Anti-depressants doing more harm than good, killing the elderly

[Richard Masters]

To bring this down to the disturbingly individual level, I'd like to know how sitting around in a sort of conscious stupor thinking about suicide but not doing anything about it because I simply didn't have the energy was somehow conducing to evolution. Or, alternatively, going around in a constant near-rage to the point that sometimes it was dangerous (for others) for me to drive.

I can relate to all of that.

Regarding evolution, depression may or may not confer any clear advantages, even if there are genetic components to it.

 

[Dancing David]

Now the brings up some of the more interesting uses of ADs, they can also help some people with migraines and neuropathy.

 

[Joey McGee]

Sorry about the tone of my later posts, I shouldn't have been posting, I took some time off..

Um... it actually *is* an argument. In the classical sense of the term. That is to say, the philosophical definition of an argument is exactly what you are attempting to do here: attempt to persuade by giving reasons or evidence for a particular conclusion.

The problem is, you refuse to give much in the way of evidence. How can you possibly expect to persuade people that you are correct if you refuse to give any evidence? Thats the basic premise behind an argument, behind this site, and behind critical thinking in general. Offer no evidence for your claims and you will be dismissed as a crackpot. Offer compelling evidence, links to journals and research, etc.. and you will be shown respect and your claims thoughtfully considered. Its really that simple (well, mostly).

Yeah, I know. I failed to live up to my own expectations here, probably because it's a pet issue I went off when I shouldn't have been posting. It's really pretty simple to find the major proponents of evolutionary explanations for depression, some people really aren't even aware they exist, at the time I thought mentioning Nesse and the fact the field exists was enough if people wanted to know more. I managed to find some more sources for those interested.

http://en.wikipedia.org/wiki/Evolutionary_approaches_to_depression

Then perhaps this is not the place for you.

I'm fine being asked for evidence when I make a claim. I'm sick of being asked for evidence like it's an argument, such as, show me a transitional fossil, or show me how me wanting to kill myself is good for evolution. This is not the place for unhelpful outbursts that's for sure.

 

[Joey McGee]

To bring this down to the disturbingly individual level, I'd like to know how sitting around in a sort of conscious stupor thinking about suicide but not doing anything about it because I simply didn't have the energy was somehow conducing to evolution. Or, alternatively, going around in a constant near-rage to the point that sometimes it was dangerous (for others) for me to drive.

This is what I mean. No one is suggesting that suicide is good for evolution. No one is suggesting that psychosis that endangers your safety is good for you. It would be more like

Dr Nesse’s hypothesis is that, as pain stops you doing damaging physical things, so low mood stops you doing damaging mental ones—in particular, pursuing unreachable goals. Pursuing such goals is a waste of energy and resources. Therefore, he argues, there is likely to be an evolved mechanism that identifies certain goals as unattainable and inhibits their pursuit—and he believes that low mood is at least part of that mechanism.

It is a neat hypothesis, but is it true? A study published in this month’s issue of the Journal of Personality and Social Psychology suggests it might be.
...
Their conclusion was that those who experienced mild depressive symptoms could, indeed, disengage more easily from unreachable goals. That supports Dr Nesse’s hypothesis. But the new study also found a remarkable corollary: those women who could disengage from the unattainable proved less likely to suffer more serious depression in the long run.

Mild depressive symptoms can therefore be seen as a natural part of dealing with failure in young adulthood. They set in when a goal is identified as unreachable and lead to a decline in motivation. In this period of low motivation, energy is saved and new goals can be found. If this mechanism does not function properly, though, severe depression can be the consequence.http://www.economist.com/node/13899022

There could be many reasons why this mechanism doesn't function properly, imperfectly and randomly as we have evolved...

Of course, EP has modern theories about the benefits of being irritable, and in a higher risk-taking mood too...

 

[Joey McGee]

Richard Wiseman! Deepak Chopra! Plato!

