Speculative questions from research into mental illness

November 30, 2014 10:43 AM

Could depression be an infectious disease? Might hallucinogenic mushrooms be an effective treatment for depression (New York Times link)? Do antipsychotic drugs hinder long-term recovery from episodes of schizophrenia?
posted by alex1965 (49 comments total)

The search for specific genes linked to depression has come up empty, he said, adding: ‘Perhaps, we have been looking at the wrong organism.’

I'm all for more avenues of investigation into depression research, but this article provoked some serious eyerolling that culminated in a facepalm at this sentence.
posted by deludingmyself at 11:02 AM on November 30, 2014 [6 favorites]

'I propose that future research should conduct a concerted search for parasites, bacteria, or viruses that may play a causal role in the etiology of major depression.'

oh good grief. Just keep ignoring social factors guys.
posted by Wemmick at 11:03 AM on November 30, 2014 [22 favorites]

Link to Canli's journal paper for anybody not wanting Daily Mail filter.
posted by rongorongo at 11:05 AM on November 30, 2014 [3 favorites]

Therapeutic use of sleep deprivation in depression

(Wikipedia)
posted by Ian A.T. at 11:05 AM on November 30, 2014 [2 favorites]

Also unimpressed by the depression article. For one thing, it's taking something that probably has a shit ton of different causes depending on the individual and going "BUT WHAT IF IT'S SOME KIND OF INFECTIOUS DISEASE ALL THE TIME?" Yeah, maybe there are pathogens that increase susceptibility for depression. I'd buy that. But depression is a complicated thing, and actual life experiences also often play into it, too.

His final argument is that re-conceptualising depression as an infectious disease is useful when thinking about the genetics of the disease.

This is the bit where I facepalmed, personally. Among other things, the GWAS studies that people use to detect genetic associations with diseases would pick up on polymorphisms caused by retroviral insertions. They assay the whole genome, not just the "human bits"--and that's where that 8 percent number is probably coming from, btw, it's 8 percent that has gotten permanently integrated into the genome rather than everyone having picked up 8 percent of their genome from random cold viruses.
posted by sciatrix at 11:07 AM on November 30, 2014 [6 favorites]

I mean, if he cared to test the hypothesis he could just go do a backwards-looking study and see if a subset of people who are then prescribed antibiotics or antivirals for something else report more improvement in mood than non-depressed people on the same course of treatment. Both groups would probably feel better to some degree due to, you know, treating their actual diagnosed infection, but c'mon.

Flint and Kendler 2014 review of what we know about the genetics of major depression (link goes to PDF). Yes, it's a complex and incomplete heritability. Canli's link to two inconclusive GWAS studies in his full journal paper (refs 52 and 53) isn't just cursory, it's downright negligent. Compare it to all the genes in Table 2 in that review from Neuron.
posted by deludingmyself at 11:11 AM on November 30, 2014

Yes but if stress and adversity can compromise immunity, you still could be looking at pathogen imbalance rising from stress damaging immunity. I'll post a few actual studies for scrutiny when I have more time.
posted by xarnop at 11:14 AM on November 30, 2014

The New York Times has a better-written story about the depression as infection idea.
posted by jaguar at 11:16 AM on November 30, 2014 [1 favorite]

Better than the Daily Mail, you say!?
posted by axiom at 11:18 AM on November 30, 2014 [24 favorites]

From the NYT link:

His team has experimented with treating depressed patients with an anti-inflammatory drug, and found that those with high levels of a particular blood marker for inflammation improved significantly. “This for us in psychiatry is a first,” he said, “where you can actually measure something in the blood.” Such an approach “gets into personalized medicine in a way that is very exciting for us in psychiatry.”

However, he cautioned, “nobody’s figured out what’s the best anti-inflammatory.” And most researchers “are still at the point of the proof of concept, making sure that if you do in fact block inflammation that that would reduce these behavioral changes.”

Dr. Miller also noted that only about 20 to 30 percent of depressed patients show high levels of inflammation. These patients are also less likely than others to respond well to current forms of treatment for depression.

Indeed, what many researchers seem to agree on is that depression may not be one illness at all. It’s “probably the case that it’s not a single disorder,” said Dr. Hollon. “It’s probably the fever of modern psychiatry — a lot of different things can cause it.”

