’d have to eat ten bowls a day, every day for eight and a half years."
https://snltranscripts.jt.org/89/89ecolonblow.phtml
That would be 5g. At this point everyone should notice that something is off. :-D 5000 mg of vitamin D3 = 200,000,000 IU (200 million IU)
People don't always realize: https://www.chemistryworld.com/news/university-fined-in-caff...
Wow that must be hell
More often written as 200,000 IU as 5000mg of D3 is not written as 5,000,000mcg
The author simply (and terrible mistaking) typed [mg] instead of [UI] in the first paragraph: if readed entirely, the author correct this typo in every other sentence
Still it needs proof reading and definitely a BIG WARNING that anyone who reads the article should first talk with their doctor before trying any "recommendations". Some of these "recommendations" could literally kill someone.
I bought the once weekly 50,000IU bottle on Amazon and am currently taking 4 a day and I am ignoring all growing signs of vitamin D toxicity because I read this guys blog and never once ever decided to consult another source, including later paragraphs in that same blog because there was no warning. Without a warning, you should blindly follow all medical advice you read online.
That is that pathway to death you are worried about?
I was going to say, wouldn't following through on this mistake require you to not just spend a ton of money on pills but also take tons of them a day? I'd like to think this would give even the dumbest of people pause just because of the practicality aspect.
You might be surprised. Medical journals that specialize in reporting one-off cases have some wild articles.
Why didn't the author notice? AI slop?
doctors prescribe vitamins in MG, but they're sold in IU. It's an easy mistake to make.
If you don't have an underlying condition it is way better to get the Vitamin D from the sun in 10-30min increments per day after which you are saturated for the day. Overdose is not possible via the sun (excluding sun burns of course).
> A single, optimal sun exposure session might produce the equivalent of 10,000 to 25,000 IU from a supplement, but it will not keep increasing with more time in the sun. That's your max per session.
From NHS Scotland:
"In Scotland, we only get enough of the right kind of sunlight for our bodies to make vitamin D between April and September, mostly between 11am and 3pm."
https://www.nhsinform.scot/healthy-living/food-and-nutrition...
Personally I found that taking Vitamin D supplements made quite a bit of difference - and I spend a fair amount of time outside (~3 hours each day).
And in Norway we often don't see the sun during certain months, due to it only being up for a few hours in the middle of the day (when we're working). And even if I was outside I would be covered in clothes.
We have a saying here to take cod liver oil all months ending with R (in Norwegian that's September to Februar) to get both omega 3 and the vitamin D.
Indeed, I was going to add that Scotland isn't really that far North (or indeed South) so there will be lots of places where the problem is far worse!
In winter, even on a sunny day, only tiny fraction of your skin is exposed to sun. 10-30 min of sun when you are wearing tshirt and shorts is much different from 10-30 min of sun when you are wearing long sleeves, gloves, and a scarf.
It's not really the exposed skin that's the issue. At higher latitudes the ultraviolet (UVB) gets scattered by the longer path through the atmosphere and so even if you were naked you still wouldn't be getting enough.
Check local/national advice. In many places it is officially advised to take vitamin D supplements, especially in winter or if you have a darker skin tone.
Yeaaah, in Finland the sun just fucks off for multiple months over the winter.
It's much cheaper to take a few pills than it is to travel 3000km south to see the sun for 30 minutes :D
We even put Vitamin D in milk by default just so that people would get some extra.
Don’t guess; just get your vitamin D levels tested. It’s $20, you can just buy it à la carte.
For some people even in sunny areas, 5000 IU might be needed to get you in-range. This is highly individual.
> it is way better to get the Vitamin D from the sun in 10-30min increments per day
spoken like someone who has never lived in the UK
Your suggestion sounds a bit detached from reality of many people.
In many countries it is physically impossible to get enough vitamin D from the sun, even if you go out naked.
Also did you ever notice that the cheap apartments in many places are facing north and do not have a balcony, and of course do not have a private garden? Now you are reduced to going to a park which in the "cheap" areas is also not a good spot to chill for 30 minutes.
I would argue to do both in the winter, since sunlight has other benefits than just Vitamin D synthesis, like mitochondrial health and better circadian signaling for better sleep quality.
Agreed, but I live in Sweden so I take vitamin D supplements every winter.
During the spring, summer, fall months I barely need it since I'm outside so much with my dog.
This is nonsense advice for pretty much anybody that is shovelling snow right now.
Why don't you just travel to the south during winter? /s
Next time I get sunburn I'm calling it a vitamin D overdose
.. how do you calibrate this against a cloudy sky? It's pretty dark up here at 56 degrees north, and on top of that it's been overcast for days.
It also sucks a lot when it's dark before starting work, dark after leaving work, and during the day rather cold to be exposing skin to the sun.
Isn't the oral intake pretty much negligible anyway? I remember getting a vitamin d supplement in a syringe (to be put on bread, from a physician) containing a very large dosis.
I'm not stating the dosage is wrong. Looks like it is anyway.
Oral has felt very effective for me. I take a daily supplement that has roughly 100% of the recommended daily dose of everything. I split it in half.
For D3, it is 25mcg / 1000 IU / 125%
After splitting in half it's 12.5 mcg / 500 IU / 62.5%.
I take with some fat-containing food to allow ir to absorb which is usually breakfast (yogurt, some nuts, some kind of fruit, oats), and it's a night and day difference in my mood (how easily I can control my temper if already agitated, how easily I brush off annoying stuff, takes the intensity off of my reactions and mood during conversations).
I did a blood test before starting, and if normal is between 30 - 70, I was at 10. Dr prescribed megadose of D2, followed by daily D3, but I skipped on the megadose and went straight to D3 -- makes me wonder if a megadose would build up my stores since D is fat-soluble and make it so I could miss a day and not notice.
All of the above is anecdotal from me, a self-professed cave dweller, but it's been a couple of years now, and I still notice the difference. Also, what I heard from people in Boston is that 90% of them are on a vitamin D supplement. My friend from there laughed at me when I was raving about it, saying "yeah, literally everyone here is on it".
It is easily possible to overdose on oral Vitamin D tablets and damage your body.
Source? There have been many articles on HN showing the RDA to be ~10x too low (something like 5,000 IU) and that the daily safety limit to be significantly higher than that (something like 30,000 IU).
Edit: for clarity I am not saying it is impossible to overdose on oral tablets, but rather that with most tablets 400 IU to 1000 IU and the safe limit so much higher than these, it seems like it would be extremely unlikely for someone to be taking 30+ tablets daily. Not impossible, but not easy either.
> Source? There have been many articles on HN showing the RDA to be ~10x too low (something like 5,000 IU) and that the daily safety limit to be significantly higher than that (something like 30,000 IU).
First: the RDA and the safety limit are not the same, and an RDA in a country being too low does not mean that the maximum safe dose is wrong.
And it certainly does not mean that there is a higher risk in under-dosing than overdosing when taking the RDA (which already includes recommendations for supplementing if you spend most of your time indoors).
I'm not a scientist, so I only know what physicians told me and what's explained in news publications or by consumer advocacy non-profits.
Here are a study (which I didn't read) and the NHS's advise on Vitamin D toxicity:
https://www.ncbi.nlm.nih.gov/books/NBK557876/
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
The study says:
> Most cases of vitamin D toxicity resolve without serious complications or sequelae. However, in some instances, severe hypercalcemia can lead to acute renal failure requiring hemodialysis. Cases of permanent renal damage due to vitamin D toxicity are rare.
Which sounds good, but I don't think it supports that there is no risk of oral Vitamin D overdose.
The first link makes the problem sound like it can happen to anyone, but then when you tease out the details;
* Toxicity resulting from lack of monitoring is frequently seen in patients requiring high doses to treat ailments like osteoporosis, renal osteodystrophy, psoriasis, gastric bypass surgery, celiac, or inflammatory bowel disease.
* Patients who are on high doses of Vitamin D and taking inadvertently increased amounts of highly fortified milk are also at increased risk for vitamin D toxicity.
* According to the latest report from America's Poison Centers (APC), there were 11,718 cases of vitamin D exposure recorded in the National Poison Data System. More than half of these cases were in children younger than 5 years.
* The clinical signs and symptoms of vitamin D toxicity manifest from hypercalcemia's effects.
* Clinical management of vitamin D toxicity is mainly supportive and focuses on lowering calcium levels.
* Isotonic saline should be used to correct dehydration and increase renal calcium clearance.
A lot of those point to people drinking too much milk! (enriched milk)
* People with osteoporosis thinking "I better drink more milk for strong bones" when they are already on supplements/medicine.
* Kids drinking lots of milk and presumably not drinking any water - hence the dehydration.
PS: There are a lot of people out there that don't drink any water, and stick to juice or milk or soda, etc. They are not always fat, but that doesn't mean they don't have issues.
I've read the article by now and I like it. It's balanced, more so than the comment section made me think.
And my takeaway is not that everyone should be taking 10k IE, but it's a great reminder to be more consistent in taking my Vitamin capsules in winter.
I'm still standing by my point that it's "easy" to overdose on Vitamin D. Like the article already mentions, one should remember possible kidney issues and not take insane doses of it.
What the recommended daily intake should be, I don't know.
The whole reason I'm commenting on this is I used to take one of the "top" antidepressants on this list.
And I am a skeptic of antidepressants, that doesn't mean I deny all positive effects in people who are prescribed them, of course.
For what it's worth, it's also easy to overdose on Venlafaxine. It's still considered safe.
Just an example to make clear that my comment was not a critique of taking Vitamin D in general.
I don't find the article's main point surprising though. That's the reason I'm taking Vitamin D, too. Doesn't mean that it's impossible to overdose, and this point is also important, because many people still think that it would be impossible to take too much of an vitamin or mineral. Thankfully, high-dose Vitamin A / retinol supplements are not as widespread.
Why would you not be able to overdose orally? It's not like it stops absorbing past a certain dose, and there is such a thing as too much (especially if vitamin k2 is lacking)
That's a bit of a non-sequitur, isn't it? The debated point is how oral intake as a delivery method can pan out specifically (and its limits), not the dosage limits of Vitamin D in general. Think consuming a drug vs injecting it.
I do know somebody taking way more than 30k/day though.
Seems to be a thing in conspiracy theories "they try to hide those simple tricks from you (drinking bleach, ivamectin, 100k D3, ...)
It may not be that crazy in fact, unless it's prolonged. Don't take 30k/day for several months without supervision, but doing that for a single month is unlikely to harm you if you start from deficiency. Some people may need even more than that.
In any case, keep your blood levels in check. It's cheap and easy. There are even services you can order to have your blood sample taken at your home.
I would say it's almost impossible with typical packaging. What makes it easy?
That’s a large enough error that it calls the rest of the writing into question, in my opinion.
Also, be careful taking 5000 IU/day of Vitamin D. I did this for a few months and it was enough to send my blood levels over the top of the range, even in winter.
Too much Vitamin D is not good for you. The supplement fans have gone too far in recommending too high of dosages. My doctor said she’s seeing a lot of people with excessively high Vitamin D levels now that it has become popular.
It's usually pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
> It's pretty hard to get to toxic levels though, most people that don't live in a particularly sunny climate won't get anywhere near there on 5000 IU/day.