Me mentioning David Buss or Randolph Nesse or Richard Dawkins is more like me saying "That's who would be able to explain this particular theory better and already has in many places easily accessible through obvious google searches." And I thought that was obvious at the time. I should have been more precise here. This is basically the cusp of this area of science right now and many, many people do not accept it. I really wouldn't expect anyone here to accept it based on a few studies I posted, it's kind of a big deal. I'm just mentioning sources and being bitched at for "making claims and not providing evidence" or whatever, ok, fine, I'll clarify that to "here are some interesting things people are saying about this interesting topic"

Anyway, you need to be careful in your wording. If you say "Look at these studies, apparently some of the symptoms of depression are not beneficial to medicate away! Does this mean we should re-evaluate our treatment, or maybe our diagnostic criteria for clinical depression?" then I think most people will discuss it with you.

When you say...

"Well David I suggest you take a long, hard look at what people like Randolph Nesse and other evolutionary medicine proponents have to say about depression. To put it simply, depression can be an evolved function that serves a purpose, that sometimes doesn't work, or becomes disordered."

That's actually nonsense. Depression is defined operationally. That means, some psychiatrists decided that "degree of depression" is what's measured by this form or these criteria. That's what Depression IS. There's no arguing about it.

It's always interesting to look if we ought to revise our operational definitions, but you can't call old definitions "wrong". The photon as a particle or light as a wave aren't wrong, they're reasonable operational definition, though neither is how we define electromagnetic radiation today.

Depression is something you can diagnose and the accepted standard is the DSM. We're talking about evolutionary explanations as to why it exists in the first place. If the "standard" was that depression never serves a purpose and doesn't, in general, have benefits that outweigh the costs (such as pain does) then that is all that is being challenged here. I have no idea where you see a conflict.

 

[Joey McGee]

Saying that, in general, anti-depressants do more harm than good doesn't mean that they don't work for certain people for certain conditions very well. Saying that depression evolved doesn't mean it can't function in a way that it didn't evolve to or with results that are clearly harmful to the person. Clearly, people don't get this right away. We have to get past it.

The theory explains things nothing else can such as how depression exists at high rates throughout all ages of humans. However I wasn't aware of any consensus in the appropriate communities and am aware of vicious battles being done over it so I figured that phenomenon would continue here. There are lots of theories, many of which can overlap and compliment each other. There are new studies released all the time, such as this one from this year called The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D). (article in Forbes).

 

[Pup]

Quote:
Dr Nesse’s hypothesis is that, as pain stops you doing damaging physical things, so low mood stops you doing damaging mental ones—in particular, pursuing unreachable goals. Pursuing such goals is a waste of energy and resources. Therefore, he argues, there is likely to be an evolved mechanism that identifies certain goals as unattainable and inhibits their pursuit—and he believes that low mood is at least part of that mechanism.
...

Is that really a new, unusual idea? I thought it was just, well, common sense. You put rats in a cage with a solvable punishment-reward problem, they'll work to solve it. You put them where punishment-reward is random, they'll act "depressed" and quit trying to figure it out--because organisms that try to solve unsolvable problems are wasting resources they could be spending more productively.

The parallel to pain also seems obvious. If I feel pain, I don't think first about taking a painkiller. I try to find out what's causing the pain and do something to solve that. The painkiller is just to make life more comfortable until the underlying problem is solved, but one has to be careful not to do things that cause more damage, since the painkiller takes away the natural warning.

Sure, there are times when the underlying problem is unsolvable, or the body messes up and reacts unjustifiably by causing pain or depression when there's no reason. That's when treating the symptoms makes sense. Otherwise, I always figured that everybody realized the goal was to solve the underlying problem whenever possible, not just to treat the symptoms, so giving up on the underlying problem and only treating the symptoms was a last resort.

I don't even remember when I learned that or started thinking that way; it's just always been self-evident. Maybe it comes from when I was stuck with an abusive, insane father, and a mother who thought the "solution" was psychiatry to help me and her cope with him. I flatly refused, and said the solution was to get me away from him.

But apparently it isn't as obvious as I thought it was.

 

[mijopaalmc]

Sorry about the tone of my later posts, I shouldn't have been posting, I took some time off..

I'm fine being asked for evidence when I make a claim. I'm sick of being asked for evidence like it's an argument, such as, show me a transitional fossil, or show me how me wanting to kill myself is good for evolution. This is not the place for unhelpful outbursts that's for sure.

