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Comment by sixo | Hacker News Reader

When you are depressed, see if there's a serious problem in your life that is causing you to be depressed and devote as much time and energy as you can muster towards exploring solutions to that problem, even if they entail dramatic life-changing decisions, because that's the kind of problem we're dealing with here.

Examples of such problems: you hate your graduate program. You have no friends in your city and no idea where to look. You are unattractive and wish you weren't. You are skeptical of your faith. You have no activities or hobbies that involve other people and wish you did. You are not as good at software engineering as you want to be. Your job is hell. You fake a character in social situations that makes you hate yourself. You are impotent at facing injustice that you perceive in the world. You are uninspired by the prospects of the career or community available to you. Any of the above + you drink, do drugs, or play video games to avoid dealing with it. * Another: your career is pointless or selfish

Short term solutions like exercise, making friends, or talking to people, and making something will only fix the depression if they happen to address the actual problem - which there's a good chance they do. And of course, the whole situation can spiral out of control and compromise your ability to do something about it, in which case professional help + drugs can make all the difference.

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I completely disagree with you.

I believe you are describing solutions to problems that can make someone sad or frustrated, which is a fine thing. I'm all about being real about your life situation and doing something about it.

However, depression is a disease independent of external factors. I had it when I had arguably one of the coolest jobs in my life up until that point. I treated it with medication, got out of the slump, and applied techniques to stave it away.

Those techniques are what you called "short term solutions." I think of them as long-term preventative measures to stave off the chemical imbalance that can cause depression. Regular exercise keeps up your serotonin and endorphin levels, as well as helps you maintain a healthy body-image. Interacting with people, also increases serotonin and endorphin levels, and ensures you don't feel lonely. Engaging creatively keeps your brain active and, you guessed it, increases serotonin and endorphin levels, as well as distracts from the "why do I bother" feeling, aka, gives you a "reason."