That seems a much more nuanced and compelling argument.
posted by jaguar at 11:19 AM on November 30, 2014 [42 favorites]

And the other question is what if the inflammation is actual useful despite having side effects and blocking it is worse long term. Like if we see the body has more inflammation after exercise so we block it but the inflammation was part of a complex repair process and we've made things worse. And what about the link with probiotics and mood? What if killing them all off worsens mood? Doesn't mean there wasn't a bacterial imbalance just that too much or too little of various kinds could all lead to worse health.
posted by xarnop at 11:24 AM on November 30, 2014 [2 favorites]

Anyhow, I like the last article about schizophrenic patient outcomes and antipsychotic prescribing, although the link kept taking me to the registration page for a bit. (Does this link work better?) I don't agree with the OP's characterization of Martin Harrow's findings, though: he's not reporting any direct evidence that antipsychotics hinder recovery, just that the patients who end up taking less or no medication years down the line are doing better than the ones on high doses. That's not surprising, exactly: people with more severe chronic conditions tend to be the ones whose physicians keep them on medication longer and at higher doses. But I think it's smart to think about how to identify which patients don't need to stay on drugs forever, and have that be a part of how we think about treating mental health issues.
posted by deludingmyself at 11:26 AM on November 30, 2014 [3 favorites]

All I know is that I am totally not taking mushrooms for my depression. Yikes.
posted by koeselitz at 11:27 AM on November 30, 2014 [7 favorites]

"[Hollon's] team has experimented with treating depressed patients with an anti-inflammatory drug, and found that those with high levels of a particular blood marker for inflammation improved significantly."

Yeah, that's a cool study. JAMA has it available by open access, too. Lots of inflammation-related pathways under investigation across the mental health and neurology field. And certainly some of those are mediated to some degree by interaction with microbes, both benign and invasive. Hollon's analogy comparing depression to "fever" seems like it could be pretty fair - it's probably a big umbrella of things driven by different mechanisms. Biology is complicated, which is the other reason Canli's "Maybe depression's just a cryptic infection no one's looked for!" is provoking the eyerolls.
posted by deludingmyself at 11:38 AM on November 30, 2014 [3 favorites]

Might hallucinogenic mushrooms be an effective treatment for depression?

I selflessly offer myself up for use in this experiment.
posted by Thorzdad at 11:51 AM on November 30, 2014 [9 favorites]

Mushrooms are straight up the most effective/long-lasting antidepressant I've ever ingested (bipolar II). The two months following the trip were remarkably depression-free compared to what came before and what followed.

I don't want to be the "mushrooms totally fixed my depression" guy, but they kinda did, for a time. Unfortunately, anecdotal evidence suggests that mushrooms increase seizure risk when combined with lithium, which I've since started taking.

It would be nice if there were actually some reliable research into those kinds of interactions, but Drugs Are Bad so we can't have nice things, and I don't want to risk a seizure in the meantime.
posted by terretu at 11:54 AM on November 30, 2014 [3 favorites]

Depression is associated with dysregulation of the HPA axis; depression causes chronic stress and chronic stress causes depression. Stress hormones like cortisol can have very different effects depending on whether they're released acutely or chronically. For example, cortisol is anti-inflammatory in the short-term but can have pro-inflammatory effects in the long-term. Chronic hyperadrenocortical conditions like Cushing's are associated with psychiatric side effects as well as increased susceptibility to infection.

In short, there are all sorts of interesting connections between psychiatric state, hormones, and the immune system. But trying to find a particular bacterial cause is kind of a dumb, simplistic idea. Not dumb enough that it shouldn't be studied, but dumb enough that it doesn't warrant an article in the NYT.
posted by dephlogisticated at 11:54 AM on November 30, 2014 [7 favorites]

deludingmyself: "it's probably a big umbrella of things driven by different mechanisms. Biology is complicated, which is the other reason Canli's "Maybe depression's just a cryptic infection no one's looked for!" is provoking the eyerolls."