If you don't want a fight, don't open woth fighting words. You explicitly and vehemently accused those who didn't accept evolution psychology, evolutionary medicine, and evolutionary psychiatry of "holding us back as a spiecies" Furthermore, when posters question the aforementioned field, you accused them of rejecting evolutionary biology. In other words, you were initially confrontational and then, when your thoughts were not met with immediate approbation, you were combative, so you have no room to complain about your "being asked for evidence like it's an argument". You were the one who made it an argument by coming in on the offensive.

 

[Joey McGee]

If you don't want a fight, don't open woth fighting words. You explicitly and vehemently accused those who didn't accept evolution psychology, evolutionary medicine, and evolutionary psychiatry of "holding us back as a spiecies"

Yeah, I still believe this is true. Notice I said critics, not skeptics.

For example, if you're a creationist doctor, you're holding back the species by a) actively spreading memetic viruses amongst colleagues and the public, b) not integrating what we can gain from evolutionary medicine into your practice. This is an obviously fair, unassailable concern.

If you're one of those idiot "philosophers of science" (say, David Buller, Critique of Pure Buller, also see Dawkins and Buss discuss the philosopher problem) that objects on some convoluted grounds, yeah you're poisoning the debate and confusing people. Kind of like philosophers like Fodor claiming natural selection isn't real and EP is equally non-existent. Keep in mind this is not really an invitation for them to shut up, on the contrary the more vocal they are the more excuses we get to address their mistakes and educate people. But I've run into enough people whose opinion of EP is poisoned by these crazy creationists and incompetent philosophers to know that their bs is having a real effect.

Hysterical reactionary activists going around contributing such things as "EP excuses rape" and "EP is social darwinism" or "EP is political pseudoscience" has made hard to have a serious conversation about these matters because people shut their minds off when these associations are made. That's the basics of the problem I have.

Is that really a new, unusual idea? I thought it was just, well, common sense.

<snip>

But apparently it isn't as obvious as I thought it was.

This is kind of my point, it's pretty obvious, evidence-based common sense. Unless you've been poisoned to the ideas from a variety of sources.

For example, I was dating a girl and found it impossible to talk about EP because she mixed with certain feminist circles who had declared war on the idea that EP is rape-enabling and male fantasism, despite otherwise being a brilliant scientist. smh. No one really ever has any grasp on the issues at hand, it comes down to paranoia.

 

[Joey McGee]

delete

 

[Dancing David]

The only critique I have of evolutionary psychology is that some proponents ( just some) propose outrageous sophisticated behaviors as being the result of evolution. When they have no suggested pathways of selection. It is somewhat like teh debate, old victorians suggested that language had to be the dominant selected for trait in humans. Well actually most likely the neonaty of the infant in response to narrowing hips that is first selected for and leads to the intense brain development. Then maybe selection for language skills.

Some traits associated with depression can be beneficial in certain circumstances, and expressed as partial traits. This does not mean that depression is selected for any more than full blown sickle cell anemia is selected for.

It does mean that partially expressed traits may be selected for. So that does not mean depression itself is selected for, it means that traits which may be beneficial to reproduction in partial expression could be selected.

But the existence of depression in a population does not mean it is selected for, if most people with depression manage to breed, then just like cancer, it is not selected against.

 

[mijopaalmc]

The only critique I have of evolutionary psychology is that some proponents ( just some) propose outrageous sophisticated behaviors as being the result of evolution. When they have no suggested pathways of selection. It is somewhat like teh debate, old victorians suggested that language had to be the dominant selected for trait in humans. Well actually most likely the neonaty of the infant in response to narrowing hips that is first selected for and leads to the intense brain development. Then maybe selection for language skills.

Some traits associated with depression can be beneficial in certain circumstances, and expressed as partial traits. This does not mean that depression is selected for any more than full blown sickle cell anemia is selected for.

It does mean that partially expressed traits may be selected for. So that does not mean depression itself is selected for, it means that traits which may be beneficial to reproduction in partial expression could be selected.

But the existence of depression in a population does not mean it is selected for, if most people with depression manage to breed, then just like cancer, it is not selected against.

Has anyone also noted that the article doesn't claim that depression is an evolved trait just that anti-depressants perturb evolved homeostatic states and that's why they may be harmful?

