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Week Off; Antidepressants are Placebos?
4 years ago - Edited 4 years ago1,682 words
I didn't work on Atonal Dreams this week because my depression's been getting increasingly worse recently and I clearly needed a break. Did you know that antidepressants are probably placebos?

Last Sunday (Valentine's Day), due to a bunch of factors that all piled up at once, the depression got to the point where I spent a couple of hours huddled in a foetal position on the verge of tears being beaten up by my various inner demons... which obviously isn't the sort of behaviour of a sane and healthy person.

One of the few good things about walking this ridiculous life path I've chosen is that when things get too bad, I don't have to worry about being pushed or punished by an employer, and can take some time off if I need to. So I gave myself this week off since I'm clearly not doing well. I'll need to get out of my bubble at least a bit more to test and promote Atonal Dreams, so it wouldn't be wise to dive into that when I'm feeling so terrible.



I didn't want to just waste the week, so I wondered how I could use it to maybe mend my mind a bit. It's not as simple as just popping down to the local therapist and getting fixed like you might see a doctor for a physical ailment though, unfortunately.

For example, ∞ here's a paper about something that doesn't really fit with the prevailing understanding about the world ∞:

Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.


I read that paper fully and looked into it a bit more, and it's certainly food for thought. The guy who did the research isn't some kind of science-denier or anti-Big-Pharma nut or anything. Obviously it's a complicated thing with a lot of debate though, otherwise antidepressants wouldn't be prescribed at all. But there are a lot of unknowns and doubts regarding the science, and antidepressants definitely aren't medicine in the sense that, say, antibiotics are.

This doesn't mean they don't work necessarily - the (fascinating) placebo effect is still an effect - but I'm mentioning this because whenever I talk about depression, someone usually suggests I go and pop some pills to make the blues go away, like how you might take painkillers for a headache. I wish it were that simple!



Talking helps a lot. But not all talking is equal. Talking to a therapist isn't ideal, because for one thing it takes months to get to see one - it's even worse during this whole pandemic situation - and when you do you're often told that you have something like 6 one-hour sessions with a complete stranger who's keeping their eye on the clock before your time is up and you have to go through the whole tedious rigmarole again. That's not even enough time to explain the intricacies of the situation, and often they just give you some workbook to do in your own time anyway which is certainly inferior to a lot of stuff freely available online. Plus the fact that I've been looking into this for years and have a Psychology degree myself means I'm already familiar with the therapy, so it's not exactly eye-opening to me as it might be for someone who's never even really thought about how to improve their mental health before.

Friends are more valuable, I'd say, but I'm lacking in those. The closest thing I have to a friend is someone I know from uni who I exchange long texts with every other day, mostly about our mental health issues, but replies are sporadic. We've been meaning to do video calls at her suggestion, but I keep putting it off due to my own issues. My demons tell me I'm socially inept and repulsive, and even though she has similar social anxiety issues to me and we've talked a lot about all this stuff - and both have Psychology degrees - so I have good reason to assume I won't be rejected, it's hard to push past the mental barriers anyway, especially when feeling so physically and mentally exhausted. I'll get there eventually, I hope.



It can be valuable just reading about others going through the same thing. I linked to a Reddit thread called ∞ What does depression feel like? ∞ last week, and here's another: ∞ Redditors who at any point have been in such a deep state of depression that you didn't want to DO anything, what is something that helped you get out of it? ∞.

It's always nice seeing confirmation that my issues aren't unique to myself, and that others found ways out of the cave, but I also end up feeling annoyed because it seems like everyone mentions this crippling depression on one hand, then their many friends, partner, and job on the other. How did they manage to acquire all those things despite their condition? It seems everyone just does, somehow. It's frustrating.

They also typically mention 'calling a friend', as if everyone has always-available friends they have no hangups about contacting on a whim, who'll happily talk about their struggles with them in a positive and helpful way, and as if that one pick-up will light the darkness forever. It always seems naive to me - even the most supportive of people get tired of how often people with issues need help, especially when they have their own to deal with - but maybe I only assume that from my own grim position.



