Thoughts About Thoughts

A friend of mine shared out an article on Facebook this week discussing that everything we think about depression might be wrong. My comment on her thread after reading it was, “I’m having many thoughts about this.” And this was the best way to describe my feelings: MANY THOUGHTS.

How do we know depression is even caused by low serotonin at all? When he began to dig, it turned out that the evidence was strikingly shaky. Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”

There is a lot to the article, and as someone who has been trying 14 thousand different meds in the last year to manage her depression, I had to fight off a lot of initial shame and defensiveness because the majority of the article was saying that certain meds might not help as much as we thought.

And as I do with anything that makes me feel a little uncomfortable, I sat on it for a few days.

And here are my many thoughts.


Meds have not been working for me. I’ve been on many SSRIs and SNRIs and I’ll feel good for a little while but then: NADA. So a lot of this spoke to me in a way that said: DO NOT LOSE HOPE. Some of the other lifestyle type triggers he mentioned could apply in my life so maybe meds are not going to help me because low Serotonin may not actually be the cause. Maybe I’ll feel better by focusing on other things.


BUT DOES THAT MEAN MY DEPRESSION AND ANXIETY ARE NOT REAL?! That is the shame spiral I immediately fell into after thought #1 and THAT is where I spent a few days and then it hit me:



Whether your anxiety and depression are caused by chemistry in your brain or circumstances in your life: THEY ARE REAL AND MUST BE TAKEN SERIOUSLY. Just because meds aren’t helping doesn’t mean my problem is any less real or any less serious. Maybe my Serotonin levels have always been fine, but that doesn’t mean my depression or anxiety are fake or non-existent. I AM FALLING PREY TO OUR TWISTED SOCIETAL VIEW ON SADNESS.


No one wins a competition of sadness. I don’t need to figure out where I fit on the “severity” spectrum in order to justify various treatments. I need to focus on MY mental health ALONE and not compare it or the treatment to other people.


There’s a large part of our culture that says: JUST GET EXERCISE AND YOU WILL FEEL BETTER or JUST EAT RIGHT and this attitude can make someone who feels like shit and very defensive because I CAN BARELY GET OFF THE COUCH, DO NOT TELL ME TO EXERCISE.

But the lifestyle causes analyzed in this article are even more difficult than getting out of bed if you’re sad. Oh, maybe your marriage is shit? Or your job is shit? Or you don’t have a great friend network? You WISH all you needed was exercise! Maybe you need an entire new career path to feel better!

Yes – a lot of these things mentioned in the article can make you depressed but IT IS NOT LIKE YOU CAN JUST FIX THEM OVER NIGHT. Changing your career is a luxury most don’t have, fixing a bad marriage requires energy and commitment from two parties or it doesn’t work, and building a friend network of support is one of the hardest things I’ve ever done. So, yeah, maybe those big things could make someone depressed and yeah, messing with their Serotonin won’t fix it, but how do we help that person when those big problems are not easy to tackle?

I’m glad my only problem is Stop eating cake for breakfast – that’s way easier to fix than How do I build a supportive network of friends.


Mental illness is damn overwhelming. All you know is you feel terrible and it’s so hard to motivate yourself to find help. Even saying for the first time out loud to someone like a doctor or a therapist or even a friend, “I’m really anxious/sad,” is nearly impossible. But then to discover that it may take lifestyle changes or medication or it could take BOTH or you could do everything right and still feel terrible and then maybe it’s more big picture stuff like your family is shitty or your career is sucking out your soul or maybe you need to not be alone so much and OH MY GOD I JUST WANT TO DRIVE ACROSS THE BRIDGE WITHOUT FANTASIZING ABOUT HOW EASY IT WOULD BE TO JUST SWERVE INTO THE RIVER.

(That’s not my particular suicidal ideation, by the way, I’m too terrified of bridges.)


Being mentally unwell is difficult and our culture is not always supportive and sometimes the causes are too big and the fixes feel impossible and I am just proud of people who get off the couch or out of bed every day amidst that overwhelming feeling of sadness and dread.