No, that’s literally what I was doing when I reached the excessive range: 5000 IU/day in winter with an indoor job.
This commonly repeated idea that everyone is deficient and you can’t overdose on 5000 IU/day is wrong.
> Just test your blood levels before you start and then after 3 months or so. It's quick and cheap, and the only way to know whether the dose is right.
Literally what I did.
Every time I explain this online it seems like the supplement people ignore what I wrote and just parrot the same “5000 IU/day and everyone is so deficient you can’t overdose” myth.
> No, that’s literally what I was doing when I reached the excessive range:
That doesn't make it easy for most people. In my case it was barely enough to move the needle, but that's not how it will be for most people either.
> you can’t overdose on 5000 IU/day is wrong
Of course you can (though it would usually have to be really prolonged to actually cause you troubles, and even then it's mostly due to calcium rather than vit D itself). The vast majority of people won't, but you don't know whether you're in that group or not until you test yourself.
> Literally what I did.
That's good, but my post obviously used plural "you" as a general advice.
(BTW. There's no evidence of toxicity below blood level of 150 ng/ml, but there are many guidelines that consider levels way below that, such as 50 ng/ml, as "too high" already)
It can also be at non-toxic levels but still cause arterial calcification.
So 5000 IU is the recommended amount?
This was linked on here a couple of months ago: [The Big Vitamin D Mistake [2017]](https://pmc.ncbi.nlm.nih.gov/articles/PMC5541280/)
> A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L.
> This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
> ...
> Since 10 000 IU/d is needed to achieve 100 nmol/L [9], except for individuals with vitamin D hypersensitivity, and since there is no evidence of adverse effects associated with serum 25(OH)D levels <140 nmol/L, leaving a considerable margin of safety for efforts to raise the population-wide concentration to around 100 nmol/L, the doses we propose could be used to reach the level of 75 nmol/L or preferably 100 nmol/L.
Multiple previous discussions:
https://hn.algolia.com/?q=vitamin+d+mistake
Vitamin D is a favorite topic around here:
https://hn.algolia.com/?q=vitamin+d
It depends. I have MS and I take 10k IU. My cousin who also has MS takes 20k but gets regular blood tests for it.
According to what I read in a newspaper article, the recommended dose is much lower, at 800.
According to the internet, it is way higher, probably over 9000.
Edit because the comment might be to shallow for HN: I sympathize with the struggle against depression and, after first-hand experience, share the skepticism against the widespread prescription of antidepressants and the methods of evidence presented for it.
Very serious and important topic.
Regarding Vitamin D, I am also supplementing in the Winter, but I have not read the article, which says it has an estimated reading time > 10min. I use one 1000IE (0.025mg according to the package) tablet a day max.
I'll bookmark this discussion page to read TFA later maybe.
It’s important to take Vitamin D, as a fat soluble vitamin, with dietary fat during a meal. Something about bile production and absorption.
Also important to take it with Vitamin K.
Yes, I remember that and have Vitamin D+K combo tablets with calcium.
Seems like it would be best to increase time spent outdoors though.
There's likely significant individual variation in bioavailability. I would start with 2-5K/day, then measure and iterate.
With K3! Otherwise you're fucking yourself up.
Oh dear, here we go again.
IU, not mg.
K2, not K3.
I was taking 2x2000 IU with almost no sun exposure and then did bloodwork. My level was 77.8 ng/mL. The lab's reference ranges listed 30-50 ng/mL as optimal, 50-100 as high, over 100 as potentially toxic, and over 200 as toxic.
I don't know why this is downvoted, I had a very similar experience a while back. I took 4000 IU/day for about 4 months, insignificant sun exposure and ended up at 60 ng/mL (lab listed normal range as 30-40).
My starting levels were unknown but I assumed they were low given my usual sun exposure and some low-energy symptoms (which resolved a couple of weeks after I started taking it). I discontinued VitD then and now I only take 1000 IU/day in the winter.
5000 IU is very high, might be beneficial during the winter for folks with very fair skin. but most probably shouldn't take that much every day
You mean very dark skin?
It's my understanding that northern Europeans evolved fair skin in order to cope with the lack of vitamin D in their diet.
yes, i had it backwards - thanks for the correction.
You got it backwards, it would be more beneficial in areas with few hours of sun for darker skin folks, since they do not absorb as much Vitamin D as fair skin folk do.
absorb or create?
i understand it as: absorbing is in the intestine, generating D happens in the skin when exposed to the sun
Correct, what I meant was absorbing UV light, that then as you state creates D.
That's equivalent to about 10 minutes of sun exposure. Not very much when you look at it that way.
That comparison doesn't work. Only 10-20% of the vitamin D we intake is delivered through food and the body cannot process more sourcing from food. Even if you take more you will not benefit in an unlimited way, processing more. The skin is much better at generating/making/doing it.
The skin is definitely much better, but a higher than "recommended" dose is definitely (anecdata) effective at bringing up and maintaining the measureable Vitamin D3 level in your blood if you are under the recommended range. It's an important metric to track in your regular blood tests.
I think you mean for those with very dark skin, not fair?
Even 5000IU a day is huge and will likely result in calcium buildup.
yes, once i saw that i stopped reading. if the author can't get that right i am not going to trust anything else they say.
Is "IU" another case of xkcd 927?
No, it's to make it easier to dose different kind of biologically active substances. They can have significantly different "recommended weight to eat of this per day", IUs make that sort-of comparable and easier to remember.
https://en.wikipedia.org/wiki/International_unit
The usability issue with IUs is that people are used to scales measuring weight and containers measuring volume, but an IU is different for each substance.
Another issue is insulin syringes are labeled in "insulin units," which hapless folks reasonably assume can be abbreviated "IU."
If you are measuring out a certain number of IUs, and your calculator or formula hasn't asked you which substance you're working with, you're gonna have a bad time.
I used an LLM to summarize and it told me 5000 IU.
Wow, so what value is there in LLM slop exctracted from already dubious self-medication advice?
They're saying that it successfully filtered out the bit where the author told people to overdose by 40000x. I guess that's the value.
There would be value if it pointed out the mistake instead of hallucinating a correction.
GPT5.2 does catch it and warns to not trust anything else in the post, saying no competent person would confuse these units.
I wonder if even the simplest LLM would make this particular mistake.
IU was correctly used everywhere else in the article except that one place with the mistak, so the LLM didn't hallucinate a correction, it correctly summarized what the bulk of the article actually said.
Only recently again I read in the newspaper, that most products are overdosed. There is a typical number that the vitamin D products usually show, and in the article it said, that only up to 800 IU is safe, and everything above is an overdose. There are many products out there with 2000 UI or maybe even more. Beware.
EDIT: Wow, the HN-local doctors at it again. Imagine getting downvoted for sharing information from newspaper article (and honestly labeling that info as such), that probably was written by someone consulting medical professionals. But hey HN will know better!
Being at the beach (in summer) for a half an hour will produce 10,000 and 25,000 IU for the average european.
See: Vitamin D and health: evolution, biologic functions, and recommended dietary intakes for vitamin D (293 citations)
Could you cite that claim from the paper?
Not OP, but the paper says on page 8
> An adult in a bathing suit exposed to 1 minimal erythemal dose of ultraviolet radiation (a slight pinkness to the skin 24 h after exposure) was found to be equivalent to ingesting between 10,000 and 25,000 IU of vitamin D (Fig. 6).
Doesn't say 30 minutes, but it may be 30 minutes depending on your skin colour and the local strength of the sun.
I think the OP's interpretation of this is wrong. Just because someone was found to have an equivalent of ingesting so and so much, after UV radiation, doesn't automatically imply that it a good idea to ingest any amount of vitamin D. Ingestion is different from exposing skin to UV/sun. The paper probably doesn't state, that ingesting that much will make a person absorb that much from that ingestion, nor does it state, that ingesting some equivalent amount will be safe and without side-effects.
So the paper may be well researched or whatever, but the interpretation of it is questionable.
I can't make any assesment on the quality of the paper as that is far outside my expertise, but as far as I can tell from a quick skim it does indeed make the claim that recommendations for supplements should be significantly increased.
From the abstract:
> The safe upper limit for children can easily be increased to 2,000 IU of vitamin D/day, and for adults, up to 10,000 IU of vitamin D/day has been shown to be safe. The goal of this chapter is to give a broad perspective about vitamin D and to introduce the reader to the vitamin D deficiency pandemic and its insidious consequences on health that will be reviewed in more detail in the ensuing chapters
The full article is available on researchgate[1]. Direct link to PDF [2].
[1] https://www.researchgate.net/publication/226676251_Vitamin_D...
[2] https://www.researchgate.net/profile/Michael-Holick/publicat...
EDIT: I just looked up the author, Michael F. Holick. Apparently he is one the people who identified calcitriol in 1971. I know appeal to authority doesn't prove anything, but it might be prudent to at least consider his findings.
So? What's your claim here? Are you claiming that our skin works the same way as our digestive system? That would be a ridiculous claim. And fyi, many people get a proper sunburn, if they stayed in the sun for 30 min straight without protection, at least in summer. So your 30 min statistic doesn't really tell us anything about something being healthy or not.
I've given you everything you need to find out for yourself. Your incredulity on this is a self-confession.
What you have given is rather a comparison, that doesn't stand up even the slightest scrutiny, and an improper citation. I am not gonna read a whole paper on a whim. Cite properly, with proper hyperlink, and at least a page number, and I will consider looking at it.
Before I take medical advice from a newspaper, I might as well ask my local esoteric nut.
Can you provide a link to the newspaper article at least while whining about the downvotes?
I would like to, but I cannot, since it is a region-local newspaper that comes as actual paper, that only has a paid online offer, to which I have no access, nor could I post a link to that. If I went through recent paper form newspaper, I could get a photo of the text in German, but then I would (A) need to spend that time, and (B) need a place to upload pictures, without having to make an account, and only then get back to you with a link. To be honest, I am too lazy to do that, just to justify a comment on HN.
Understandable, but you wrote all of that and you still haven't even named the newspaper.
That's not unreasonable, but then you also didn't really "cite" your source. Even without photographing the paper, giving the name of it, article title, or author would go a long way.
I think the downvotes are harsh btw and in general HNers have gotten too reflexively downvoting IMHO.
perhaps citing a source would be helpful
Misinformation. Do more research.
If you have useful information to share, please do so. Telling people "Do more research" adds nothing to the conversation.
Examine.com's page on Vitamin D has a table on tolerable upper levels segmented by age ranges.
https://examine.com/supplements/vitamin-d/
Neither does "I read in the newspaper, that most products are overdosed" to the honest.
While (I think) I agree with you on the facts here, I don't think this type of dismissive comments are that useful either.
Can you give the replyee some pointers, for example? Link to articles or studies that show a different view?
Just Google it. There's tons of research on this so I don't know why I need to provide a specific link when this is common knowledge.
But also here is something to think about: your body will produce more D3 than that by being in the sun for just several minutes. So if you consider such a low dose of D3 an overdose then you better steer clear of the sun!
> But also here is something to think about: your body will produce more D3 than that by being in the sun for just several minutes. So if you consider such a low dose of D3 an overdose then you better steer clear of the sun!
This is another superficial statement, that displays shallow-at-best understanding. Staying in the sun and producing via the skin, and intake via food are 2 separate pathways. You cannot just make wild assumptions about one of those pathways from stuff you know about the other pathway.