Eh, speak for yourself. I'm rolling my eyes because I think the obsessive emphasis on biology is wrongheaded, and this is just a new and particularly absurd variety.
posted by Wemmick at 12:08 PM on November 30, 2014 [2 favorites]

Also pertinent: virus impacts cognition and mental health.
posted by xarnop at 12:14 PM on November 30, 2014

Also to believe someone is sick in the head, defying any actual proof that their emotions actually are "wrong" and justifying forcing pills down their throat WITHOUT even checking pathogens as a source of brain disease not only sounds stupid but deliberately ignorant. The BBB may give a great buffer for pathogens to hide out from anti-biotics of anti-virals- so response to them does not negate the reality that this absolutely must be explored and there is nothing ridiculous or stupid about it.
posted by xarnop at 12:16 PM on November 30, 2014 [3 favorites]

Sorry to triple comment, I'll make this my last even if I keep thinking of things-- but psycho-social and environmental variables may play a role in physical health, I'm just picking one of the dozens (or hundreds maybe) that I've read on this topic, but for example, loniliness has an impact of physical health. So finding out trauma may reduce brains resiliency to pathogens would not dismiss pathogens as having a role, nor in fact would it mean that social support and trauma healing might not play a role in rebuilding immunity against pathogens. Understanding this process however, and what does or does not aid in healing or repairing the body would be very helpful whether the proposed treatment will include medication or other modalities of healing including rebuilding social connectedness, trauma recovery etc.

Frankly I hope people will refrain from smashing down this topic (although seriously hard not to kneejerk daily mail I know...) because even-- or especially-professionals in the field o psychiatry are used to pretending they know what's going on so scoff or reject any theories that don't support what they believe despite that what they currently believe is made up and not really science based at all. Their inflated confidence in what they do not know seeps into the public who reinforce the beliefs that people entering the profession take as "givens" when doing their learning and then fail to challenge the actual factual base (or lack thereof) of the entire profession.
posted by xarnop at 12:30 PM on November 30, 2014 [1 favorite]

@Ian

That's interesting, because it just so happens that my symptoms of depression decreased dramatically during a time of about 4 week when I was sleep deprived. But then I got really sick with the worst flu I had since a child and I was forced to not only sleep but over-sleep and the symptoms came back again.

It's a catch 22 I suppose. If you don't sleep enough you're body will get sick, but as far as depression goes it seems to help it get better I guess.
posted by rancher at 12:57 PM on November 30, 2014 [1 favorite]

You might reasonably argue that current psychiatric treatment guidelines are biased towards pharmacotherapy, but to call them "not really science based" is pretty obtuse. Treatment guidelines for psychiatric conditions are composed the same way as guidelines for cardiovascular disease, diabetes, cancer, etc: consensus based on the current literature and data from clinical trials. I think most clinicians are well aware that social and environmental factors play a huge role in the pathogenesis of psychiatric conditions. That social/environmental interventions are often downplayed in favor of pharmacotherapy has more to do with the current structure of healthcare reimbursement than with the "made up" theories of clinicians.
posted by dephlogisticated at 1:15 PM on November 30, 2014 [6 favorites]

If they find a marker for inflammation, and anti inflammatories work, these patients are a better srarting point for the search for infectious agent. Patients with sleep apnea, sometimes are more rested with less sleep because they have a lower duration of oxygen deprivation. Situational depression can be many things and on top of those things sleep disturbance or infection.

Sometimes situarional depression goes on for so long, it becomes an addiction to self induced endorphans to ease chronic emotional pain, and dull emotion to protect from emotional outburst. This juncture is where a new exercise form, taking up meditation, or vanishing into the woods for a fungal snack/reset comes in.

I would rather be diagnosed with a curable infection, than a psychiatric disorder without a cure, but mitigated by the skill of a prescribing physician, and the need for pharmaceutical companies to make mega bucks over my miserable long haul. I like this new approach. There are also neurologically damaging substances sprayed endlessly in our environment this has also not been mentioned.
posted by Oyéah at 1:24 PM on November 30, 2014 [4 favorites]

dephlogisticated: "That social/environmental interventions are often downplayed in favor of pharmacotherapy has more to do with the current structure of healthcare reimbursement than with the "made up" theories of clinicians."

