Good post! But you’re missing a big piece: Chronic depression is often about relationships. Dysfunctional families, shitty childhoods and abusive spouses get a lot of people depressed—and that includes many who do not realize they learned some bad lessons in their childhoods or that they have unacknowledged needs their significant others aren’t meeting. Which is unfortunate, because realizing what’s wrong about one’s relationships can uncover avenues to improvement.
Personally, I call depression “the slavery response” and think it used to be an adaptive response to certain kin group dynamics. If you’re depressed (and it isn’t iodine deficiency or something), find out who you feel enslaved by and powerless against, and obtain social support in changing that relationship. Getting this right is what psychodynamic therapy has going for itself and what I think helps it compete with the far more scientific CBT people.
Thank you for mentioning that someone to talk to can be as helpful as a therapist, under some circumstances. Anyone can be that someone, too, and maybe do a lot of good. But it takes some skills: You have to be non-judgemental, interested, observant, honest, quiet and let the sharing person come to his or her own conclusions. Those skills are worth having for other purposes, too. (Therapists are almost universally very pleasant people.) But often the most important help you can give is help establish contact to a better helper.
The SSRIs you mention as “newer” antidepressants are likely to soon be eclipsed by NMDA receptor antagonists, which are in the approval pipeline now and seem to be working somewhat better and much faster than current standard of care antidepressants, without increased suicide risk. Since these aren’t approved yet, nootropics-minded folk are getting this kind of help outside the health care system and I’m told it is highly effective.
The SSRIs you mention as “newer” antidepressants are likely to soon be eclipsed by NMDA receptor antagonists, which are in the approval pipeline now and seem to be working somewhat better and much faster than current standard of care antidepressants, without increased suicide risk.
There’s little doubt NMDA receptor antagonists can cause rapid alleviation of depressive symptoms in a majority of patients who have previously not benefitted much from SSRIs. The effect of a single dose seems to last days, often weeks and sometimes months. Off label use of ketamine is growing because of this.
Now the pharma companies are developing several similar but new (i.e. patentable) substances that they hope have less hallucinatory side-effects, such as lanicemine. Big money is going into this, so the evidence seems to be good enough.
Good post! But you’re missing a big piece: Chronic depression is often about relationships. Dysfunctional families, shitty childhoods and abusive spouses get a lot of people depressed—and that includes many who do not realize they learned some bad lessons in their childhoods or that they have unacknowledged needs their significant others aren’t meeting. Which is unfortunate, because realizing what’s wrong about one’s relationships can uncover avenues to improvement.
Personally, I call depression “the slavery response” and think it used to be an adaptive response to certain kin group dynamics. If you’re depressed (and it isn’t iodine deficiency or something), find out who you feel enslaved by and powerless against, and obtain social support in changing that relationship. Getting this right is what psychodynamic therapy has going for itself and what I think helps it compete with the far more scientific CBT people.
Thank you for mentioning that someone to talk to can be as helpful as a therapist, under some circumstances. Anyone can be that someone, too, and maybe do a lot of good. But it takes some skills: You have to be non-judgemental, interested, observant, honest, quiet and let the sharing person come to his or her own conclusions. Those skills are worth having for other purposes, too. (Therapists are almost universally very pleasant people.) But often the most important help you can give is help establish contact to a better helper.
The SSRIs you mention as “newer” antidepressants are likely to soon be eclipsed by NMDA receptor antagonists, which are in the approval pipeline now and seem to be working somewhat better and much faster than current standard of care antidepressants, without increased suicide risk. Since these aren’t approved yet, nootropics-minded folk are getting this kind of help outside the health care system and I’m told it is highly effective.
How strong is the evidence?
Pretty good, actually.
There’s little doubt NMDA receptor antagonists can cause rapid alleviation of depressive symptoms in a majority of patients who have previously not benefitted much from SSRIs. The effect of a single dose seems to last days, often weeks and sometimes months. Off label use of ketamine is growing because of this.
Now the pharma companies are developing several similar but new (i.e. patentable) substances that they hope have less hallucinatory side-effects, such as lanicemine. Big money is going into this, so the evidence seems to be good enough.
Reddit thread on using DXM for depression. DXM beginner’s guide. Doesn’t seem that promising, although chronic use at regular cough syrup doses could be interesting?
My impression was that memantine was the safest NMDA antagonist and it doesn’t seem to work for depression.