And actually: Yes, you shouldn't stay in the sun for too long without proper protection. Having the sun shine on your skin is not some inherently healthy thing. It too comes with acceptable dosage and overdose. Symptoms of overdose are commonly known as getting a sunburn.
Thanks for clearing that up for me.
The problem with "Just Google it" that you can find a lot of bullshit on this.
You can find scientific papers on Google if you know how to use it.
You can find scientific papers on a lot of search engines, not only Google.
The problem with that is, that you still need to know how to interpret any results and statements within the supposedly scientific papers. If you are not a statistician, you might overlook methodology mistakes. If you are not an expert in the matter of the paper, you might not realize some side condition, that makes some statement or result of the paper irrelevant for your individual situation.
Another overly verbose worthless comment from you. Why do you continue spewing text like this as if you're actually helping anybody?
I do, but surprisingly a lot of people do not.
Hi, Mr. wolf language.
It's unbelievable crazy what the author suggests, even say "10,000 IU if you're feeling daring / have darker skin / live in less sunny climates.".
Just a simple look at the side effects of high dosages:
Safety and side effects
Taken in typical doses, vitamin D is thought to be mainly safe.
But taking too much vitamin D in the form of supplements can be harmful and even deadly. Taking more than 4,000 IU a day of vitamin D might cause:
https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-2...Hi, author of the blog post here! Thanks for your concern. I do still stand by my claim, since more recent peer-reviewed studies have shown that up-to-10,000 IU is safe. As written in the post:
> McCullough et al 2019 gave over thousands of patients 5,000 to 10,000 IU/day, for seven years, and there were zero cases of serious side effects. This is in line with Billington et al 2020, a 3-year-long double-blinded randomized controlled trial, where they found "the safety profile of vitamin D supplementation is similar for doses of 400, 4000, and 10,000 IU/day." (though "mild hypercalcemia" increased from 3% to 9%. IMHO, that's a small cost for reducing the risk of major depression & suicide.)
So why then does Mayoclinic, etc, all say 4000 IU is the limit? I think because policy is decades behind science (this happened with trans fats), and also policymakers are much more risk-averse. (this is why in California, thanks to Prop 65, up until ~2018, there used to be a warning in every coffeehouse that coffee causes cancer.)
But thanks to your comment, I will edit the intro to note what the official max safe dose is, and that more recent peer-reviewed research shows it's too low!
To my understanding Vitamin D is regularly underdosed. Several points:
1) There are lots of studies that correlate Vitamin D production with sunlight exposure. For example, https://pubmed.ncbi.nlm.nih.gov/20398766/ this one lands on 1/4 of a MED = 1000 IU. Of course now we have a MED definition problem, but we're roughly talking single digit numbers for a white person in midday sun in NYC to reach 1/4 of a MED.
2) If you also supplement with Magnesium, a lot of your side effects go away. Vitamin D3 depletes Magnesium absorption.
I've been taking 20,000iu of Vit D daily for years, split into 10k AM/PM
Regularly have my Vit D levels checked and they are always within the upper bounds of healthy reference range
FWIW just anecdotally I took 160,000 IU per day for a few months along with 800mcg to 2mg of K2 MK-7 and about double the suggested amount of magnesium citrate. I slowly titrated up to that amount over a few months. I am not suggesting anyone else do that as I had a specific purpose slow action TPA when combined with many protease so to speak but just my own experience I did not have any of those issues. I don't know how they came up with them so I figure they are just guessing like they did with the toxic level of selenium which has a funny back story. I am back down to 5000 IU a day. Years later still none of those issues. But that is just me.
I did have one issue related to magnesium however. If I did a very high dose of magnesium taurate and a couple of other chelated forms I would have trouble catching my breath after physical exertion similar to chronic high doses of iodine. Not the end of the world but it was unnerving.
Don't anyone else do what I do. I experiment on myself more than scientists experiment on mice minus the whole dissection bit. I am just continuing some experiments from the 1900's but as I understand it AI will be learning all of those soon. Fascinating stuff really.
Hi, I'm the author of the main blog post. Just wanted to say that's a fascinating experience, 160,000 IU a day! I mean, I'm not going to try that, but that's good to hear that 5,000 IU/day for years has been working fine for you. Thanks for sharing!
I respond well to magnesium oxide and magnesium citrate in capsules but the chelated magnesium gives me heart palpitations or makes them more frequent if I am already having them. I hadn't noticed shortness of breath since the palpitations would have outweighed that.
It depends on the person, as a sample size of one I was on 5,000IU and my levels were still on the low end (almost still deficient), and my calcium levels were still safely on the low side as well. Ultimately people should be getting their levels checked before and after to see exactly what the effect on them is
Be careful - many studies in the Vitamin D meta-analysis *enrolled patients already taking antidepressants.* [1] Reporting effect sizes without specifying "on which population?" is misleading.
(As an aside, Cohen would be the person not to tell you to assign qualitative values to effect sizes. They are as arbitrary as any other threshold used by working statisticians.)
[1] https://www.cambridge.org/core/journals/psychological-medici...
EDIT – that is, please don't draw the conclusion that you can substitute supplements for antidepressants. The meta-analyses don't seem designed to examine that hypothesis, and I doubt anyone would ever participate in a such a trial. In general (and as a working biostatistician), I would be very, very, very cautious applying estimates of average effect to myself, you, or any other individual person in a field as murky as psychiatry. That's why even the stingiest American health insurance plans still have an incredibly large range of antidepressants in their formularies.
Hi, author of the blog post here! Thanks for bringing this up -- it wasn't my intention to say one should replace antidepressants with vitamins (the conclusion even says "(Don't quit your existing antidepressants if they're net-positive for you!)", but you're right that the intro may give that impression. I'll edit the intro to say you can stack, not substitute, regular antidepressants.
> many studies in the Vitamin D meta-analysis enrolled patients already taking antidepressants.
Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
Table 1 of the meta-analysis ( https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/ ) shows the raw sub-group analysis. There were 9 studies on patients using antidepressants, 13 on patients who weren't, the rest were Mixed or Not Reported (...how do 6 studies just not report that?) Anyway,
Effect size of Vit D for people on antidepressants: −0.54 (−0.85, −0.23)
Effect size of Vit D for people NOT on antidepressants: −0.28 (−0.40, −0.16)
Both negative. Weirdly, the effect of Vit D seems to be a bit stronger for people on antidepressants, but the difference isn't statistically significant at the p<0.05 level (P subgroup difference is 0.23)
(As for why those effect sizes, -0.54 & -0.28, are lower than what I (and that meta-analysis itself) report, -1.82, that's because the majority of RCTs for any group used far less than 5000 IU. Table 2 in that paper shows the effect (with 95% CI) for various dosages.)
I'll lightly edit my blog post to emphasize stack them, don't substitute. Thanks again for your comment!
> Yes, and that's even more encouraging, that there's still effects of Vitamin D on major depression even if already on antidepressants! This suggests we can "stack" the interventions.
I think the point here is that such a study selects for people where their antidepressants are already known not to work very well for them, or they wouldn't be interested in participating.
Based on your own citation, this is untrue. The citation you have linked is a meta analysis of 31 trials, many of which specify no medication use at recruitment.
You are however correct about population being important (which is a big reason meta analyses can be very useful).
I said "many", not "all". (Many don't indicate, either.)
I saw a thing from HealthyGamerGG youtube[1] that he said one of the things about depression is that it causes/influences one to avoid the things that would make their life less depressing.
eg just to paint the picture: you're depressed so you don't get out of bed, therefore you don't go do your workout, therefore you lack endorphins and look in the mirror and see squishy, you're sad about how squishy you are and so you get more depressed. You're more depressed so you also don't do your dishes, when you do get out of bed you are depressed you feel like a slob and you're squishy, so you get more depressed...
Whereas adding anti-depressants, and other virtuous cycle things like vitD/O3, exercise et al. Give the boost necessary to _make your life less depressing_ ...
So if you know someone who's depressed, it might be helpful to help them make their life less depressing too. (in addition to all the best medical advice!)
[1]- he's a real Dr... Dr. Alok Kanojia (Dr. K), a Harvard-trained psychiatrist (MD, MPH) specializing in modern mental health
>he's a real Dr.
Careful, he is also a believer in Ayurveda[1]. Which basically basically categorizes people into different elements like fire and water and then tries to change their diet and habits to match their elemental style or something. You can hear him talking about it here [2]. Kinda reminds me of Humorism [3]. Dr. K seems like a nice enough guy but don't get too lured in by the "Harvard-trained" credentialism.
[1] https://en.wikipedia.org/wiki/Ayurveda [2] https://www.youtube.com/watch?v=rQ2xnThRGPg [3] https://en.wikipedia.org/wiki/Humorism
I agree there's nuance, but he's way above the "has a webcam and yeti blue" bar that most of youtube falls under, that was my point in putting his credential up. Not to rise him to a perfect status, but to not allow him being on youtube to fall to the minimum bar of youtube.
Definitely agree. He sometimes says things that sound interesting or true, but for the most part I believe he is full of it. The field of psychology is barely removed from charlatanism anyway, having a diploma from Harvard doesn't change that.
I found this to be the case. Tried Sertraline for a while, gave me headaches and made me feel sick. Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped. I also felt quite an extreme uptick because I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood. I suspect one of the main reasons my mental health declined was due to the lack of Omega 3.
Disclaimer, not saying vegans should stop being vegans, just make sure you find a good supplement, and make sure you understand the difference between EPA/DHA Omega 3.
All my nutrient numbers improved when I became vegan because nearly every one in the US/UK is deficient in VitD, Omegas and B12.
Fortunately today’s vegan communities are much more aware of this so I started taking these supplements right up front and all my blood markers improved dramatically since when I consumed meat/dairy.
It’s annoying to hear some push back against this when it’s as simple as taking relatively safe supplements (just make sure you talk to a doctor, and not a social media influencer, about how much you should take, and if you get a chance to regularly check your bloodwork don’t miss out).
My cholesterol improved massively, but over time, a few, such as Omega 3 suffered. But those were ultimately my own fault, wasn't managing it properly. So, I'm absolutely not suggesting there's an issue with veganism, this isn't really why I fell out of it. So I do want to stress I wasn't suggesting people should steer clear of Veganism, just something to be mindful of. Oh, and my cholesterol immediately shot back up again when I stopped being a vegan. So, swings and roundabouts with every diet/lifestyle, I guess!
Why did you become a vegan if apparently even non-vegans are deficient in B12? Do you supplement B12? Since B12 is mainly found in meat, and B12 deficiency is irreversible.
why do you think the reason for them becoming vegan has something to do with B12 levels? likely they became vegan for different reasons, became much more aware of the importance of B12 and started taking a supplement.
every vegan should supplement b12, so they probably do too
> All my nutrient numbers improved when I became vegan because nearly every one in the US/UK is deficient in VitD, Omegas and B12.
> Fortunately today’s vegan communities are much more aware of this so I started taking these supplements right up front and all my blood markers improved dramatically since when I consumed meat/dairy.
Yeah but that sentence does not refer to why the person switched to being vegan, the first one does. In any case, let us not beat the dead horse there. :P Supplement B12 and it is fine.