One of the most important lessons I ever learned when I had a shit job. I kept thinking "if I just get a better job, then I'll be happy." Then I realized how much it would suck if my internal happiness depended totally upon externalities - who's to say a good job is the "best" job? If I adopt that mindset I'll always be chasing the carrot on the stick. The important thing is to do what is necessary to be happy no matter what, and then focus on the externalities (the "problems" you describe).

~~~my anecdote~~~

During my first semester of university, I suffered crippling depression and at some point tried to kill myself. Soon after I entered a mental hospital and started journaling. In one of my first journal entries, I noted that I was fairly smart, had great friends, had parents that loved me, had a full scholarship to university, and yet I hated my life and wanted to die. At the time, my condition certainly seemed like some sudden contingency resulting in brain malfunction.

What I did not then realize, and in fact did not at all realize until last year, was that I spent the first 16 years of my life in a literal doomsday cult. I was raised a Jehovah's Witness, and since that was really all I knew, even when I eventually came to the point where I disagreed with some of the doctrines, it never crossed my mind that there was anything at all nefarious about how that organization treats its members.

What you have to realize is that without exceptional self awareness or being adapt at adopting multiple perspectives, people are mostly blind to context of their own circumstances. That's usually fine; such awareness takes a ton of energy and most people just don't need it to stay alive. But when things do start going seriously wrong, and you're experiencing non-congenital mental disorders, is it really reasonable to believe that your mental state is "independent of external factors"? As if that's somehow the one thing the brain's constant processing of sensory data and immediate experience and past memories isn't effecting?

A relative of mine has been battling depression for decades. After this person retired, they had a noticeable improvement in mood and energy within months, and around two years later had started a new exercise regime, begun doing low-paying but enjoyable work again for the sheer joy of it, gotten involved in local government, and quit medication with the help of their doctor.

It's not clear what "independent of external factors" really means, but in this case quitting the job seems to have worked. It wasn't that the job was bad in the sense of prestige, but rather that the job was a massive stressor in physical and emotional ways.

Now, everyone is an individual, but I'd hate to see someone else spend decades fighting depression without access to every weapon they can use.

>Those techniques are what you called "short term solutions." I think of them as long-term preventative measures to stave off the chemical imbalance that can cause depression

What causes the chemical imbalances? Research on animals show that chronic stress causes depression, so it definitely can be caused by external factors. If your job is causing chronic stress then changing job is obviously a plausible cure for your depression.

To do that, you actually have to both be actually able to find and take a different job plus have the clarity to know that such a thing will improve your situation.

And with depression (or anxiety), this isn't so easy. It gets difficult to see opportunities and easier to blame yourself, thinking, "I'm lucky to have this crappy job and that they put up with me". It can make your job seem crappy, even when it isn't.

I get to see the way the chemicals affect my brain once a month. Once a month, I think I'm going to lose my job. That people dislike me. That people are suddenly treating me harshly and I must have done something wrong. I consider changing jobs.

This is like this even when I enjoy my work and actually like the folks I'm surrounded with. It doesn't stop with work, but is a handy example.

I likely should be on anti-depressants half the month - if you've not figured it out, I'm female and this is entirely hormone-related. Instead, I've adjusted life. Once I realize what is going on, I can relax some on the temporary nature of it all. Sometimes it works better than others.

The thing is when depression hits, for me, it is much like this. All the freaking time. Work becomes a relief from home, home becomes a relief from work, sleep a relief from it all. I literally don't have the capacity to sort out which things in life to change or what to do next. I get stuck.

This is why it is a long-term preventative measure. Gotta catch this stuff before the darkness sets in and messes with your sensors.

>before the darkness sets in and messes with your sensors

I like this language, "messes with your sensors." Depression is a disease within the brain, and naturally it's difficult to observe a system from within that system - especially when those observational tools are affected by the system itself.

So it's really hard to know you have depression and take the steps to treat it, when you have depression.

It is a marvelously true expression. _Whatever_ the cause, a real black-dog depression robs a person of all sense of effective agency. The leg is broken and needs a cast, and for many the drugs do work (personal experience). But then the person needs to learn to walk again. It may be a disease (there is a genetic component) but we don't know whether the observed neurotransmitter problems are cause or effect.

Freud said that the purpose of therapy was to replace neurotic misery with ordinary human unhappiness. Some Californians find that a bit of a downer, but it's true, and we can do something about unhappiness.

Depression seems to be caused by both external factors (such as crappy job) and internal thought processes (worrying too much, negative thoughts, etc) or a combination. And some people are just more prone to depression than others. In your case it sounds like some kind of CBT, ACT or mindfulness therapy might be helpful.

Hormones are well known to interact with the stress system and exacerbate depression.

You make a good point about depression itself causing issues with (for example) your job, making it difficult to know what is the source of the problem. I think the best that people can do in this situation is to take a break from work, and think carefully about what they really want from life.

> Research on animals show that chronic stress causes depression...

Source?

That sounds like an oversimplification in my opinion, as there are some pretty glaring problems with using other animals to model mental illness in humans.

Wouldn't the only real analogue be learned helplessness, or am I missing something?

See for example:

http://www.nature.com/npp/journal/v33/n1/abs/1301574a.html

>there are some pretty glaring problems with using other animals to model mental illness in humans

Yes, but the research also looks into stress and depression in human subjects (see above).

The paper you linked to doesn't really show that "chronic stress causes depression", though.

The key sentence in the abstract, I think, is this:

    Here we provide an overview of the evidence that chronic stress, which can precipitate or exacerbate depression, disrupts neuroplasticity, while antidepressant treatment produces opposing effects and can enhance neuroplasticity.

The paper states that stress "contribute[s] to the development of major depression in susceptible individuals", as is well known. It also states that chronic stress correlates with features that are associated with major depressive disorder.