Here’s to fighting the good fight with whatever tools we have, no matter how tired we are of fighting. Here’s to not turning mental illness into a contest of who has it worse by comparing tools used. Here’s to not shaming people who use different tools, and here’s to be open to using other tools if the ones we have are not helping us as much as we hoped, or as much as they once did.


12 thoughts on “Thoughts About Thoughts

  1. Ashley says:

    I have many thoughts, too. And I know medicine doesn’t work for everyone, but I do know that it works for me. I went off of my medicine when I was pregnant with Benjamin and it was terrible. I can tell when I try to lessen my dose. Maybe it’s a placebo effect, but I believe it. And sure, maybe I could go without if I ate right all the time and worked out everyday and had time with friends, but without the medication, I find it very hard to do any of those things (not to mention the time that they all take). And something as complex as mental health must have multiple treatments for different people. There’s not one solution for cancer, why would there be one solution for depression?
    I am realizing that this sounds snarky…but it’s not directed at you…it’s meant to agree with you about how complex and hard this disease is! Here’s to fighting the good fight (with naps along the way! And donuts!)

    • zoot says:

      I have been SO frustrated with the medicine situation so much that I think I want to stop trying for awhile because I think the meds NOT working is making me MORE anxious. But I am also making appointments to find a PSYCHIATRIST because I’m allowing maybe my GP hasn’t figure out the right path yet b/c that’s not her specialty and maybe there are other chemicals my brain needs!

  2. Karen says:

    All. The. Feels. You have captured the complexity of thought so well. Thought 5 especially resonated with me. And #4… that “just” word is so incredibly frustrating (didn’t you write about that, too?).

    I’m sorry meds haven’t been helpful. When I took them (maybe for about a year), I didn’t even realize I was depressed, mostly because my depression didn’t “look” like depression, and as far as feelings go, I was in a place where I didn’t really “feel” a whole lot. I couldn’t even tell the meds helped; it was others who could notice that I was different.

    Since then, my mental health has improved over 4-5 years of talk therapy and lots of baby steps in my approach to life. I am not nearly as well-rounded in my life as you… if I were, I would feel like I really had things conquered. You are so incredibly self-aware (I know I say this all the time, but it blows my mind how great you are at examining yourself and understanding yourself) that I KNOW you are going to find an answer. Until then, this wonderful transparency you have cultivated will help us continue to support you.

    Love you!

  3. Liz says:

    Thank you for sharing. I had a bad couple of months/year before I had a massively comprehensive blood test where they found a B12 deficiency. I had a blood test 4 months before and the B12 check wasn’t done during that, so I tell everyone to specifically ask for it. I had extremely low energy, memory issues, and other things. My memory issues propelled me to ask for it. I give myself shots and it has completely changed my life. A large number of vegans have B12 deficiencies. I’m throwing this out there for you and your readers. I am so sorry that you are going through this, whatever the cause. I love your blog. You are awesome and you will find your way.

  4. Do you have a link to the article that you read. Depression is very real. Medication works well for me. If a particular medication is no longer as effective after a while, it may be what is needed is a larger dose. Try that before a med switch. Because i had not reacted well to 2 different meds (severe nausea on the first) the Dr started with Effexor 35which I tolerated. We went up 75. It helped but left me at just a bit above functional. The sweet spot was 150for a couple years. Now I am at max-225. It works for depression. Buspar for the anxiety. Depression is real and meds work- thats all I need to know for me. I also was in counseling to be able to talk out what was in my head.If you are depressed keep seeking until you find the right combination of medication and treatment.

  5. Julie says:

    Thank you for writing this and continuing the conversation. I agree completely about the psychiatrist vs. the general doctor. The psychiatrist I went to diagnosed me with Adult ADHD–which i took offense to at first “What?! I am a very efficient and organized human being!! I get a lot done! I don’t miss deadlines, I’m not scattered!!” But then I realized I do have millions of thoughts racing through my head, I am a non-stop talker, I multi-task like no bodies business, I am hyper aware of things going on around me, I over think everything etc etc. He explained that the sometimes the ADHD isn’t a detriment to your functioning, in some ways it makes you highly competent and a “go-getter”. Unless it doesn’t.
    So he put me on ADHD medication which was actually wonderful in a lot of ways until about a year into it when it started messing up my stomach big time. I eventually quit taking it because I had also worked through other things and was in a better place but I am very much more aware of the ADHD / anxiety cross over than before. It will be interesting to hear what the new Dr. says.
    And I agree. It doesn’t the matter the cause, we still need to acknowledge how we are feeling.