No sentence referred to why they became vegan. Their nutrient numbers improved when they became vegan. This happened because becoming vegan moved them from a group who didn't know they needed supplements to a group who knew they needed supplements.
> In any case, let us not beat the dead horse there.
You would not have replied if you meant this.
> as part of a new gym plan
There's your answer
Possibly, deffo would have been a big factor. Anecdotally though, I forgot to take these supplements for a while recently, just got out of the habit, and definitely felt worse again for a bit. But, could have been a coincidence/something else
Omega 3 comes from algae, which might be okay for some vegans.
Unlikely any vegan would have any moral qualms about algae, given that they’re not animals. Maybe you were thinking of oysters/clams/bivalves?
What vegans would not be ok with algae?
algerians
@buddhistdude - thank you :) made my day!
I think they meant their vegan diet didn't naturally have Omega 3 in it if they didn't take supplements; not that they couldn't take the supplements once they realised it.
Yeah I took that for a while, and did slightly improve things. Only problem I had at the time was those were super expensive in the UK. Maybe that's changed now
Or fish oil
> Then as part of a new gym plan, started taking Omega 3+VitD daily, and I just felt a sense of calm and peace after a few weeks. The massive uptick in exercise probably also helped
I would bet that 95% of that improvement or more was due to the exercise.
Your anecdote is common: People start taking Vitamin D or fish oil as part of a bigger plan to have a healthier lifestyle and then they attribute success to the pills, not the lifestyle changes.
Possibly, but anecdotally, I went through a period of forgetting to take them again recently, and definitely felt worse again. Sleep started suffering, felt lower energy again. But, could have been a coincidence/something else entirely
I wouldn't bet so eagerly on these lifestyle changes being achievable without these pills.
> I was a vegan for 10 years, and found out I had basically zero Omega 3 in my blood
I see your disclaimer, but just for more context, vegans can get Omega 3 without taking pills per se. Flax seeds are an excellent source. I often add a spoonful to a bowl of oatmeal or as a pancake topping along with fruit sauce and granola.
Grind the flaxseed before eating them so your digestive system can access more of the nutrients in flaxseeds.
from https://www.bhf.org.uk/informationsupport/heart-matters-maga... :
from https://www.peoplespharmacy.com/articles/must-you-grind-flax...Flax seeds are a very tedious and inefficient way to get omega-3 as a vegan, particularly because they contain ALA, a short chain omega-3, which our bodies are extremely inefficient at turning into long chain fatty acids.
Just get an algae oil based DHA+EPA supplement.
Flax seeds & other seeds provide ALA but not EPA & DHA. You need all 3.
The body has some ability to convert ALA to EPA & DHA, but at extremely low rates (particularly for DHA) - it's not a consideration in practice.
So no, eating seeds will not fulfill your body's requirements.
Flaxseeds are probably the most flavorless things I've ever tasted.
Chia seeds taste ok but you need to prep them by soaking which is a pain (or experience bloating).
All other seeds have more omega 6 than omega 3.
Funny - I feel the opposite about chia. Soaked and plumped is when I hate them. Dry on salads/etc. or just submerged in an active bowl I'm eating is when I like them most - the crunch adds texture to what I'm eating.
With depression it is important to find the cause of it.
You might be depressed because you life objectively sucks. Then you symptoms are good and healthy and a signal to make changes in your circumstances.
You might actually have a good life but still feel depressed because there is a chemical imbalance in your brain. (Very simplified). That is when drugs come in.
It might be just a seasonal thing and you need to go outside more and take some supplements.
You might have some other undiagnosed issue. You might have ADHD, autism and other things that cause you to struggle and develop depression as a side effect.
So find out what works and what doesn't work for you.
The problem with the "your life objectively sucks" option is when you end up too depressed to actually bother doing anything and just give up. That's another case where drugs can help.
You mean relatively sucks. Else every single human ancestor would have to be super depressed too given the standard of life in the past.
Objectively in the sense that there are actual causes in you life that distress you and cause your symptoms instead of thinking your life is shitty because you are depressed. Of course being able to determine if it is your depression talking or if things are objectively bad isn't easy and people often need outside help from a therapist for that. Plus it isn't really clear cut in practice.
On a sidenote, I know that knowing that it is "just your depression talking" is also a pretty hard pill to swallow and not always helpful. Personally I have a lot of fears that I know are irrational but that doesn't make them any less real.
And even if your problems are external, sometimes you need to focus and your inner self first, find some strength and help so you can tackle the external problems later. But for other people "working on yourself" can be avoiding the actual problems they need to work on.
And yes happiness is always relative.
I don't think that's true. I think that just shows how disconnected we are.
We tell ourselves that we must have "better lives" than say a native american in the year 1000AD, but there's no reason to think that.
I think odds are that maybe the native american was happier -- having a small group that you spend time with outdoors every day, getting extensive exercise, having a clear sense of purpose, eating healthy fresh food every day, never once thinking about politics or bills or global warming. I bet they liked their life more than a depressed divorced accountant in our modern society, even if we have more material wealth or health access.
I guess there are different types of "life sucks" that can or cannot contribute to depression, my current understanding is that a lot of it depends on whether you feel you have some control over the situation or if you think you have absolutely no power over it
According to Victor Frankl (psychiatrist concentration camp survivor, author of Man's Search for Meaning) being in a shitty situation without any control over it isn't necessarily bad. Humans can still be mentally okay in the face of extreme unavoidable suffering like in the camps. The key thing is that you need to have some purpose / meaning in life (often a loved one or dependent).
Isn't people in the past had less control? There were dying from infections and not only had no vaccines and drugs they didn't understand how infections are spread. They also suffered from various natural disasters not having a protection a modern civilization gives us.
I don't know enough about how people lived in the past but I would tend to agree with you that they might have had less control than us on many things. But what I meant was that it depends on how much control you *think* you have rather than the control you actually have. So I think a lot of it is about perception, in 100 years time people might wonder why we weren't all depressed because we had a life expectancy of "just" 80/90 years, but for us it's just normal and expected
> You might be depressed because you life objectively sucks
The problem with this that to a bad situation different people react differently - some trying to do what they can to improve the situation or at least don't make it worse and some give up and let situation to slip and become worse and worse (becoming a self fulfilling prophesy). It's not a choose one makes I think (it's likely a biological predisposition) but the difference is still exists.
People prone to depression genuinely believe the main (only) reason for a depression that the life sucks and as a result they avoid medical help and don't do anything which could help them.
This stuff is complex. There are no magic potions or hacks that work for everyone. No amount of positive thinking can fix physiological issues that you have because of some underlying condition. But it's quite possible to create new issues as a side effect of being depressed, stressed, chronically exhausted, etc. So, working on those issues is probably smart.
And each of those things can be caused by physiological issues as well. You might feel stressed because you don't sleep well. You might sleep poorly because you suffer from e.g. sleep Apnea. Which in turn might be because of a mix of physiological and other reasons (diet, weight, alcohol abuse, etc.).
Or you might be working too hard, which makes you stressed and causes you to lose a lot of sleep. Different causes that have similar results. Including long term physiological results. Your brain can actually get damaged if you chronically abuse it or neglect it. Many "between the ears" type problems are actually physiological.
Root causing your issues enables you to deal with them properly instead of fighting the symptoms.
Anyway, I take vitamin D and a few other things. Getting yourself checked out regularly once you hit middle age is a good idea. There's a lot of stuff that is long term lethal that a checkup can detect early. And some of it is fixable. I have the usual cardio vascular challenges that many people struggle with because of a combination of genetics, age, and life style. And indeed a vitamin D deficit.
I was also recommended to consume more omega-3 as well. Eat salmon. Work some flax/chia seeds in your breakfast. I put flax seeds in my yogurt and use it as a thickener in sauces as well. You have to grind it to dust for it to get absorbed properly. Dirt cheap and it doesn't mess with flavor/texture too much. I keep a jar of ground flax seeds in my fridge. Takes 2 minutes to top it up every 1-2 weeks or so with some freshly ground seeds.
But I'm also aware that me being a stressed startup founder has health consequences that a few pills and suplements won't fix for me. I need to actively make sure I get my rest and sleep. I deal a lot better with stressful situations when I'm well rested. And I seem to be better at avoiding getting in to those as well. And I feel happier. Sometimes the best thing I can do for my company is having a proper weekend or going to bed early enough that I can get my 8 hours of sleep. You can survive on 4 hours (been there done that), for a while. But most people are not at their peak performance if they do that. And it's not good for you to work yourself to exhaustion all the time.
Most people's lives objectively suck. Most of them are not depressed.
Pinpointing problems in your life as the cause of your depression is a trap.
That's the sorta standard socially accepted way of thinking about this. but uh... to a lot of people it doesn't ring quite true.
For example: if your life objectively sucks, why aren't you doing anything about it? Some people whose lives suck fix their lives, and other people get depressed and do nothing; what's the difference? And: all of us know somebody who appears to have a good life and therefore their depression is presumably a chemical imbalance thing but if you're being honest the vibes in their life are a bit off, actually, like you can tell they're not really getting everything they need out of it, that they're clearly good at masking (for example people who are clearly not thriving in their relationships) .... in which case sure medication could help but you can't shake the feeling that facing the reality of their life would help a lot more.
However! Questioning this stuff becomes a bit of a moral minefield. "Believing" in the chemical imbalance theory is part of why it's medically helpful. If your life has sucked for years and you could find no way of fixing it and then SSRIs helped, then you basically need to believe that it really was a chemical imbalance, because believing that it might not be threatens to take away the thing that's making your life work. So much so that I would bet at this point there are already readers of this comment who are ready to angrily reply to my preceding paragraphs, because the model I just described threatens their existence. (If so, wait a sec and read the rest...)
On the flip side, for some people not believing in the chemical imbalance model for some particular case might be important. Maybe they want to feel responsible for their life being bad, so they will be motivated to do something about it, and being happy due to drugs would make them feel complacent and okay with years passing by at a shitty job or something. Or picture someone whose parent has gone their whole life unable to take them seriously as an adult, which as a result means the child and parent have a bad relationship, and then picture the parent complaining about depression and taking medication for it. This can be really infuriating: the child thinks about the parent, "your life sucks because of the tension created by not treating people around you with respect, and you're so incapable of recognizing this even when it's told to your face regularly that you're taking drugs to feel better despite not fixing the problem". Now ascribing depression to medical problems seems like avoidance, and having people write off your frustrations and say that you're just depressed and need to take a drug for it is frustrating.
Just saying: the two narratives really get tangled up. I don't really know what to do about it, but I do think that some harm is done by harping on the concept of a "chemical imbalance". A lot of the issue is avoided if you just think of the drugs as helpful but don't choose any model (with its moral implications) for what exactly it is they're helping with. Just treat them as a tool for making you feel better.
Also, I suspect that people who have an intuitive aversion to mental health drugs are probably way overindexing on that intuition. I definitely did this for a long time, as did some friends I knew growing up. Turns out whatever your issues you can sometimes just deal with them sooner than later if you accept that doctors might be onto something. (Actually I think the reason people get stuck avoiding medication for so long is precisely that they feel like they're not allowed to be skeptical of them... which makes them kinda plant their feet in the ground and refuse to be open to it. That's kinda why I'm typing this long comment, to tell anyone reading that it is a reasonable thing to feel. And now that you know that maybe try them anyway..?)