Notice there not being any mention of a causal relationship here.

Agreed. I should have said chronic stress can cause depression.

"Chronic stress can trigger the onset of depression in those predisposed", I would say.

Not really a cure, but a necessity. You still need treatment.

It depends. My own depression was completely cured by lifestyle changes, as was my wife's (different causes for each, but mostly related to jobs).

Treatment doesn't have to be medication or therapy, as I said in my post I consider exercise, meditation, and mindset modifications to be forms of treatment. It's certainly how I handle upticks in depression now that I don't medicate anymore.

- However, depression is a disease independent of external factors.

What? No disease is independent of external factors. You even list a bunch of things which affect it. Depression is a pattern, subject to countless factors. I think what you mean to say is, there isn't a single cause of depression, and it can manifest when many of the factors affecting it seem to be "pretty good", and it can not manifest when those factors seem to be "pretty bad".

>What? No disease is independent of external factors.

This statement is true only in the narrowest sense and is actively harmful to people with mental health issues. Let's compare depression and cancer to see why.

It is common to say something like "cancer is independent of external factors" to mean that anyone can get cancer. It doesn't matter how healthy of a lifestyle you live. Due to random chance, the guy who regularly works out and eats fresh vegetables and avoids toxic substances can get cancer when the guy who watches tv all day, eats nothing but twinkies, and smokes like a chimney might never get cancer. The first guy's cancer was out of his control.

When people talk about depression being "independent of external factors" what they're trying to say is depression can happen to anyone. It doesn't matter how healthy your "mental lifestyle" is. Depression, like cancer, is a disease. Some things may make depression more likely, but anyone can get it at anytime and there's nothing you can do to completely prevent it.

No one feels ashamed for getting treatment for cancer because society recognizes that cancer is disease that can happen to anyone. But people feel ashamed for getting treatment for depression because most people believe "depression doesn't happen to normal people." If you make statements like the parent's about depression but don't make similar statements about cancer, then you are actively contributing to the problem even if your statements are factually correct.

No one feels ashamed of seeking treatment for pneumonia, but there's no way you would say it's independent of external factors. That depression is affected by external factors should neither be controversial nor related to your concerns about society's acceptance of its treatment. You seem to be conflating "dependent on external factors" with "arises due to bad life decisions", which is bizarre as it's kinda the exact thing you're worried about.

In a strictly clinical discussion it is fine to use language like "dependent on external factors" with its technical meaning. But when you're talking to someone potentially suffering from depression and not a clinician, you need to be aware of how they will respond to your words. The average person conflates "dependent on external factors" with "arises due to bad life decisions" and so we need to adapt our language accordingly in an average conversation.

I'd think most people would mistake it as implying that depression was caused by, say, lead in your pipes or that time they were mugged and felt powerless. External factors seem to me to push the blame away, not towards, the individual. The alternative of saying that depression is causeless to me sounds more likely to induce people to think it's "just their fault" or "if there's no cause, why can't they snap out of it?" But I don't have much experience dealing with such people to know.

When you are down, nothing can really make you feel like it is not your fault or that you don't somehow deserve the feeling. Except perhaps, at least among the people I know, this knowledge: That feeling of worthlessness, itself, is the symptom of a condition you have. That condition is called Depression, and Depression lies. So the depressed person can maybe make it through for a little while longer by trying to actively distrust their own feelings and thoughts and waiting for the episode to pass. If they wait long enough, the episode will pass. If they can't wait, they may end up taking their own lives, which is really the only other option they see in the worst moments of this disease. So recognizing that it is a medical condition for which you are not to blame could be very useful for people right on the margin of surviving a depressive episode vs not surviving. I hope this was not too much of a reply!

> true only in the narrowest sense

I think it's true in the right-width-of-sense. Illnesses like depression are difficult because they certainly _do_ lie somewhere closer to the symptom side of the "symptom-disease" spectrum than cancer.

Alcoholism is good for comparison, because it presumably falls even further towards the "symptom" side of the spectrum. But there is certainly a spectrum!

So we have Cancer which is mostly-disease and Alcoholism which is mostly-symptom, and Depression which is somewhere in between.

The fact that these complications lead to weird moral baggage (socially-derived feelings of guilt, etc.) is completely separate from a good analysis of the situation. Depression and cancer are just very different phenomena.

This thing you assert hasn't been proven though. We still don't know what causes depression, we don't know what causes cancer and we don't know what causes alcoholism. Out of the 3, we understand how cancer works the most, because it is the most life threatening one, and affects the most people, and is also probably easier to understand. So we are putting more money and effort into cancer research.

There's as many known external factors for cancer as depression. And as with cancer, they've got only a small impact of likelihood of reducing your risks of getting the disease.

It's therefore unknown if depression is caused by external factors, or simply triggered by them, or a combination, and if so, we're not exactly sure what all the factors which have an influence are.

As it stands today, it's still very possible depression is caused by generic defects, bacterial infection, virus, or some other unknown external factor like polution, exposure to some toxins, or very early development problems, etc.

Honestly, I'd love to be enlightened on some very definite research that knows what causes depression, but as far as I'm aware, science doesn't know.

So there is this problem that some people have depression, and we assume it's just there lifestyle, or they were raised poorly. This is due to the nature of mental diseases, which we understand poorly, and often we associate our mental state as our conscious of our own doing free will. Like someone who is naturally grumpy, we say that's who he is, no one questions that it might be he's got a disease, maybe there is a brain anomaly, or a weird communication of his neurones happening that don't balance out his emotions properly and skew him to being grumpy. But being a grumpy guy would never affect your life enough that you'd seek medical help. So people who are depressed, they're like grumpy guy, except it affects their life so much that we put some research into addressing it. Sad truth is we found very little yet.

