Unanswered Questions and Antidepressants

If a placebo is having an effect, it isn’t a placebo. If you have all the answers, you’ve been asking boring questions.

Unanswered Questions and Antidepressants

The Cultured Warrior Newsletter #003


Thoughts to Ponder:

Don’t just teach your children to read, teach them to question what they read. Teach them to question everything. ~ George Carlin
This seems particularly in our day and age where there are far more answer that can’t be questioned being proffered than there are people asking questions that can’t be answered. At any rate, people throughout their lives, especially children, need to remain curious. We need to learn to educate and develop ourselves. Curiously, we all have things we “believe” in; and not without purpose. Perspective is everything here. Can we see outside ourselves that our biases (beneficial and blinding) are not universal? Do we dare dream that an alternative is possible or that there is evermore to learn?
The curious paradox is that when I accept myself just as I am, then I can change.~ Carl Rogers
It is a curious paradox indeed. Congruence, paradoxically, is a paradox. When there discordance between our view of ourselves and the world / people around us we have the bedrock of pscyho-social “dis-order” or “dysfunction.” In fact this is the foundation of trauma; a rupture in our world view such that the “cure” is to re-person the person. At any rate, we all have to start exactly where we’re at. Until that position is acknowledged and honored (internally and externally) we cannot move — perhaps any direction, least of all forward.

Things I’m Reading:

Antidepressants and the Placebo Effect

“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…. To summarize, there is a strong therapeutic response to antidepressant medication. But the response to placebo is almost as strong. This presents a therapeutic dilemma. The drug effect of antidepressants is not clinically significant, but the placebo effect is.”
This is a fascinating provocation. As a clinician I’m well aware that what’s “statistically significant” (p-value / not by chance) is not always “clinically significant” (or vice-a-versa). This highlights the importance of “N=1” / case studies and so-called anecdotes. I tell patients all the time; “If the placebo is working, it’s not a placebo.”

Personalized prediction of antidepressant versus placebo response

This is equally fascinating in that it explores different sub-types or characteristic manifestations of depression (e.g. depression does not present equally in all people). What struck me is that “chronicity” of depression teds to have a poorer response to placebo (not surprising), but “those with more intact cognitive control exhibited better outcomes in SSRI vs. placebo…” This is fascinating because it implies that one needs a certain amount of cognitive coherence in order to get a benefit from one’s brain’s “happy chemical.” Do I need to know I feel happy in order to feel happy? Ironically, the authors point out that “continued cognitive impairments — even following symptom remission — are among the most common residual symptoms of depression.” If in fact, then, I need to know how I feel to feel better, I am, by definition of my disorder, not able to feel better because of my impaired thought processes.

Resources to Thrive:

Environmental Working Group (EWG):

… has some great resources including checking how clean your tap water is;
cancer, toxicity, and alergen severity ratings for cosmetic and personal care products; and
toxicity and cancer severity ratings for household cleaning products.

I compiled an Amazon list…

… of products I use that score either a 1 or 2 (low toxicity; the highest standard is “EWG Approved”) on EWGs rating system (view list on Amazon).

Trainer’s Corner:

  • I’ve been chunking down material from Now What by Dan John regarding The Prisoner’s Paradox and the most fundamental parts of jiujitsu and strength training. Stay tuned on Instagram!

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