My depression is largely situational. My life is crap; I'll be 33 in a few days (I'll probably post again then), and I still live at home, never seeing anyone, hoping what I'm working on every day might maybe perhaps earn a fraction of the minimum wage in the end if I'm lucky. I'm mentally ill, I have brain cancer, I lack freedom, companionship, sex, etc. I assume most people in this position wouldn't exactly be jumping for joy every day. I think it's amazing I'm able to get anything done at all; the personal satisfaction of creation is at least a potent driving force for me, and I'm grateful to the people who support me, particularly on Patreon, which I'm constantly aware of even if I'm never sure what to post there. Those factors are enough of a push to do at least something most days. I'm not quite as bad as people whose depression leaves them bedridden more often than not.

I hope it'll improve if my situation improves, so I feel bad taking time off because of that. I feel like I should be pushing myself constantly, keeping on down the dark corridors because I'll find the exit to the cave more quickly if I just keep moving. I won't get anywhere by setting up camp with no exit in sight! Except energy isn't infinite, and sometimes it's more important to stop and rest even if it means not getting closer to getting out right now. Or so I try to tell myself.

I often wonder if my situation even will improve by carrying on the path I'm on... I see other indie devs all the time on Twitter, and it often feels like watching bright-tailed, bushy-eyed youths all excitedly asking the nearest rock whether the sleek wheels and torn-towel flag on the go-kart they're making will help out when they finally use it to try to leap over the Grand Canyon. Or something. It's difficult to feel like I'll be one of the lucky few who doesn't end up catastrophically disappointed after all the effort I've put in, especially considering that already happened with Sindrel Song. I know I need to look deeply into how to do better this time, but it's all so draining and it's why I felt I needed a break before tackling it.

Did you know that the Grand Canyon is 18 miles wide? That's almost as wide as your mum. HAHAHAHA. That is a multi-layered joke. Like your mum.



I composed a piece of new non-game music this week, so that's something! I'd like to compose enough pieces over the course of the year for an album, so this is one step towards that.



I've still yet to decide on a game to play next! I'm paralysed by the number of choices on my To Play list... and annoyed that some AAA games that I'd like to play cost too much. Maybe I just need to literally use a random number generator or something.



There, that's a very trimmed down version of the much longer post I originally wrote. Honestly I still feel crap and wish I could just take some more time off, but I get the feeling that's not going to change unless I try to make some more progress towards getting somewhere... So I'll try finishing off preparing for an alpha test next week.

8 COMMENTS

astralwolf92~4Y
From one anonymous stranger to another, I'm rooting for you
1
kidupiscean37~4Y
"I also end up feeling annoyed because it seems like everyone mentions this crippling depression on one hand, then their many friends, partner, and job on the other. How did they manage to acquire all those things despite their condition? It seems everyone just does, somehow."

Those who do not manage to do so may choose not to talk about it on social media. So it's not quite "everyone".
1
TheJop32~4Y
I think a lot of dealing with depression comes from one's self, so therapy and medication isn't as useful as most people think, like you said. They're just ways to help you learn to deal with your own issues. I'm definitely surprised to see how big of a part the placebo effect has in antidepressants though. Kind of ruined it for yourself by looking into it. :P

I hope you feel better soon, and don't worry too much about taking a break. As long as you treat the break as a period to recuperate instead of time to weep on the floor in the fetal position, I think it will help you. You can't really brute force your way through depression anyway.
1
Tobias 1115~4Y
I may be insane, but curling into a ball and crying definitely isn't usual behaviour, to be clear! I used the week to get a bunch of non-game stuff done and do feel better for it.

Antidepressants being placebos was taught during my Psychology course, and I had a negative and doubtful opinion of them anyway, but I did wonder whether to mention this if it might spoil the placebo effect for other people who rely on them! Hopefully not.
1
Grattiano1~4Y
1) You're not insane. There's no need to feel ashamed about crying and taking some time to recover after getting knocked down. You did the smart thing, realized you were hurting and focused on recovering. You lived to fight another day. I'm grateful you decided to do that.

2) I'm someone who's been on ADHD medication basically my entire life and have friends who have depression. Medication for anything psychological is tough to get correct for a number of reasons, for reasons I'm sure you know better than me given your education.

The way I look at it is that because everybody's psychological state of mind and levels of chemicals in their brain will fluctuate from day to day, medication has to account for the fact that they have to try and hit a moving target without being able to adjust as the target moves.