I've never had a psychiatrist give me a prescription with a guarantee that it would solve my mental illness. Every one of them told me that it would (hopefully) help but therapy would do the real heavy lifting. Experience has shown that to be true in my case. I'm in a pretty good place right now after years of work. I don't think that they ignored my social factors or environment at all. I think everyone recognizes that depression sucks but it sucks even worse when you have bad things going on in your life (which often forms a vicious circle with the depression.)
posted by double block and bleed at 1:46 PM on November 30, 2014 [1 favorite]

No one claims that we're living in the golden age of mental health, but I really have a hard time when people claim that current treatments are just scams created by greedy pharmaceutical companies. You only have to look back 50 - 60 years or so, when treatments for schizophrenia and severe depression were so non-existant, that people thought lobotomies were a decent idea.

We can stand back and criticize them now, but doctors had so few tools available to them to help patients with very serious problems.

In the past 50 years we've gone from basically zero effective treatments to a decent smattering of things that kind of sort of work more or less a good percentage of the time.
posted by the jam at 1:54 PM on November 30, 2014 [17 favorites]

dephlogisticated: "You might reasonably argue that current psychiatric treatment guidelines are biased towards pharmacotherapy, but to call them "not really science based" is pretty obtuse. Treatment guidelines for psychiatric conditions are composed the same way as guidelines for cardiovascular disease, diabetes, cancer, etc: consensus based on the current literature and data from clinical trials."

If you are talking about the DSM, I'm pretty sure this is incorrect. The DSM, as far as I can tell, was largely made by drawing circles around clusters of symptoms and giving them names. It really isn't science based. Saying "you meet X out of Y criteria for depression" is fundamentally different from having a causal explanation for observed symptoms. Plus you have issues of trials being withheld which Ben Goldacre has continued to rail about, which means the evidence from those clinical trials really isn't as scientific as we'd like. It's hard to judge the effectiveness of a treatment if the pharma companies have their thumbs on the scales and negative results disproportionately go unpublished.

And for what it's worth, my personal experience of psychiatry has been that standard practice really is to finagle together symptoms until you have something that looks like a plausible diagnosis, then throw pills at the problem until something (hopefully) works. If it were based on responsible use of clinical data and literature, I would've never been put on antipsychotics as a kid without exhibiting, you know, symptoms that called for an antipsychotic.

(there's a reason a number of major pharmaceutical makers have been hit with huge lawsuits for off-label marketing in the last few years. Psychiatrists were following the marketing, and a lot of kids were given antipsychotic medications they shouldn't have.)
posted by Wemmick at 1:57 PM on November 30, 2014 [2 favorites]

Generally, I think the argument against antidepressants is just that when people have done meta-analyses of the studies purporting to show their efficacy, they're basically about as effective as a placebo for patients with mild to moderate depression. But placebos can be very powerful! And they're more effective with more severe depression, as that meta-analysis shows.
posted by dialetheia at 2:02 PM on November 30, 2014 [4 favorites]

If you are talking about the DSM, I'm pretty sure this is incorrect.

I'm not talking about the DSM, and I'm in full agreement that it's an outdated, overrated, and frequently misused resource. The more prominent medical associations and committees (e.g., the American Psychiatric Association) publish clinical practice guidelines focusing on specific disease states. The most well-accepted and widely-used ones are taught in medical schools.
posted by dephlogisticated at 2:06 PM on November 30, 2014 [2 favorites]

the jam: "No one claims that we're living in the golden age of mental health, but I really have a hard time when people claim that current treatments are just scams created by greedy pharmaceutical companies. You only have to look back 50 - 60 years or so, when treatments for schizophrenia and severe depression were so non-existant, that people thought lobotomies were a decent idea.

We can stand back and criticize them now, but doctors had so few tools available to them to help patients with very serious problems.

In the past 50 years we've gone from basically zero effective treatments to a decent smattering of things that kind of sort of work more or less a good percentage of the time."

I don't think they're scams, exactly. The scenario I think we're facing is that many of the problems considered individual mental illnesses are in reality somewhat normal reactions to the conditions of modern society. Our assumption is that our environment is "normal", and therefore any failure to thrive and function is an individual flaw. Individual flaws call for individual solutions, and in our market-base society pharma companies step in and sell us a means of ameliorating distress caused by things we have no control over. It's far easier to change one's brain chemistry than to fix all the hierarchy, stress, isolation, sexism, racism, poverty, meaninglessness, or powerlessness in one's life. (And at times, to take a darker view, medications provide a means to pacify students at school, make the elderly easier to care for, and generally reinforce the status quo much like straitjackets and lobotomies did decades ago. I've seen people so drugged into oblivion that claims we've improved our treatment methods radically since the 50s look suspect. A chemical lobotomy looks more humane, but I don't believe it's the incredible improvement some think.)