The first thing I would do in case of depression is to make sure that the patient's energy levels are good and that mitochondria and other energy-related biochem phenomena work as expected.
I know first-hand that low energy-levels and lacking energy production mechanically lead to depression.
Also, look at how people (children also) experience the world and their relationships and their stresses when they are tired (or even just hungry) compared to when they are fit...
Fix those, and the depression might be gone.
This is not bashing against anti-depressants, they play their role to. But in some cases, energy-management is key.
Thank you for the comment. This is not in my area of expertise, so I hope you can clarify - how does one test that "mitochondria and other energy-related biochem phenomena work as expected"?
There are tests out there like https://www.chrismasterjohn-phd.com/mitome
(No affiliation, just have been subscribed to the founder’s substack for a while)
Chris Masterjohn is a noted quack. He takes bits of actual science and research and weaves them together into narratives that make it sound like he has everything figured out with his unique protocols, but it doesn’t hold up to actual scrutiny. People spend years following his ever changing protocols without getting anywhere (beyond placebo effect and a large bill for supplements)
I know I won’t convince the parent commenter but hopefully I can convince other readers not to go down this road or invest any money in anything related to him.
Pure ad hominem FUD. “This guy sometimes disagrees with scientists employed by the government, don’t listen to him!”.
The technical details are beyond my understanding but I’ve heard from a PhD in the field that Masterjohn’s understanding of metabolism is second to none. Whether his protocols work or not is certainly a case by case matter (like any health protocol), but he always appears to substantiate it with well-cited lines of argument, and is willing to engage with interlocutors.
As for spending years with changing protocols without getting anywhere besides spending lots of money, well that can be said for people with complex issues who go the institutionally approved route as well. It isn’t discrediting in its own right that a protocol didn’t work for some.
Second the question
Just as an example, here is a small part of it: MTFHR mutation causes megaloblastic anemia: https://news.ycombinator.com/item?id=45085439
It's interesting that one way to improve mitochondrial dysfunction is getting sunlight, the same way you get Vitamin D.
> A 2014 systematic review concluded that vitamin D supplementation does not reduce depressive symptoms overall but may have a moderate benefit for patients with clinically significant depression, though more high-quality studies were determined to be needed.
https://en.wikipedia.org/wiki/Vitamin_D#Depression
The meta-analysis cited in the article is from 2024 and specifically mentions the Shaffer et al. 2014 review cited by Wikipedia as being low quality:
> Some of the available reviews, owing to the limited number of trials and methodological biases, were of low quality (Anglin et al., 2013; Cheng et al., 2020; Li et al., 2014; Shaffer et al., 2014).
https://pmc.ncbi.nlm.nih.gov/articles/PMC11650176/
Therefore what to do? I have seen these Hacker News vitamin D ads appear every few months for the past 15 years, or so. I always seem to have a vitamin D deficiency, so it reminds me to take supplements. I take them for a few months, hoping to see a change, but I don't feel any benefit. Then, I forget to take the supplements until the next time I see an ad. How to know if they're actually doing something useful?
Until you see an article like this which calls for '5000 mg' of supplementation, decide that you didn't take enough and overdose...
HN and dubious self-medication advice go hand-in-hand. Please consult a medical professional instead of a bunch of ad-tech devs.
Remember when HN had an entire year of articles about how we should all be on microdoses of various hallucinogenic and psychoactive substances for "peak performance"?
Good times.
HN is as bad at medicine as it is at everything else.
No, I was here just for the year in which they ended COVID with vitamin D. With the weekly (n=5) articles garnered with blog posts from randos swearing by it...
you could make a decision informed by actual information, i.e. your blood levels
If you're not in the respective fields it can be pretty difficult to distinguish good from bad research. I am not able to do so.
If you (or your close ones) don't suffer from depression, then I guess it's best to ignore it until scientific consensus has formed. That will for sure show up on wikipedia. As far as I can see as a layperson there is a lot of correlation with Vitamin D that breaks down in interventions and Vitamin D is recommended mostly for babies and elderly people. On the other hand I see Vitamin D pushed as a miracle drug not unlike Vitamin C used to some decades ago and regular reports of overdosing of supplements leading to organ failure.
If you're suffering from depression, you should talk to your doctor. They will be able to help you to weigh potential benefits with risks
Can I just add: In addition to this, if you struggle with anxiety or have some sort of ADHD, then try cutting out caffeine entirely. Not just switching to "decaf" (which isn't), but cutting out tea and coffee, and switching to an alternative like Barleycup.
Doing this has had a massive positive effect for me, and combined with decent nutrition and daily exercise, has been wonderful.
Agreed, anyone that already struggles with something like this should quit caffeine. My life is so much better off of it, but I struggle to stay off of it because I'm addicted to the 2hr productivity boost vs the all-day steadiness when you're not on caffeine. Things that improve for me were: No sense of urgency for every single thing. Significantly improved confidence. Word things better and speak better in general. No hard crash later in the day. All my scattered thoughts become cohesive. No more random heart palpitations.
All of these likely got better due to the overall effect of decreased anxiety and not making ADHD worse. I'm not myself when on caffeine. Nikola Tesla quit all caffeine/other stimulants for a reason.
The silly thing is that when I drank caffeine, the hit from it would make me overcreative. Yes, I might do more, but it probably wasn't what I was supposed to be doing - I'd pursue some new and exciting thing with tremendous fervour, before realising later that it was a load of nonsense.
> Not just switching to "decaf" (which isn't)
Going to argue here, this is wildly bad advice. Decaf practically has no caffeine, it has 2-7 mg from what I can tell which is less then chocolate. 2-7mg is like impossible to notice and might aswell be water with how little there is.
My advice was along the lines of saying, in the 1950s, "give up all cigarettes, not just 'low tar'". Potential straw man here, but surely you wouldn't call that "wildly bad advice".
My comment was predicated on the belief that we wildly underestimate the negative effects of caffeine, as well as its activities at lower doses.
Agree, althouh quiting it altogether might simply help with establishing the new habit.
But replacing it with decaf is also easier to get into.
Yeah, some people need to go cold turkey. Or... Help them out by replacing their coffee with decaf without them knowing. ;D
Downside with going completely off caffeine is you get so tired and unfocused and it lasts for ages.
I tried doing this for almost a full year, and while the improved sleep and generally improved mood was fantastic, and even toward the end it was so much harder to get any focused work done.
I think my average level of useful focus is just simply higher with caffeine. I was off it for three years, which is well beyond the time it would take to lose any tolerance, but never really reverted back to the same level of focus that I get with caffeine.
I'm not sure my overall focus over time is higher with caffeine, but it does allow me to nudge more of it into the useful part of my day. However I'm a fast metaboliser of caffeine, and it doesn't impact my sleep at all, so could be that there's a genetic component to one's experience here.
I have to say that I don't find this at all. I've been off caffeine for years, and I'm perfectly able to focus without it.
Stimulants (of caffeine is one) are the de-facto treatment for ADHD, not entirely unlikely caffeine is keeping me subclinical.
Some stimulants are a treatment for ADHD. Caffeine is not one of them, and whilst there are suggestions it can act as a short-term treatment for some people, it's not recommended.
Actual ADHD meds aren't available to me, so it'll just have to work.
I did the same thing and experienced the same effect.
I'd add that my ability to sleep naturally was negatively affected as side effect of medication. I tried a various combos to induce sleep and found the best solution to just be... exercise.
No caffeine, exercise, sleep lead to a significantly reduced anxiety and more.
I am in the middle of trying this out. When I first stopped caffeine I had better sleep and very vivid dreams every night. I also feel better as I think coffee was making my stomach too acidic which was causing me other indigestion problems, not to mention that coffee was nuking my teeth as well with acid.
Im on week 3 of no coffee now, I will maybe give it a month or two more to make a judgement call if I want to continue with coffee or not.
It is unfortunate as I really enjoy coffee, but it causes some issues for me with anxiety and stomach problems.
> if you struggle with anxiety or have some sort of ADHD
Those are two different things. Cutting out caffeine can help with anxiety but not ADHD. It's the opposite for ADHD, stimulates help significantly.
This is not true. Caffeine is not necessarily helpful for ADHD. It has a different mechanism of action from ADHD stimulants. They are not interchangeable. Not all stimulants help ADHD.
Also there’s a growing trend of diagnosing every focus problem as ADHD when many patients might have focus problems secondary to another condition like anxiety. It’s sadly all too common to find someone who believes they have ADHD due to TikTok self diagnosis or even a lazy doctor’s diagnosis but their core problem is actually anxiety. For these people, stimulants of any kind can actually worsen focus even if then provide a short term perception of helping due to the energy boost.
Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee.
I’m quite sensitive to caffeine, yet I can drink green tea all day without noticing much effect, while even a light coffee or a caffeine pill is clearly noticeable. I can also drink tea before going to sleep without any problems.
> Tea, especially green tea, doesn’t have the same caffeine bioavailability as coffee – otherwise people would abuse it just as much as coffee
You can absolutely get high doses of caffeine from tea if you really want to. It comes down to the type of tea, how much is used, and how strong it’s brewed.
There is nothing special about tea that breaks the rules of caffeine. It comes down to the content of the leaves, quantity, and extraction into water.
> while even a light coffee or a caffeine pill is clearly noticeable
Caffeine pills generally have really high dosages, FYI. Even light coffee drinkers can be caught off guard by how much caffeine is in a typical off the shelf caffeine pill.
> There is nothing special about tea that breaks the rules of caffeine.
There's definitely something special, just poorly studied: typical "how much caffeine is in X?" tables show tea having caffeine levels similar to coffee, but I never feel the same effects.
> Caffeine pills generally have really high dosages, FYI.
I use 200 mg tablets split into quarters for doses of 50–100 mg. Yet, they produce a much milder curve than coffee (which I no longer drink) and, as a side effect, cause no gastrointestinal side effects!
> typical "how much caffeine is in X?" tables show tea having caffeine levels similar to coffee,
I have never seen a caffeine comparison table that shows tea and coffee at the same level.
It’s common knowledge that typical coffee brews are in the range of 2-5X higher in caffeine content than typical tea brews.
Tea is widely used as a lower caffeine alternative to coffee.
Quick search shows various infographics: green tea at 20–35 mg, black tea at 45–50 mg, espresso at 45–75 mg, and instant at 60-80 mg on average. The day I feel anything close from a cup of black tea to what I get from an instant coffee or a quarter of a pure caffeine pill, I might start trusting those numbers, but for now I see them as nonsense that tries to present as science.
There are also other ingredients in coffee and tea that may affect caffeine's effect (L-theanine in many teas for example). Same with energy drinks, these will have a different effect even when the same caffeine intake is the same due to presence of taurine.
i thought that the mechanism in green tea is that it has l-theanine that helps with caffeine jitters/spikes. a bunch of people drink coffee + theanine which gives a much calmer high.
I cut coffee for over 6 months, and one of the most significant thing it did for me is that, when I resumed, I noticed that caffeine actually helped me feel more awake and alert (while I didn't notice any effect when taking a lot of it before stopping cold-turkey)
Fascinating.
Can you describe what else you tried? Other supplements? Any other non-food/supplement techniques like journaling, breathing, etc.? Any therapy and other similar human interventions?