 

[Dancing David]

I am not rebutting you mijo, but the article.

Except depression by definition is not exactly homeostasis. I came away with the impression that they thought depression itself was an evolved beneficial trait, which means it would benefit reproduction.

then there are strange statements about how ADs decrease coping skills, when efficacy of coping skills is improved by ADs in moderate to severe depression.

-There are also strange statements about the increased relapse of depression in the use of ADs, and I have to check again, but I am not sure about what the control group was.

here we go
"An alternate view is that current diagnostic criteria do not accurately distinguish between true instances of disorder and normal, evolved emotional responses to stressors (Wakefield, 1992, 1999; Watson and Andrews, 2002; Hagen, 2003; Horwitz and Wakefield, 2007; Andrews and Thomson Jr., 2009; Andrews et al., 2011). This latter view suggests that the pharmacological disruption of depressive symptoms could negatively affect the ability to cope with or manage stressors."

Nope, in response to stressors the individual may already have depression, and there is no mention of what happens and how long if it is untreated.

How is being vegetative beneficial to the individual, or having severe insomnia?

More strange reasoning unsupported by actual evidence:
"So, while we had difficulty finding strong evidence of beneficial effects, it is possible that antidepressants have a significant beneficial effect not yet identified."

"Patients should be informed that current research suggests that unless they have very severe depression, the symptom reducing effects of antidepressants are modest and are not considered clinically significant. "

Which just shows they don't know about the scaling. The Hamilton Depression Rating Scale I believe has a built in cap on the score, which has a strange effect, there is also only a two or three point difference between severe insomnia and no insomnia. Depending on the type of insomnia, you could have a score from 0-6 depending. So a major reduction in insomnia may show only a shift of a point or two.

http://healthnet.umassmed.edu/mhealth/HAMD.pdf

"Two other things about the HDRS are noteworthy. First, patients with a score of 13 or higher typically meet formal diagnostic criteria for an episode of MDD (Bagby et al., 2004). In other words, many people who meet diagnostic criteria for MDD only have mild/moderate symptoms according to NICE guidelines."

You can get a score of 14 for having insomnia, attempted suicide and being unable to work. So some caution should be taken in what the paper says.

So again we have the same issue as in Talking to Prozac, where a scale meant to assess really only the presence or absence of depression is used to support what should be assessed on a finer scale.

Both pharma and the critics are wrong for using such scales. Again a major part of teh problem is pharma and researchers using the BDI and the HDRS to assess symptom response. (The BDI is worse for that)

We could easily go through the HDRS and make an individual who has a score that varies by only seven points and still has major improvement in their functioning. Especially since the HDRS has a built in cap

 

[Joey McGee]

Some traits associated with depression can be beneficial in certain circumstances, and expressed as partial traits. This does not mean that depression is selected for any more than full blown sickle cell anemia is selected for.

Sickle cell anemia was selected for battling malaria. Also, it decreases wherever there is no endemic malaria because sufferers are at a distinct disadvantage.

Depression is found at high levels in all age groups and throughout all known cultures. On top of that are findings such as "we have found evidence that people who get more depressed while they are working on complex problems in an intelligence test tend to score higher on the test." (source) We would expect depression to start disappearing where it put people at a distinct disadvantage just like malaria. We can show that depression is still helping people solve problems which is why is hasn't and probably won't begin to disappear unless the world becomes extremely easy to live in and understand.

It does mean that partially expressed traits may be selected for. So that does not mean depression itself is selected for, it means that traits which may be beneficial to reproduction in partial expression could be selected.

I'm not sure how you can square this with the evidence and case that has been made by these researchers, or on another level, what you even mean. Either these traits survive because they help us survive or not. Either depression is a function that becomes disordered or a disorder, I don't see any other options or middle ground or "partialities" here.

But the existence of depression in a population does not mean it is selected for, if most people with depression manage to breed, then just like cancer, it is not selected against.

Does cancer appear at high rates in all age groups and in all human groups across the world? Are people most likely to experience cancer in adolescence to young adulthood? Why are all other mental disorders occurring at less that one-tenth the rate depression is?

It's not direct proof, these are questions that must be asked and answered, and they point the way to research, which has been done and mostly seems to support the idea.