So, under the conditions of our society, if a pill helps someone cope with a toxic social environment, a toxic workplace, isolation, poverty, stress, etc., then the pill works, in a way. There's no conspiracy. But that doesn't mean medications are the best approach, and in addition to biological side effects, I fear the widespread use of medication may obscure our ability to see the big picture. Unemployment and isolation can contribute to depression. Violence and crime contribute to PTSD. Rates of mental illness vary by country and subculture. And so on. So when NIMH says approximately one-in-four American adults experiences a mental illness in a given year I start to think — this is ridiculous! They can't all have genetic problems. It doesn't seem reasonable that one quarter of the population was born with an illness. Even if the pills "work", I'm convinced much of this suffering must have origins outside our individual biologies.
posted by Wemmick at 3:02 PM on November 30, 2014 [16 favorites]

they're basically about as effective as a placebo for patients with mild to moderate depression. But placebos can be very powerful! And they're more effective with more severe depression, as that meta-analysis shows.

This is wrong!

(After lurking for years, intending to someday create an account, I always wondered what would lead me to bite the bullet.)

A few weeks back I attended a seminar by a statistician named Thaddeus Tarpey, "Calling Models Wrong for the Wrong Reasons". He talked about all sorts of misconceptions about the meanings of statistical parameters that lead good models to be called wrong, or misleading models to appear useful. Toward the end he gave an example based on his recent study reanalyzing that study, showing how a statistical error related to Simpson's paradox led it to reach incorrect conclusions. In truth, both antidepressants and placebos are more effective as depression gets more severe, but antidepressants are always more effective than placebos at all levels of depression. (Check out figure 1 from the study, if nothing else, to see a dramatic plot of the error in action.)

So as long as we're talking about problems like the file-drawer effect, or the influence of drug company marketing, it's also important to talk about how our culture projects its anxieties onto the conversation in various ways, such as how the Kirsch et al study got a 60 Minutes segment but the Petkova, Tarpey, et al reanalysis got jack squat.
posted by traveler_ at 3:35 PM on November 30, 2014 [25 favorites]

That inflammation study looks very interesting, but has there been any replication? The reason I ask is that they had like 20 clinical variables like age, sex, etc., and they tested all of them to see if any made a difference. It's good that the one that was significant was the one you'd expect if there were a real effect (the inflammatory marker) but the fact is that they also tested a bunch of hypotheses and didn't do any correction for that. And the p-value for that one significant test is pretty pedestrian as well (p = 0.01), with some pretty huge error bars in their plots. So it's interesting and has some biological plausibility but I'd really want to see replication in an independent cohort where this was actually the hypothesis going into the study.
posted by en forme de poire at 3:38 PM on November 30, 2014 [2 favorites]

After re-reading, I see you linked to the Fournier et al paper, not Kirsch et al. Sorry. But the Petkova study addresses them both as having the same flaw, so my point stands.
posted by traveler_ at 3:49 PM on November 30, 2014

traveler_: "In truth, both antidepressants and placebos are more effective as depression gets more severe, but antidepressants are always more effective than placebos at all levels of depression."

Isn't one of Kirsch's theories that antidepressants have an "enhanced" placebo effect because their side-effects allow trial participants to break the blind? I haven't looked at the literature, but I'm curious to know how antidepressants fare against active controls.
posted by Wemmick at 4:00 PM on November 30, 2014

It's far easier to change one's brain chemistry than to fix all the hierarchy, stress, isolation, sexism, racism, poverty, meaninglessness, or powerlessness in one's life.

I do agree with you. I think it comes down to making the best of your situation with the tools that you have. It's wrong to say that people should always turn to drugs to cope. It's also wrong to say that people should be ashamed to use drugs to cope with stress, anxiety, and depression regardless of the origin. There is no magic pill and neither is there a magical utopian village of nature and peace and yoga where no one experiences mental issues.