After all those - is it / was it still the case that cutting caffeine drove the best outcome?
Not OP but I'll share my experience. For me, I have to quit caffeine for those to even become an option. Otherwise I get my short burst of productivity then everything shuts down after and I don't want to do a thing, everything feels "impossible" or like it doesn't matter at all.
Things like journaling / breathing / etc calm the nervous system while caffeine stimulates it. I would say caffeine is counterproductive to those practices.
Thanks for sharing.
I briefly quit caffeine once but it as well before any realization of anxiety. So, hard to extrapolate forward from that experience.
What feels different to me (compared to you) is this: sometimes I'll drink 2 cups of coffee in the morning and be awake but useless. Sometimes totally productive. Caffeine in some form is there - recently sometimes substituting coffee for a Celsius.
I am OP, and I can confirm exactly this line of thought. Once I had given up caffeine, I was able to start using methods like Pomodoro and Eisenhower grids, and they actually worked.
How long would you say it takes to feel the effects after switching? I did this a couple of years ago and as far as I remember the only real effect was my energy levels were more stable.
I gave it maybe 2-3 months and decided it's not worth it.
Tempted to give it another shot!
I think some of the positive effects are very quick (better sleep) whereas others take longer to materialise. My wife commented after maybe 2-3 years that I had become much more organised. I think that happened because I came off caffeine and then adapted over time to having a different brain chemistry, so I learned techniques to organise myself that I wouldn't have stuck to had I carried on consuming caffeine.
Very true! I recently found out that i am extremely sensitive to caffeine, and one cup at 6 pm makes me unable to fall asleep at night until 4 am. Trying to cut off the caffeine entirely now.
Yes, I'm sensitive to it, and a slow metaboliser. A lot of people will be in the same boat and not realise it.
I wish I could cut down on my caffeine intake to help my ADHD. Unfortunately, I already have basically zero caffeine intake (apart from diet coke sometimes)
Exercise is another good thing to do on a daily basis. It prevents me from self-medicating with alcohol.
Does walking 1.8 miles to work and back each day count as exercise? :P
Counterpoint, purposely adding caffeine in the form of different mushroom coffees has greatly improved my ADHD symptoms.
As someone from the Middle East, just thinking about not drinking coffee makes me lose my will to live. It’s like asking me to wear sunglasses on a cloudy night.
I love coffee so much, I'd prefer to deal with the anxiety, and I do suffer from it.
Or the addiction just makes you think that this is good for you when actually you'd feel better without it?
It's the smell, texture and taste of coffee I love, not really the caffeine. I tried decaf, doesn't taste the same.
Find better decaf. Caffeine has no taste.
Don't the beans need to be processed to remove the caffeine ?
The quality of the coffee depends on the technique used (and who does it). Yes, most decaf coffees suck, but there are some very good you can find. For example, Arpeggio [1] is for me and few people I know the best of all Nespreso coffees. In specialized coffee bars you can get amazing decafs.
[1]: https://www.nespresso.com/us/en/order/capsules/original/arpe...
You can also get decaf beans, or try to see if you can get used to tea. I do both right now and I feel a lot better
At this point, I mostly avoid prescribed medications and don't take very many things at all regularly. Mostly because I've had some of the worst interpretations of the side effects of most medications I've ever been on. These include hospitalizations and side effects I'm still dealing with years after (looking at you Trulicity/Ozempic)...
I'm usually able to reason or force my way through depression and the like, but have had a few deep bouts in my life. The medications have ranged from ineffective to building a tolerance quickly, to just plain worse than the symptoms being treated. Nothing like missing your highway exit multiple times back and forth because you get lost "in" the drive on medication, or having 140 browser tabs open and losing 5 hours of work time.
Everyone is different. I am amazed at how much western society has so many hormonal issues that come down to the lack of quality or appropriate fatty acid intake and a lack of something as simple as more outdoor/sun time. I think the "low fat/cholesterol" advice for most of the past half century combined with the increase in snacking and junk foods have been massive disservices to humanity as a whole. I wouldn't be surprised if some of the effects are multi-generational in the making either.
My physician prescribed Vitamins D and B12, so a quality Omega 3 is the only supplement I currently purchase.
After an absurd amount of trial and error with every over-the-counter, trendy supplement over the last couple of decades (and lord only knows how much money), these are the only ones that seem to make a subjective difference on my quality of life and an objective difference in my bloodwork.
can vouch for a diet high in fatty fish along with supplementation of D3 + cofactors (K2, A, magnesium, zinc, copper, boron). sample size of one but noticeably improves mood and energy levels.
recent evidence [0] suggests there's not much of a link between serotonin and depression, and therefore the effects of SSRIs are either placebo or an as of yet unexplained mechanism of action. IMHO it seems much more likely that modern lifestyles (excessive screen time, poor diet, lack of socialization, no connection to nature, no spirituality, etc) have more of an effect than serotonin levels.
[0] https://pubmed.ncbi.nlm.nih.gov/35854107/
> due to some quirk of evolution, Omega-3, -6, and -9 are the ones biological life uses most. As far as I can tell, there's no specific reason they're all multiples of 3. Probably just a coincidence.
This curio bothered me as well. I didn't yet get a fully satisfying explanation for this either.
There's this diagram, showing for example the full pathway of how linoleic acid catabolizes: https://commons.wikimedia.org/wiki/File:Linoleic_acid_beta_o...
It shows dependencies of the process onto several very specific molecular machines we call enzymes.
(main pathway, handling saturated fatty acids)
(unsaturated side-branch) These, when viewed as a set of combinators, seem perfectly sufficient to metabolize any fatty acid chain. Their chemistry reads pretty straightforward — and it must deal with cis/trans isomerism shenanigans, with neighboring π-bonds, with odd/even parity of the carbon chain. But it apparently handles all that!Besides catalysis (combustion of the acids for energy), the two other paths for consumed fatty acids are excretion, and laying them into cell walls and membranes. These two paths aren't selective; they mostly don't care about the length of the chain, and where which π-bonds occur in it, if any.
So this must imply, that the "quirk of evolution" lives somewhere on the anabolic (synthesis/production) side of fatty acids; definitely not on the catabolic side.
I can only provide anecdotical evidence, which is ... not evidence, really.
Within my peer group of people on the spectrum (which very often comes with a depression, which is logical) we've discussed Vitamin D studies for years. And multiple of us decided to give it a try for a couple of months. And neither those who tried it INSTEAD of an SSRI, nor those that took both (SSRI + D) could report any measurable difference.
I have a theory on why is that: It is known that low levels of Vitamin D is one likely cause for depression - in Northern Europe, where during winter time people do not get enough sunlight, that correlates very clearly with the suffering of depression.
But potentially it simply does not work the other way round: I moved to near the equator, and I therefore basically have sunlight shining out of my butt, but still am depressed. It makes sense that in this case Vitamin D makes no difference at all.
In summary my theory would be: Vitamin D only has an effect on a depression that was caused by a lack of Vitamin D.
To many people without relevant expertise give medical advice online.
I remember a similar case with levelsio who was advocating people to take melatonin and discussing how much grams is good vs bad. When I said that people shouldn't take medical device from someone who was successful in building web apps, he blocked me.
And better than taking pills for the former, add hemp hearts or flax seeds to your cereal. One serving of hemp hearts has 10 grams of protein and 12 grams of Omegas 3 and 6. Flax seeds are lower in protein but an even better source of Omega 3 in particular.
Never going to advocate against eating whole foods if they taste good! But beware, the ALA omega 3 fat in flax and plant sources is not the DHA and EPA omega 3 fats used by animal cells, and so it's not as potent as what's in fish.
The main problem with ALA is that to have the good effects attributed to omega-3s, it must be converted by a limited supply of enzymes into EPA and DHA. As a result, only a small fraction of it has omega-3's effects — 10%–15%, maybe less. The remaining 85%–90% gets burned up as energy or metabolized in other ways. So in terms of omega-3 "power," a tablespoon of flaxseed oil is worth about 700 milligrams (mg) of EPA and DHA. That's still more than the 300 mg of EPA and DHA in many 1-gram fish oil capsules, but far less than what the 7 grams listed on the label might imply.
https://www.health.harvard.edu/heart-health/why-not-flaxseed...
Also, beware of omega 6 fats. Seed oils (corn, soy, canola) used in commercial food products are incredibly omega 6 dominant in terms of polyunsaturated fat content. Consequently, the ratio of omega 3 to omega 6 fats we consume has plummeted as food production has industrialized. Omega 3 fats are precursors to generally anti-inflammatory signaling compounds, whereas omega 6 fats are precursors to pro-inflammatory signaling compounds. The bias in fat intake leads to more pro-inflammatory signaling in the body, and a lot of alt health types have alleged this is a major causative factor in the obesity epidemic.
This is important for depression, because chronic brain inflammation as a cause of depression was one of the going hypotheses at least a decade ago when I last looked into all of this. Upping omega 3 intake is an intervention that can address chronic inflammation, which is potentially why it improves some cases of depression.
Pretty much nobody in the west needs more omega 6s these days. I hear even farmed salmon eat primarily corn and soy based feeds these days, meaning their fat ratio is skewed much more heavily toward omega 6 than wild salmon and fish.
I'm not an expert, but I've done a bunch of reading on this previously, and also skimmed the article which also mentions some parts of this.
First, when taking omega 3 supplements, you generally care about increasing the ratio of omega 3 to omega 6. Hemp hearts have much more omega 6 than omega 3, so they're not very effective for improving the ratio.
Second, hemp hearts contain ALA, while what you generally want to improve is EPA and DHA (this is also covered in TFA). The body can convert ALA to EPA and DHA, but it's not efficient.
So all in all, if Omega 3 for the article's stated benefits is what you want, this is not the way. I recommend looking into eating more fish, or if you want a vegan route, algae-based supplements. [0] is a decent source from the NIH about foods and their Omega 3 content, split by ALA/EPA/DHA.
[0]: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthPro...
The ratio of Omega 6 to 3 needs to be below 4:1 to be a good source of Omega 3, and hemp hearts are at 3:1, so they're listed as a good source of Omega 3.
Flax seeds are even better just for Omega 3 at 1:3, but hemp hearts have other benefits, like more protein, which is why I called them out. That said, I eat a fair amount of flax seeds as well.
Just to reiterate, both of those (hemp hearts and flaxseed) only contain ALA, while what you're generally looking for is EPA and DHA. TFA also explicitly mentions it's only talking about EPA.
This is not to say that they're unhealthy of course.
EDIT: see the sibling comment by code_biologist, it's much more comprehensive than what I've written.
Your body converts ALA into EPA and DHA, however, so plants are fine sources of both.
Coincidence? "Vitamin D is currently the only Essential Vitamin or Mineral which appears to have deficiency rates at a similar level to Magnesium"
https://examine.com/supplements/magnesium/research/#nutrient
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial https://pubmed.ncbi.nlm.nih.gov/30541089/ "Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
So it might well be that general deficiency in Vitamin D is caused by the deficiency in magnesium status. This would also be an explanation why we see Vitamin D deficiency in sunny Africa: https://theconversation.com/think-vitamin-d-deficiency-is-no...
