Thanks for writing this, great to hear that you’re feeling better.
I’m usually a fan of self-experimentation, and the upside of finding an antidepressant with few side-effects (and that you can take a lower dose of) is definitely valuable. This seems especially true if you can stop taking it during better mental health periods, then have it in your arsenal for future use. But I still have a few doubts about this process, and I’m a little concerned that some of the premises behind your experiment need a bit more scrutiny. I hope someone with a bit more domain-specific knowledge can correct me if I’m wrong, or improve my arguments if I have a point. I’m also aware that there’s no such thing as a ‘perfect self-experiment’, and I don’t think there are obvious ways that you could have improved the experiment. But here are a few things that I’d like to hear your thoughts on:
Firstly, the depression episode was triggered by an disruptive external factor- the pandemic. This would probably invalidate any observational study held in the same period. As this external factor improved, and people could start travelling/ socialising normally, you might expect symptoms to lift naturally from mid-2021 onwards. From what you’ve mentioned here, you don’t seem to have disproved this hypothesis. I gather that depressive episodes seem to last a median of about 6 months ( see pic below), with treatment not making a huge difference for duration within the first year (some obvious caveats about selection effects here). How do you consider the possibility that you would have recovered without antidepressants?
Secondly, the process of switching between 5⁄6 antidepressants seems to be a significant confounding factor here. I don’t know how good the evidence base for the guidelines link you sent was, but it seems likely that the multiple (start, side-effects, ending, potential relapse) effects of antidepressants are significant enough to really mess up any attempts to have a ‘clean slate’ between treatments, and to therefore make it a unfair comparison. It seems possible that what you thought was a negative reaction to x medicine was actually contingent on having just tapered off y medicine and/ or experiencing a relapse. Does that seem plausible, or do you think that there was a stable enough baseline for comparisons to be valid?
Third, just a bit of concern about the downsides of the experiment. There are some long-term side-effects to antidepressants, and they seem understudied for fairly obvious reasons (most clinical studies only last for 6 months, no long-term RCTs). There seems to be a few studies that point to longer-term risks and ‘oppositional effects’ being underestimated. Unknown confounding factors and additional health risks from going on and off antidepressants would make me very concerned. Obviously, untreated depression also has a range of health risks, so I don’t want to discount the other side of the ledger, but I would definitely not be confident that I was doing something safe. How confident do you feel in your comparison of these risks? And did you feel that you had to convince yourself against (potentially irrational) fear of over-medication?
Finally, a bit unrelated, there’s a meta question that often comes to mind when I read posts about more rational/ self-experimenting approaches to health issues, which is: “How strong should our naturalistic bias/heuristic be when approaching mental health/ general health issues?” Particularly for my own health, I have a moderate bias against less ‘natural’ (obviously a very messy term, but I think it’s useful) health solutions. I often feel EAs have the opposite bias, preferring pharmacological solutions, perhaps because they can be tested with a nice clean RCT. I’m interested what level of bias you, (and forum readers), think is optimal.
Thanks for this article, I agree with a lot of the takeaways, and I think that more research into developing an evidence-based theory of change for short- and long-term uptake of alt proteins is very valuable.
But I think the problem with arguing against an informal hypothesis is that I don’t think you’re actually arguing against a commonly-held view.
This is how you frame it:
“The price, taste, and convenience (PTC) hypothesis posits that if plant-based meat is competitive with animal-based meat on these three criteria, the large majority of current consumers would replace animal-based meat with plant-based meat.”
I’ll call it the “positive-PTC hypothesis”, the idea that if we achieve PTC-parity, the market will automatically shift. I don’t think anyone in the space holds this view strongly. To the extent that they do stress PTC over other factors, the sources you quote seem to put more emphasis on the ‘negative-PTC’ hypothesis- achieving PTC-parity is a necessary but not sufficient criteria for people to start considering PBM.
Szejda et al. say:
”… only after a food product is perceived as delicious, affordable, and accessible will the average consumer consider its health benefits, environmental impact, or impact on animals in the decision to purchase it.”
This negative-PTC hypothesis also seems to be implied
moreto some extent in the Friedrich 80k podcast you refer to. He also says explicitly that he doesn’t think everyone would switch to PTC-matched PBM (hence the need for cell-cultured meat).There’s a bit of positive-PTC in the GFI research program RFP (2019) claim that “alternative proteins become the default choice” (both cultured and PBM), but even then it’s not exclusively PTC, they also refer to these proteins winning out on perceptions of health and sustainability, and requiring product diversity.
As well as this, every source you quote, and every paper I’ve ever read on PB meat acceptance, also stresses a bunch of other factors besides PTC. In particular, the main report you associate with PTC (Szejda et al. 2020) stresses familiarity throughout the report. “While many people have favorable attitudes toward sustainability and animals, the core-driver barriers to acting on these attitudes are too strong for most. More than anything, products that meet taste, price, convenience, and familiarity expectations will reduce these barriers”. Familiarity in itself could go a long way to explaining the negative results in all the studies you refer to: all are comparing an unfamiliar product with a familiar product.
So I’d argue that very few people in this space actually support the PTC hypothesis as you frame it. Few people think that PTC-parity is sufficient for widespread PBM uptake.
Having said that, I think there probably is an interesting, genuine divergence of views with people who hold a PTC+ hypothesis and those who hold a more “holistic” view. So if a diverse range of alt proteins achieve parity in price, taste and convenience, while also being positively perceived in terms of familiarity, health, environment, status, safety etc., some might believe that there will be an inevitable shift to these products, while others would think that meat and carnism is so embedded within our cultural and social norms that even if we get overwhelming good alternatives, the majority of the population would still be very unlikely to stop eating meat. It’s an interesting question, but one that I don’t think you’ve answered in this piece.