You can change your environment to an extent and now you can change your biology to an extent. We just have to do the best we can with the tools we have.
posted by the jam at 4:22 PM on November 30, 2014 [2 favorites]

the jam: "You can change your environment to an extent and now you can change your biology to an extent. We just have to do the best we can with the tools we have."

Oh, I agree. I'm not completely anti-drug either, but it seems to me that a number of factors — the individualist perspective in the West, the profitability of pharmaceuticals, and the belief that chemicals, genes, and fMRIs are more scientific than measures of social connectedness, financial security, etc. — I think they tilt our understanding and our imagination for possible solutions much more toward biology than environment.
posted by Wemmick at 4:51 PM on November 30, 2014

Kirsch's theory on the side effects is refuted, at least in part, by a natural experiment: there's an antidepressant with really bad side effects that really does turn out to be no better than placebo, known as reboxetine. If side effects were causing the placebo effect, this drug should be *better* since its side effects are worse.

Also, Kirsch simply ignores the data on the wide variability of antidepressant responses, which is a much better explanation for why they can look like either poisons, placebos or panaceas. They are all of the above, just for different people. The miracle cure people are washed out by the suicidal folks, making extreme responses look like no response. Anyone who has ever seen more than 2 people take an SSRI knows that these drugs are pharmacologically active in ways that are difficult to predict, making some people way better and others way worse and having little effect on others. To say that this means it's all placebo is willfully ignoring data.

And sure, inflammation may be involved in some depression— but it's clear that elevated inflammation also frequently results from the same type of childhood stress that massively increases depression risk so the relationship is probably more through the stress system than it is likely to be through an infectious agent. Though, of course, there could be some cases where infection is involved just as this seems to be the case with some cases of childhood OCD.

this post is a mishmash of too many disparate elements, I think ;-)
posted by Maias at 5:16 PM on November 30, 2014 [4 favorites]

Wemmick: "Isn't one of Kirsch's theories that antidepressants have an "enhanced" placebo effect because their side-effects allow trial participants to break the blind? I haven't looked at the literature, but I'm curious to know how antidepressants fare against active controls."

It sounds like it is, yes. But from this article it sounds like his overarching theory is "antidepressants bad" and everything drives from there.

I think there's sort of a philosophical question of what it means to be an "active placebo" in psychiatry—if it's active, and has an effect, what's the difference? Does it have to change a known neurotransmitter in a known way to count as real? I mean, lifestyle treatments like exercise or sleep deprivation are pretty much unblindable, is anyone worrying that they might be active placebos?

Nevertheless out of curiosity I did a quick search through google scholar (and got a lot of noise so this isn't the most reliable, but):

I found two studies examining antidepressants for specific conditions, that tested against active placebos, and found an effect; one looking at treating depression and another on diabetic nerve pain. There was one pretty influental study suggesting that "unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos", but it's a meta-analysis and I'm getting skeptical of those, most who cite it mention that it examines a small number of older studies, and in their abstract (I don't have access to the full paper) they say they throw out "one strongly positive trial". So color me skeptical.

But honestly I'm most interested in this study: Blindness and Bias in a Trial of Antidepressant Medication For Chronic Tension-Type Headache. It's the only one I found that actually measured the amount of unblinding and its effect on study results. The money quote: "Penetration of the blind needs to be assessed, not assumed in clinical trials in headache. However, penetration of the blind did not produce a prodrug bias as has been asserted by critics. Better methods of assessing and quantifying blindness are needed." Trial participants were somewhat accurate in identifying whether they got the drug or the placebo, but what's interesting is that their judgement looks to be based entirely on whether their headaches improved (causing both false-positive and false-negative errors), and not at all on whether they noticed side-effects.

P.S.: How do you quote people like that? I did it manually, but it's so common I'm thinking there's a button or something I'm not finding.
posted by traveler_ at 6:18 PM on November 30, 2014 [3 favorites]

I think there's sort of a philosophical question of what it means to be an "active placebo" in psychiatry—if it's active, and has an effect, what's the difference? Does it have to change a known neurotransmitter in a known way to count as real?

It seems like it's possible that believing you're well, or better, would actually change your neurochemistry anyway, even if the sugar pills were not doing so directly.
posted by jaguar at 6:28 PM on November 30, 2014 [1 favorite]

Not dumb enough that it shouldn't be studied, but dumb enough that it doesn't warrant an article in the NYT.