Super interesting, just sad that Omega-3 supplements are one of the main drivers of unsustainable Krill overfishing https://seashepherd.org/2025/02/25/protecting-the-oceans-vit...
Look for algae oil instead.
Confusing mg and IU units up front really do NOT inspire confidence on the topic and conclusion as a whole.
Why does this keep popping up?
"Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being."
https://pmc.ncbi.nlm.nih.gov/articles/PMC4907952/#:~:text=Bo...
Anecdotally, I've been taking a 5,000 IU vitamin E supplement this winter. Seattle area, indoor desk job, I am a vampire. It does seem to help, I would rate it as going from a C to a B grade. I'd prefer not to use antidepressant medications to fix a problem that for me is mostly caused by living at a different latitude than I grew up in.
Do be aware that not all vitamin E supplements actually contain the dosage that they are labeled at, and that inclues both no-name brands and some big name brands. I'm having trouble finding a good reference on google due to AI and SEO pollution. But I recall Nature Made was labelled accurately and that is what I buy.
My wife on the other hand has struggled with life-long anxiety/depression even when living in Atlanta. For her a fairly low dose of lexapro enables her to live her life like a normal person. We wish we could get her mother to give it a shot for a few weeks, as she now can see a lot of similarities in both their personality traits that were affected by a life of untreated anxiety.
We also have cat that would probably have been put down for fear-biting of people and attacking our mild and mellow dog until we got his aggression under control with kitty prozac. I kid you not, it's a transdermal fluoxetine cream we put in his ear each day. Without the constant anxiety stimulus in the way, his real personality came through and he is actually very sweet. To me at least. Still bites my wife, but not hard anymore, just enough to keep her alert.
>caused by living at a different latitude than I grew up in.
or society in its current incarnation. its an underexpressed opinion that maybe depression is a justified reaction to ... life, as humans across a lot of earth in 2026.
Do you mean vitamin D? Humans don’t produce vitamin E at any latitude.
The only problem here is that "going from an F to a C in mental health" is vastly different than "going from a C to an A." It's very well known and well documented that antidepressants have very little effect on mild depression compared to say, exercise, but that F grade of depression tends to be a different beast with different causes.
That's not to suggest that exercise etc isn't great, just that society has come a long way in destigmatizing mental health and just being like "oh just take fish oil" to someone dealing with that kind of depression, either through shitty genes or childhood trauma or whatever, can be really harmful.
Vitamin D toxicity is absolutely real, causes hypercalcemia, and can occur even at the 4,000 IU dose. I would really recommend you be getting regular bloodwork done if you go beyond that. Here’s a fun podcast on a case study. https://www.barbellmedicine.com/podcast/episodes/episode-381...
Most commonly from lanolin, a grease extracted from sheep's wool.
It's processed into (7-DHC), the same compound in human skin.
7-DHC is bombarded with UV light, triggering a chemical reaction that creates Vitamin D3.
As a neurologist I cannot be persuaded. Their is a huge placebo and confounding component in the spectrum stress-depression. There are syndromes where AD drugs make wonders, literally saving lives, and others where they are useless. But taking 150000 IU of vitD per month definitely doesn't have the effects it promises.
You might want to take magnesium with Vitamin D, because taking vitamin D depletes magnesium. Not sure if it's strictly necessary, but if you're already low on magnesium it might be an issue. I once got tinnitus (which lasted a few months) when supplementing Vitamin D, the only explanation I've figured is that my magnesium was very low, which can cause tinnitus. Might be something else too, who knows.
One flaw in this analysis is that the source he cites for antidepressant effectiveness didn't include tranylcypromine (or any MAOI class drugs), which the STAR-D trial found was one of the most effective antidepressants.
(The STAR-D had a cumulative remission rate of 67%, I don't know how to convert that to the format he used)
Otherwise I agree that vit D and omega 3 are underrated for depression, it would be interesting to see if they have a cumulative effect with antidepressants.
Anecdotal, and even meta-anecdotal, but hey: four months ago I started to supplement omega 3 thanks to this hyperbolic HN comment: https://news.ycombinator.com/item?id=45169875
Unlike the commenter, I didn’t suddenly turn into a chess grandmaster, but I did notice that my winter blues didn’t show up this year, the first time in a decade!
How many people have depression without vitamin D deficiency? And how many people have vitamin D deficiency, but no depression? Are there any studies about that?
For a single time fix (“rewire brain to be healthy again”) you need psychedelics (psilocybin has seen multiple studies where its effect is way better than psychopharmacological drugs). A single dose can make you healthy for a year to come, potentially also for life as you’re no longer a potential victim to it ever again.
I have seasonal affective disorder and was taking a medication that sort of helped, but was causing mood swings if taken even slightly out of rhythm, increased my blood pressure, and was just generally not that effective, but it was better than nothing. Last winter I switched to vitamin D (it was already uncovered in blood tests I had a deficiency, which is what turned me onto it - when I started taking it, I felt a lot better) and omega 3 and I won't go back. I wish someone had told me a decade ago, probably would have saved a lot of damage to my organs (another reason I got off of it)
This made me think of Pauling (https://en.wikipedia.org/wiki/Linus_Pauling) who was a famous scientist and big proponent of high-dosage C-vitamin. He claimed it could cure everything from a cold to heart disease and cancer. Later studies did though not find any benefit of high-dosage C-vitamin and that potentially had a higher risk of prostate cancer. Pauling died of prostate cancer.
Edit: This may also be of interest: https://en.wikipedia.org/wiki/Orthomolecular_psychiatry
Try NSAIDs. Depression is a set of emotions. Emotions affect the body. I thought to try NSAIDs to deal with the physical discomfort. That partially shutdown the feedback loop of mood -> body discomfort -> reinforcing mood.
There are studies that show this is an effective intervention.
I used to have very rough winters. Despite the fact that I ate well and was outside 2+ hours every day. I got my blood tested and I had very low vitamin D, two tiers below normal. This was the first winter being on Vitamin D, and my energy and hunger levels stayed normal. I never crashed or had extreme hunger or trouble sleeping.
Getting Vitamin D from food is a fools errand, and since sunscreen and protective clothing slow vitamin D from the sun drastically, it's in most people's best interest to get it tested.
You may consider that you have a dust mite allergy. If you have any of: chronic coughing, frequent sickness, eczema, or IBS then that is even more evidence this is your problem.
Not a bad suggestion, I live in the country so it's very dusty here and my digestion has always been wonky. Thank you.
If you look at the studies on which this post is based, you find out that the (very) positive effect of a Vitamin D supplement is only short-term.
The effect after taking the Vitamin longer than 24 weeks is not significant anymore.
While I agree with the general point
Vitamin D is toxic (and ultimately fatal) at high doses, which is why the 'suggested' dosages of between 400IU and 1000IU are so conservative. You may need more, but you should get a blood test.
THIS. And not just for Vitamin D. Not everyone absorbs / metabolizes / excretes vitamins or minerals in the same way. Learning whether or not you're an outlier can be done either the safe way, or the dangerous way.
This is all in a book called The Depression Cure by Stephen S. Ilardi (https://bookshop.org/p/books/the-depression-cure-the-6-step-...)
I read this years ago and it's fascinating. Looks like it's been updated for a second edition last year.
I used to take a supplement with 10k vit D units. Made by a reputable company here in Europe.
I did a blood test for vit D metabolites (oh 25 or something). It turned out I was deficient.
The doc gave me 8k units as a prescription drug. In theory weaker. After 2 months I was no longer defiecient (kinda borderline). After 4 months the doc decided to go down to 4k iu.
Now I wonder why some experts are telling people to take 10k iu? Is it because the supplements are crap and contain 10% of what they claim? (I've been taking vit K as well)
I think the general idea is that the stats labs use to decide what is normal is not necessarily ideal, and like everything else will vary per person.
Too much Vitamin D3 can be toxic, so doctors are reluctant to tell you to go over published guidelines. but if you don't have other issues, and stick to what you can get OTC from a normal vitamin brand and follow the instructions, you're probably safe. There was a story a while ago about a woman who died from too much D3, but it turned out she was taking a whole bottle's worth every day for years.
> Now I wonder why some experts are telling people to take 10k iu?
Taking 10K per day is a bad idea. I went into the excess Vitamin D range with half that dose even in winter with an indoor job.
More is not always better.
Before you start taking crazy amounts (or any amount) of vitamin D just get a blood test. It's simple. As part of my insurance I can get a bunch of different blood tests, but I did have to pay about $50 extra to add the vitamin D test.
Based on the test I was just a tad under where I should be and so now I am taking 800 IU per day. I may stop in the summer when I get more sun.
I read somewhere that too much vitamin D has similar effects as too little (permanent hair loss, anemia, etc) but that may have just been on a blog similar to the linked blog on this submission.
I am taking so much Vitamin D and I can confirm!
It is depressing ... :(
(Note: my own real therapy is to do what is fun. That is, humour. This can occur via social interaction; it can also happen to some extent by studying human behaviour via ... youtube videos! There are some surstromming videos that are just epic display of human behaviour. If aliens ever arrive here, I'll show them the Top 3 videos there. Either they will laugh too - or flee from this strange planet.)
Several people in my family have a MTHFR gene mutation that screws stuff up, including causing problems with anxiety+depression. But a simple B12 shot every couple of weeks does wonders.
I’ve personally found meditation, exercise and healthy food intake are more effective for self regulation and coping with tough emotions over medication and supplements.
Each human being is unique, as is the recipe for sustained positive metal health.
I think it’s helpful to consider and experiment with different ideas and strategies.
I strongly disagree there is one single solution that can provide significant lift for a large population.
I was an RA at the RAND Corp who put together literature reviews for mental health interventions like this. The Vitamin D result is implausible. If true it would be the biggest breakthrough in the history of psychiatry.
This is the referenced meta-analysis: https://www.cambridge.org/core/journals/psychological-medici...
The largest N study (N=18,353; more than half of the entire 31 study sample) included is https://jamanetwork.com/journals/jama/fullarticle/2768978, which found: "Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group...and the placebo group."
The highest dose study (100,000 IU/week) included is https://pubmed.ncbi.nlm.nih.gov/30532541/, which found: "...the treatment response or BDI scores did not differ significantly between groups."
The paper/supplementary materials doesn't include a simple table of the depression outcomes for the 31 included studies, which is a glaring omission.
I think someone just messed up here. Maybe missed a decimal place?
For a more realistic perspective, here's another careful meta-analysis of RCTs of Vitamin D for depression that found null result: https://www.sciencedirect.com/science/article/abs/pii/S08999... (granted, 2015). And another from 2025 that found a .36 effect size, which is plausible and still fantastic: https://www.frontiersin.org/journals/psychiatry/articles/10....
I don't mean to dissuade people from trying these given the low risk profile, just don't expect to go from a C to an A.
Chia seed and flaxseed high in omega3
ALA, not EPA, though, and it is unclear how much of it is converted then to EPA in the body. Afaik only EPA has shown antidepressant effects.
+ great for fiber. I load up chia as much as I can throughout the day.
Chia is awesome for making pudding out of random liquids. I have to restrain myself from eating a batch of coconut milk cinnamon chia pudding in a single sitting.
A useful way to look at the effects of vitamin d and omega-3s: supplementation isn't really a hack, it's more that their removal is a handicapping of our "normal" state. Our evolutionary conditions would have been more rich in both of those things. Also see light exposure during the day, proximity to green space, etc.