  6. MommyAttorney says:

    **admits I haven’t read the article**

    Sometimes the causes of things are so complex, that medicine discovers one contributing factor, and runs with that. And so for some people, that treatment will help. But it won’t for everyone. I’ve heard lots of people talk about ketamine as a better treatment for depression than SSRIs and how you develop physiological dependencies on SSRIs. I’m sure in 50 years, standard treatment for depression will be viewed akin to leeches. Turns out leeches can be an effective treatment for some ailments. But it’s not a one-size-fits-all, and there are better treatments for some things.

    Depression sucks and it lies and you’re right. When you just get up and keep going despite it, you are a warrior.

  7. Cheryl says:

    I found that before I could even tackle any of the other stuff, I needed some meds to even out the EXTREMES of my brain. There’s no way I could talk about things if I couldn’t get to the office to actually you know, talk. I personally found that the psychiatrist was MUCH more effective in prescribing for me. I liken it to why you see a dermatologist if the first cream that works for most everybody doesn’t work for you. For most people that first cream your GP prescribes works and the eczema goes away, but for those of us with more complicated skin, we need someone who is familiar with complicated skin. Eventually, as I adjusted other things in my brain and life the med dosage went down.

  8. Lucy McConville says:

    Hi! Thank you so much for this post, and for linking the article, which contains such powerful “food for thought.” I’m so glad I read it, and will for sure share it with several people. I have said all along (in my own mental health struggle, and mostly in the struggle with my ex, who has bi-polar) that it CAN’T be just about medication…there MUST be talk therapy, as well, and for some maybe CBT: (Cognitive Behavior Therapy.) The path to wellness can not be just an ice pick…it must be multi-pronged, like a fork.

    THAT said, there truly ARE some people with brain chemistry imbalances. For them, medication IS necessary, along with talk therapy and life changes. I think it is similar to how, suddenly, every child was diagnosed with ADHD and prescribed medication. Not every child had the disorder! But…SOME DID! MY child for sure has ADHD. No amount of talk therapy or life style changes would have been able to change his behavior. It was a night and day change when he began medication, and it changed all our lives for the better. THAT said, he was also having some severe anxiety and depression. For that we went the talk therapy route (because didn’t want to pile on so much medication in a 9 year old brain), and it has worked. The anxiety and depression were a result of LIFE experiences, manifesting largely because his behavior in school before being medicated for the ADHD made him “weird”, so other kids picked on him…add to that the fact that he was smarter than they were…it was a bullying situation waiting to happen. And, of course, that caused anxiety and depression.

    So, the ADHD is FOR SURE a brain chemistry issue and needs medication…but the anxiety and depression were not.

    For some, anxiety and/or depression might actually BE a chemical disorder. Therefore, I think it would be a shame for the pendulum to now swing back completely the OTHER way. I think the bottom line is that all of this is extremely complex and there simply is not going to BE a “quick fix” answer. I will be happy to see the mental health community taking a closer look at ALL factors that may be causing a person to feel anxious and depressed, and to encourage a multi-pronged path to recovery.

  9. Sarah D says:

    I’m struggling.

    This is my 6th year teaching, and it is hands-down the hardest. I have so many needs that I can’t fix, and behaviors that I can’t manage. It has taken a toll on me, and I’ve only recently come to realize I need to find help.

    I told you on Twitter that I reached out to Kaiser, and can’t even make an appointment until I have a phone evaluation. Which STILL has not happened.

    The big word that sits on my shoulders is Struggle. I’m on the Struggle Bus and I can NOT get off.

    I appreciate you sharing your struggles. I don’t feel so alone.

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