So there will be almost always be days where you feel like your meds aren't working at all. It doesn't mean they aren't working, it could just be that the chemicals in your brain that day were more out of whack than normal.

Or it could be that you're not on the right set of meds. Depression's tricky like that.

If the meds are placebos, then the worst thing that can happen when you take them is nothing. There are days where I feel like my Adderall isn't working at all. Then I remember that Adderall is basically meth. It's fucking doing something even if I can't see it at the moment.

You're more knowledgeable about this field than I am, but I always get scared when I hear someone talk about how useless or ineffective their anti-depression medication is. On more than 1 occasion the next conversation I had with the person was one where they asked me to visit them while they are being hospitalized.

3) You said, "even the most supportive of people get tired of how often people with issues need help, especially when they have their own to deal with". As someone who has multiple friends with mental health issues, I will admit that I don't like listening to my mental ill friends talk about their issues isn't enjoyable and I don't like doing it. However, do you know what's worse? Not getting a chance to talk to them about it because they decided to take their own life rather than call you. That's the most extreme example I've experienced, but I'd rather have my friend call me and talk for an hour than have them suffer in silence or have another relapse.

4) You said that your life is crap and you listed some reasons why that's objectively true from your perspective:

-I'll be 33 in a few days
-I still live at home
-never seeing anyone
-What I'm working on every day might maybe perhaps earn a fraction of the minimum wage in the end if I'm lucky.
-I'm mentally ill,
-I have brain cancer,
-I lack freedom, companionship, sex, etc.

All of the above are perfect valid reasons to feel shitty and self-pity. I should know, a lot of them also apply to my situation right now.

HOWEVER, here are the counter points

-You have made probably the single greatest Flash RPG ever with Mardek. It's at the very least in the Top Ten and you did that by your fucking self. You and you alone took an idea bouncing around in your head, worked your ass off, made it a reality and gave great enjoyment to literally millions of people around the globe.

Reread that last line. You created something epic. No matter what happens from this point onwards, no one can ever take that away from you.

...and to say it was "somewhat popular" isn't downplaying it or being modest. You're straight up lying to yourself if you think otherwise and you're doing yourself a disservice in the process.

-After releasing Mardek 3 you went on to kick ass at your psychology studies and were crushing it up until you had to battle FUCKING LITERAL BRAIN CANCER. You're alive and surviving after having had brain cancer.

-You're immensely creative and talented and Alora Fane is looking like it's going to be amazing. Please continue to take care of yourself so that all the time, effort and work you put into it thus far can be rewarded.

-Signal Song didn't perform as well as you had hoped. True, but Mardek, a game you rereleased from a decade ago has already got 10 times as Signal Song many positive reviews in half the time.

-There's no shame in being alone, lonely, single and living with your parents in your thirties at this point in time. The pandemic are taking a tremendous toll on everyone. It would be far weirder if you spent more than a year living in lockdown and came out of it happier, wealthier and more socially active. Thank you for following the rules.
1
bkjnt2019~4Y
Hello. I just want to say that lots of people around the world are feeling things similar to what you are. The pandemic has made things worse but even before that people were feeling lonely and exhausted and depressed. It doesn't mean you're weak or defective, and it doesn't mean you'll feel that way forever. All of us who read this blog want to see you happy and successful and we know you can do it because you've given us hours and hours of memories. Maybe now it feels grimly realistic to say there's no way to succeed but from where I'm standing it seems equally ridiculous as aspiring to a seven figure income. You're not delusional; you're a brilliant artist; if you weren't, we wouldn't even know your name let alone be here.
1
Tobias 1115~4Y
Thanks for the kind words. A lot of people definitely are struggling, especially now... Throughout history, too; the idea we should be 'happy' is a relatively new one. And struggling just seems par for the course for artists throughout history too! I'm just glad the number of supporters on Patreon seems to be slowly growing.
0
Slothboy2531~4Y
For what it's worth, a newsletter I follow just looked at the theories behind the working mechanisms of antidepressants:

[LINK]

It's really quite interesting, considering how unsure we even are about what the cause of depression exactly is - there's so many leads we don't know what to do with them!
1
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