That's a pretty revealing position, for what it's worth.
posted by mhoye at 6:30 PM on November 30, 2014

traveler_: " P.S.: How do you quote people like that? I did it manually, but it's so common I'm thinking there's a button or something I'm not finding."

Anybody whose quotes show up in this kind of format is probably using the MeFi Quote Greasemonkey script.

(But really, as long as you're not @ing people, it's all good. Italics mean quoting, quotation marks often mean paraphrasing/"I'm presenting something I've heard but can't attribute", bold means emphasis… just no @. The smarmy and judgmental phrasing I've seen is "At MetaFilter we don't talk at people, we talk with people.")
posted by Lexica at 6:33 PM on November 30, 2014

That's a pretty revealing position, for what it's worth.

I support the testing of dumb hypotheses. I don't support journalists writing about them. See, for reference, the anti-vaxxer movement.
posted by dephlogisticated at 7:16 PM on November 30, 2014

I have never taken hallucinogenics in my life (not against them, just never got around to it.) But if there is evidence that something like psilocybin can do something to dent my lifelong depression, I'd be the first to step up and try it.

Unfortunately, I can't for a number of reasons, including being old and not knowing were to even go about getting it and not knowing anyone who has experience and could guide me through my first trip.

Who knows. Things are changing. Maybe they'll legalize it and I can sit in my therapists office and be tripping balls while I explain that I'm willing to see the whole world in shades of grey, but for myself my judgment is black and white, and I always come out on the wrong side of it. Mainly because I don't much like myself.
posted by quin at 7:18 PM on November 30, 2014 [2 favorites]

All I know is that I am totally not taking mushrooms for my depression. Yikes.

I don't have depression (AFAIK), so maybe this is a siderail, but I have been blue and in the dumps plenty of times.

Mushrooms are a godsend--sometimes I think quite literally--and have made me feel connected to my environment like nothing else, not even the love and friendship of loved ones. But those experiences were when I took shrooms with a number of different motivations: curiosity, questioning, fun, adventure, etc.; with a dollop of seriousness backing each one.

Once I took shrooms to simply escape. I was at a particularly low point in my life, and probably should've simply grabbed a bottle of bourbon. But I had had such amazing and positive experiences with shrooms, I thought a trip would turn me around. Boy was I wrong.

It was a hellish trip, made worse by the fact that I did it alone, and it was almost as if I was being scolded for being in the wrong frame of mind, wanting to take rather than give. Again, that's the part of me that absurdly thinks there's something godlike about those things.

That said, even if you have depression, as long as you have support and are open and sober-minded, I think mushrooms could well be what could help. I definitely think more research into psyilocybin and DMT should be done.
posted by zardoz at 8:45 PM on November 30, 2014 [1 favorite]

Yeah, one reason psychedelic drugs are not addictive is that you can't take them to escape. They magnify your problems *while you are high*— unlike cocaine or heroin or alcohol. So, if you take them while depressed or even just sad in a depressing situation, alone, without feeling able to connect— they will make that worse. OTOH, if you take them in a therapeutic one (and this doesn't have to be formal therapy, but it does have to be emotionally and physically safe), where you feel able to be supported and open, they may help.
posted by Maias at 5:10 AM on December 1, 2014 [1 favorite]

When drugs do work - "LSD and MDMA have long been seen as dangerous party drugs but research suggests they may help people suffering from post-traumatic stress and other illnesses" (prev.)

Rachel Hope is an unlikely ecstasy user. Brought up to be fiercely suspicious of recreational drugs, she now raves about the “party pill”. Abused from infancy, she repeatedly sought professional help in the US. “I spent 15 years in and out of clinics, on and off medications. I tried psychotherapy, hypnotherapy, yoga.” Doctors diagnosed her underlying condition as complex/chronic post-traumatic stress disorder – a state better known among soldiers returning from military conflict. “Whatever I did, it was getting worse. I was desperate,” she says.