I had sleeplessness that eventually led to depression and gastritis. I took medication for two years to recover. The root cause was a vitamin D deficiency my level was 8 ng/mL, which was far below the required range. There was a period when i was only able to sleep with medicines. Now coming back to normal life.
I would add that the issue with Omega-3, is the imbalance between Omega-3 and Omega-6. It turns out that many of the food products have been manufactured with Omega-6 rich oils and that is causing some issues. One can ingest Omega-3 supplements, try to eat foods rich on that fatty acid or reduce foods with lots of Omega-6 in order to restore that balance.
These are always tricky, vitamin D deficiency and low fat diets clearly cause depressive symptoms.
Does that mean vitamin D treats depression in general?
When most people talk of depression they aren't even using talking about major depression.
We live in a world that in many ways is comfortable but crushing. Is that depression? Or just harmful levels of understandable unhappiness? Are they different?
Before anyone goes out and overdoses on Vitamn D (since lots of multiple vitamin include too much), see this article on toxicity from too much Vitamin D
https://www.ncbi.nlm.nih.gov/books/NBK557876/
Juxtaposing with the quoted passage from the post: “Because vitamin D is potentially toxic, intake of [1000 IU/day] has been avoided even though the weight of evidence shows that the currently accepted [limit] of [2000 IU/day] is too low by at least 5-fold.” --https://www.sciencedirect.com/science/article/pii/S000291652...
It cites a study about vitamin D toxicity where the range of cumulative intake causing it was identified to be 2.2 million - 6.3 million IU. When you take 6000 IU daily for a whole year you only reach the lower end of that range, and you definitely shouldn't do that without checking your levels somewhere in between. Taking it for a few months may get you above the recommended blood levels, but is very unlikely to cause issues unless you started with very high levels already (which you most likely did not).
Toxic levels of vitamin D can be life threatening, so do keep your levels in check, but you won't get there unless you really try, so if you can't get out of the bed to have your blood tested just start taking it and check it after 3 months when things get hopefully easier for you. Just make sure to get the number of zeros in the dose right.
Hey OP, kudos for being so engaged in the discussion + making edits and not just firing the link off and then going AFK. Makes the comments more interesting and (I think) the actual work better.
> So why are all the official sources still so paranoid about Vitamin D
It is fat soluble vitamin, together with A, E and K. That in itself makes in more risky in terms of overdose. I didn't hear of any cases outside kids eating jars of vitamin gummies but it does happen.
Precision Medicine is the way, and maybe we will get there one day Too many effective agents are averaged away because the population for whom it is effective is just a subset of the population with the targeted symptom.
If you look at the studies on which this post is based, you find out that the (very) positive effect oft Vitamin D is only short-term.
The effect after taking the Vitamin longer than 24 is not significant anymore.
As one would expect when you get your blood level out of the deficient range? It takes a while to get back down.
I would take these articles about vitamin D with a grain of salt, there is a big vitamin D supplement and testing market and most of the studies about the miracles of it are dubious at best
including the mentioned meta-analysis? if yes, can you explain why you think that it's dubious?
Please talk to a doctor if you're curious about this instead of following this advice. Megadosing vitamins and supplements comes with risks not addressed by the author.
I eat so much vitamin d and omega 3 i should be shitting fish shitting sunshine... and yet, cold baltic winters with only a few hours of sun still make me depressed.
Wrong unit in text, right? Graphs shows UI. 5000 UI would mean 125µg of D-vitamin. Which is a bit smaller than 5000 000 µg from the next
On mobile a padding would make reading better. Add px-4 if you use tailwind in the article body.
How many of you feel worse when taking vitamin D supplements? Alternatively how many of you feel only temporarily better?
A very important article for the hacker news community. Maybe we should pin this on the top for a couple of days.
Scott Alexander observes in this piece https://www.astralcodexten.com/p/all-medications-are-insigni... that the effect size for even EXTREMELY EFFECTIVE medications are remarkably low.
> Zolpidem (“Ambien”) has effect size around 0.39 for getting you to sleep faster. Ibuprofen (“Advil”, “Motrin”) has effect sizes between from about 0.20 (for surgical pain) to 0.42 (for arthritis). All of these are around the 0.30 effect size of antidepressants.
...
> Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875.
As for why, read his essay I guess. But I wouldn't take at face value the interpretation of effect sizes in the original article.
(I also couldn't say why the effect size of vit D and Omega-3's is so large, although per Scott Alexander's article if fewer people drop out of the treatment group, that should increase the effect size, so maybe the relative tolerability of the treatments is part of the story?)
> The twisted kink is caused by the hydrogens being on opposite sides, hence "trans". (And yes, if they're on the same side it's "cis". Latin was a mistake.)
Why you being mean to latin? ;)
Homemade Avocado toast is easy and inexpensive
can only say, if you have depression or mental problems: NIACIN. not the niconinamid or whatever which is a scam. do not drink alco or smoke! kidneys will suffer.
The article even states that nothing here is written in certainty. It’s just pure speculation. No, fish oil and vitamin D do not have a larger effect than SSRIs for depression.
Not to say they don’t help, but it’s asinine to state that nutrients are a replacement for selective serotonin reuptake inhibitors, whose sole purpose is to help with depression, and has been designed by an army of scientists, researchers, psychologists, psychiatrists.
To add another data point: 4,000 IU (two Kirkland capsules) daily keeps my Vitamin D levels at the high end of the reference range. I also take six Kirkland fish oil capsules which happens to hit the 1,500 mg DHA+EPA target suggested in the article.
Honestly, Costco supplements are hard to beat since they're both USP certified and are usually the cheapest.
> "mild hypercalcemia" increased from 3% to 9%. IMHO, that's a small cost for reducing the risk of major depression & suicide."
- I believe this crucial bit is missing from TLDR
Here you go HN commenters. Last month when I made the observation that "from what I've read recently, I've started to get the impression that the explosion in mental health problems (depression, autism rates etc) has more to do with the western diet than genetics"[0]
Y'all called me MAHA and down voted me into the negatives. Please, insult your own analytical ability by doing the same here. This time I'll just revel in your ideologically confined science denial this time.
[0] https://scitechdaily.com/simple-three-nutrient-blend-rapidly...
A study proposing that diet can affect the expression or severity of some autism-related behaviours is not the same thing as claiming “80% of what people consider autism is actually just the western diet's effect on normal brain chemistry."
Except depression rates are rising at similar or worse levels in other places too, including sunnier/tropical regions and the ones with "better" diets.
The main instigator of depression is still societal as the postmodern era is pushing everyone into seclusion and addicting them to constant individualized dopamine hits, increasing the miserable effect on one's chronic mood and exacerbating one's self-consciousness about it.
I started back on Vitamin-D and Omega-3 (with extra EPA & DHA) about 2 months ago or so. Sadly, I don't feel much of a difference, but I believe the potential harms are quite minimal, so I am going to maintain supplementation for the purposes of self-experimentation.
It took me more than 3 months to get to the lower edge of the desired range with my blood level on about 8000 UI daily. There was no instant improvement, it takes time.
Do keep your levels in check though.
Also magnesium! Magnesium bisglycinate, in particular. Great stuff.
Can confirm. Since I take 20000 IU vitamin D every sunday, my winter depression is gone.
why is this nonsense trending here? this is a random blog
Staying awake is an antidepressant, up to a limit.
then it would suggest why depression gets worse in colder and less sunny part of the year. That even has its own name - Seasonal Affective Disorder (SAD).
Yeah, I call bullshit. Tried both, and SSRIs are a godsend.
Over the last few months, I’ve increasingly come to believe that depression is not caused by a chemical imbalance. After trying ten different antidepressants with no success, I found far greater improvement by changing my patterns of thinking.
The amount of people in this thread rejecting behavioral health as a legitimate science/field and calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense. Very sad to see.
> "calling for bootstraps to solve depression et al. is wild to see. So many anecdotes and grand statements saying that it’s all nonsense."
That's not what I was doing in my other comments that you replied to. If you have a knot, and imagine all the possible things you can do with your hands and body and tools in the universe and notice that to a first approximation none of them will untie the knot. Not hitting it with a spoon, not stroking your chin, not jazz hands, way more than 99.999% of possible movements will not untie it. Some of the things which won't work also include pulling yourself up by your bootstraps, "not being weak", "toughing it out". "just get over it". All those are no more effective than any other of the 99.999...% of things which won't work.
The things which will work are in a tiny space of things involving fingernails, needles, knot-eye-hand-feedback-loop and some understanding of rope and tangles. Or fire.
Just because fire will have a useful effect doesn't mean the knot is caused by an imbalance of fire and so you should keep burning your fingers for the rest of your life as "the cure" for knots. The way to untangle a knot is to develop the focused, pointed, targeted skills of untangling knots. And (I argue) the way to untangle negative thoughts is not by powering through them, toughing them out, positive mental attitude, fortitude, being strong, manifestation, dreaming big, just getting over it, or crowbarring your mood up with sledgehammer drugs to an 80-billion neuron network for the rest of your life, or anything else of the millions of other concepts one could do or imagine doing - except the focused, pointed, feedback-loop skills of untangling negative thoughts wielded by a particularly good therapist or by yourself.
Whether you develop such a thing by therapy training, meditation, prayer, Stoicism, biofeedback systems, luck, intuition... I suspect there are multiple ways which are effective that can be developed through multiple approaches, but not many. And "I tried thinking my bad thoughts away and it didn't work so it must be genetic" is not one of them.
You don’t need to chase down my comments to have the same discussion in two places, and this isn’t (only) about you.
I didn't chase you down, I was reading the whole thread.
Your one-line dismissal is annoying deliberately-vague-accusatory trollbait, and I was baited.
Have a good weekend man. Neither of us is looking particularly great here. Let’s move on.
My dad if he was alive would have shouted "I told you so"
wait till they discover sex, drugs and alcohol :)
Your body makes Vitamin D when in sunlight. Could it be that sunlight - and the whole being outdoors situation - is the thing that helps rather than vitamin d levels?
There's a research that winter sunlight in northern latitudes just does not convert precursors to vitamin D. Even when it's shining, no matter how long you are outside.
And I guess you need uncovered skin which can be tricky in a cold winter.
Well if you'd be so kind to move the earth so that we get enough sun during winter then that'll solve the problem.
Interesting point, there is at least one theory out there which says that neither sunlight nor Vitamin D is necessary if an individual is really healthy. The ones that feel better on the Sun and/or Vitamin D are people who are at least mildly unhealthy and it's of form of addiction where the individual ought to keep taking something to just not feel miserable.
What drove you to write this comment? There are enough countries where sun is an exception in winter and this is a valid problem.
Comment is neither helpful nor is it funny.
Sunlight alone don't help, it helps just because our body makes Vitamin D during the sunbathing process.
So sunbathing is one of many way of integrating Vitamin D in our body not THE way.
It's going to be sunny this morning, but also -14 and also I'm too far north for adequate Vitamin D synthesis in winter. But thanks for the advice.
In most northern countries like the UK, there is simply not enough UVB in the winter to make any Vitamin D through sunlight.
It could be, but the same effect can be observed in people who dont change their outdoor habits but take vit D and omega 3 supplements