 

[Joey McGee]

then there are strange statements about how ADs decrease coping skills, when efficacy of coping skills is improved by ADs in moderate to severe depression.

Which statements? They explained and referenced everything they said in my reading of it.

 

[Dancing David]

Sickle cell anemia was selected for battling malaria. Also, it decreases wherever there is no endemic malaria because sufferers are at a distinct disadvantage.

It is late so more later...

The trait selected for is partial sickle cell anemia, not full blown sickle cell anemia. That is why the partial trait was selected for, it increases the life span of the bearer, in the full blown trait it does not. It is the partial trait that benefits reproductive success not the full trait.

 

[Dancing David]

Which statements? They explained and referenced everything they said in my reading of it.

Not trying to fight but this is a guess, not evidenced or demonstrated.

"This latter view suggests that the pharmacological disruption of depressive symptoms could negatively affect the ability to cope with or manage stressors."

When in fact the use of ADs often help increase coping skills and daily life functioning. Most people who have depression don't get treatment, of those who do, most do not take them for an extended period.

If someone is feeling unable to cope because of insomnia, then the alleviation of that symptom does improve coping skills.

the point being that if you have a significant decrease in functioning, it does not matter if it is endogenous or exogenous.

Good night.

 

[Joey McGee]

It is late so more later...

The trait selected for is partial sickle cell anemia, not full blown sickle cell anemia. That is why the partial trait was selected for, it increases the life span of the bearer, in the full blown trait it does not. It is the partial trait that benefits reproductive success not the full trait.

In this case, saying "partial" and "full-blown" is both misleading and unscientific. (not terms used anywhere on the wiki pages on this, for example) Also the analogy to depression is improper, there is no parallel in genetics or heritability, this is a condition ubiquitous to age and race. Finally, it's not "full trait", it's developing the disease. We can tell the trait works for a purpose and the disease is an occasional unwanted result. Obviously, many more people have the protective trait than develop the disease. So the fact that this mutation sometimes leads to disease is just a cost that is outweighed by the benefit. When there is no more malaria, the disease starts to disappear, it's a complete picture.

So, depression evolved as a function, and can become disordered for a multitude of reasons, but like sickle-cell, there is nothing "partial" or "not directly selected for" about it.

 

[Joey McGee]

I am not rebutting you mijo, but the article.

Except depression by definition is not exactly homeostasis.

You need to look at what they are saying are the homeostatic properties of depression are, not dismiss that aspect of the theory by saying that contentment is homeostatic, if that's your contention.

I came away with the impression that they thought depression itself was an evolved beneficial trait, which means it would benefit reproduction.

then there are strange statements about how ADs decrease coping skills, when efficacy of coping skills is improved by ADs in moderate to severe depression.

-There are also strange statements about the increased relapse of depression in the use of ADs, and I have to check again, but I am not sure about what the control group was.

here we go
"An alternate view is that current diagnostic criteria do not accurately distinguish between true instances of disorder and normal, evolved emotional responses to stressors (Wakefield, 1992, 1999; Watson and Andrews, 2002; Hagen, 2003; Horwitz and Wakefield, 2007; Andrews and Thomson Jr., 2009; Andrews et al., 2011). This latter view suggests that the pharmacological disruption of depressive symptoms could negatively affect the ability to cope with or manage stressors."

Nope, in response to stressors the individual may already have depression

I understand what the words mean individually but have no idea why you think it's a rebuttal.

and there is no mention of what happens and how long if it is untreated

You're saying that they do not compare treatment with SSRIs with no treatment at all? And that no studies are referenced in this regard?

How is being vegetative beneficial to the individual

"In this period of low motivation, energy is saved and new goals can be found."

or having severe insomnia?

"In addition, “psychomotory changes,” such as solitariness, decreased appetite, and insomnia also reduce distractions."

You know dude, I swear you have not even looked into this at all. If you had, you'd be offering rebuttals to those common positions, not asking questions.

Myself I wish I had time to look into it more.

I could keep going but yeah, it's late.

Cheers

 

[Dancing David]

I am looking into the hypothesis that the monoamine homeostasis is at the root of depression, now it will be involved in the neurobiology for sure but the papers assertion that it is the root of depression may be harder to establish.