But then Hope discovered a network of maverick scientists and doctors challenging the taboos around a number of drugs in small clinical trials. Ecstasy, LSD, psilocybin (the active ingredient in “magic mushrooms”) and cannabis are among the compounds beginning to make a cautious experimental comeback for conditions including trauma, depression, anxiety and pain relief. Hope stumbled across one such trial in South Carolina. It combined psychotherapy with 3,4-methylenedioxy-methamphetamine – better known as MDMA or ecstasy. In 2004, she became participant Number Seven.

She was suspicious at first. “I thought MDMA put holes in your brain,” she says. “I’m not uptight but I am a wholegrain, organic kind of person. I was very far away from believing this drug had anything for me.”

But after just two consultations following a small dose of MDMA, Hope felt a radical transformation. “It reduced anxiety, not numbing you but enhancing your awareness, giving you a feeling of connection,” she says. “It lit my head up like a Christmas tree, so I could see every single neurone . . . I could go inside my head, see the wiring and rewire it. It was as if I was born again, as though someone took me out of prison.” In 2012, she took the drug and therapy again as part of a follow-up study. She now considers herself cured.

[...]

For specialists such as David Nutt, professor of neuropsychopharmacology at Imperial College London, the prejudice against psychoactive compounds has been far more dominant than scientific assessment of the risks and benefits. He cites research pointing to potential uses of MDMA not only for PTSD but also in autism, Parkinson’s disease and recovery of cognitive functions after brain trauma. Other studies suggest applications for psilocybin in the treatment of cluster headaches, obsessive compulsive disorder and depression; and LSD for pain and alcoholism. Yet these drugs have the toughest classification in the UK, stricter than heroin.

Such legal restrictions present researchers with major difficulties in finding funding and covering costs of procurement as well as meeting tight requirements on the drugs’ administration. “It’s beyond surreal,” Nutt says. “The scientific community is scared and ignorant. We are killing people by not allowing access to ecstasy. Half a million kids are taking it every week but scientists are considered criminals for using it in trials. I need taxi receipts to show we’ve delivered the drug to laboratories. It’s as if it’s plutonium.”

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posted by kliuless at 8:55 AM on December 1, 2014 [1 favorite]

maybe there are pathogens that increase susceptibility for depression

If there are, I'm tipping they'll turn out to be gut bugs.

Guts and brains are interconnected in all kinds of weird ways.
posted by flabdablet at 8:58 AM on December 1, 2014

Guts and brains are interconnected in all kinds of weird ways.

How Boy Bits First Came To Be - "Certain birth defects in male children are on the rise, and nobody knows why. Scientists say basic research into how external genitalia evolved in reptiles and rodents might offer a few clues."

So what causes two penises to grow from the region where a snake once had its legs, and one to grow from the tail region of a mouse? It turns out that the cells are getting orders from another part of the body: the anus.

This may surprise you, but the digestive tract is among the most ancient parts of any animal. Even the most primitive animals have mouths and bottoms, says Marty Cohn, who studies evolutionary and developmental biology at the University of Florida.

And when more complex animals are developing in the womb, it's actually the gut that spurs other organs to grow. Organs like the liver and pancreas, he says, "bud off of the gut."

And, apparently, so does the penis. Cohn also has a paper out this week in the journal Scientific Reports showing that the chicken's penis starts near its bottom. Wherever the gut happens to end, signals go out telling the penis to form.

It's not just the penis. In women, the clitoris is formed by these same signals. But interestingly, the rest of the female reproductive system seems to have followed a different evolutionary path, according to Denis Duboule at the University of Geneva in Switzerland. "It's useless to have a penis if you don't have a vagina or somewhere to put it" he says. "So how could they co-evolve?" Researchers still aren't sure.

The new work shows a common way in which penises form among many different animals. But exactly how orders from the gut shape the cells is still an open question. Cohn says it may be important to determine the details of this signaling system, especially for humans, as a way of figuring out how the system can go wrong in fetal development.

"In the past 30 to 40 years, the incidence of genital-urinary defects has risen, sharply," he says. "We don't really understand why."

kinda OT, but interesting i thought :P more research!
posted by kliuless at 9:16 AM on December 1, 2014

The search for specific genes linked to depression has come up empty, he said, adding: ‘Perhaps, we have been looking at the wrong organism.’

It's the Thetans, all along!
posted by FatherDagon at 12:20 PM on December 1, 2014