With that said, we can see how socially we should be careful how we speak of this, because we're often giving the impression that external factors is the known cause, and that a few lifestyle change is the cure. Except that's false. The cause is unknown, and exercise is just the best we got to help. Imagine if we thought similar of cancer, we'd cut funds for cancer research, we'd just tell people they should eat better, stop smoking and exercise. And everyone who gets cancer got it because they probably didn't follow the right lifestyle.

Robert Sapolsky compares depression to cancer in another way.

https://www.youtube.com/watch?v=NOAgplgTxfc

The acceptance for cancer is great, but I believe both cancer and depression can be avoided with good chance due to factors you decide yourself. Living healthily, eating healthily.

Er, no. You can reduce your risk of cancer greatly by living and eating healthily, but you cannot avoid it. Being alive is in itself a cancer risk, because there are many different cancers and many different ways they can arise - and some of those ways are pretty much purely random.

Having a chance to avoid and reduce the risk of it sounds like the same to me.

Indeed, they do sound the same. They are not.

If I buy a lotto ticket, I have a chance to avoid losing. If I win, it's over. If I lose, it's over. It's only good for one drawing.

However, I have some risk of cancer as long as I am alive. I may be able to do things to reduce that risk, but my chances are infinite as long as I breath. I can choose not to play the lotto, but I can't choose not to get cancer.

Let us assume the goal of a human is to 'lead a long and happy life'.

The chance you win the jackpot with Lotto is miniscule. It is basically so small, that it isn't worth the investment. You're better off not taking that chance because the risk isn't worth the reward. These games are, basically, fallacies designed to manipulate humans, tricking them into behaviour they should not [logically] resort to.

With cancer, you have genetic risks to get (certain types of) cancer, sure.

However, for example living next to a highway increases the chance you get cancer. So, not living there increases your chance of not getting cancer [at a young(er) stage of your life]. Which increases the goal of human life as we agreed upon.

So I agree they're not the same, but your example of Lotto (or similar games) I find rather bad.

I think with regards to cancer this is related to risk/reward. People take risks such as speeding, eating overburned food, or living near a highway. They feel the risk is worth the reward, and they live under the assumption they get away with it.

Brain damage, such as from a concussion, can result in depression along with other psychological problems. Yeah, the concussion is an external factor in the sense that something hit your head, but there's not a whole lot you can do about fixing that factor yourself.

If you think of depression as a self-sustaining feedback loop in your mind, it may very well persist regardless of external factors; in such situation it sounds reasonable to focus on killing off the factors that sustain the feedback loop, with the expectation that once gone, it won't restart again (at least not any time soon).

>However, depression is a disease independent of external factors.

Citation needed. The popular theory of depression being caused purely by a "chemical imbalance" independent of all other factors remains unproven, though it does make for a good and simple advertising ploy for big pharma in that it makes their consumers believe the only way to happiness is through their patented drugs.

I had depression from doing poorly in graduate school.

I felt inadequate and useless. You can call it temporary sadness, but I constantly contemplated suicide and nothing helped.

No matter how much I studied, I still didn't get new concepts as quickly as others and needed to study all the time which sometimes wasn't enough. Once I failed the qualifying exams, I quit and got a software engineering job where I'm doing really well and have plenty of money.

Now I'm really happy and never have such thoughts, so for me it was a matter of fixing a condition where I kept failing.

"However, depression is a disease independent of external factors."

Blanket statements like this (and quite a few in the article too) should be suggestions at best. That might be your experience but it sure as hell isn't mine. I think we can agree to disagree on this and possibly recognize that depression is not a one size fits all disease. What works for you might not work for me. Thus presenting any analysis or solution as fact simply confuses people and can be quite dangerous. Presenting the chemical imbalance theory as fact is especially misleading and extremely dangerous. It's much harder to admit we know a lot less than we actually do, but it's also much more helpful.

I think the observations in your last paragraph are very wise.

I've recently begun to wonder if pursuing 'happiness' is even a useful goal. I'm not really sure what 'happiness' is, or whether it exists. In the past, I have conflated transitory 'ups' in my life, caused by external factors, with sustainable and lasting happiness. When those external factors change, as they always do, it never seems to end well. But it's such a difficult thing to avoid; even being aware of all of this I'm pretty sure I'm going to fall in to this same trap at some point in the future.

Happiness for me can be just as much reflecting on the awesome things that have happened to me in the past, and where I am now, as much as it can be looking forward to the future.

I don't think there's something wrong with setting "happiness" as a goal - I think the important thing is separating that goal from other ones. So not attaching "achieving happiness" to "when I get a raise," instead just looking at internal things you can do to "be happy" in whatever situation.

But exercise, good diet, and not being in a stressful situation does help.

>However, depression is a disease independent of external factors.

Just to clarify, are you saying that systems as intensely interconnected as brains in bodies in the world only ever enter depressive states... for no externally visible reason? What kinds of external factors are you counting (or discounting) here?

Not parent, but I think I can help clarify. As goofy as it can sound: "being depressed" or in a "depressive state" can have many causes and some of them are obvious, but those states are not the disease of depression, exactly. They are serious, of course, and can be life threatening in their own right. But the distinction here is that depression can act like any other disease or illness - like, would making more friends improve tuberculosis? Too often we treat depression as a puzzle that can be solved. But it can just be something a person "has" and is stuck with, and needs medical treatment for.

That's not what the person I replied to said. They said

>However, depression is a disease independent of external factors.

Which sounds like "all depression is a disease independent of external factors". Further supporting this interpretation is that they "completely disagree" with the person they were replying to, as if their comment stood in contradiction.

If we are weakening the parent to just say "There exist cases of depression not caused by external problems" then they don't really contradict what they are replying to. The person they were replying to said "When you are depressed, see if there's a serious problem in your life" because they acknowledged that potential causes of and contributors to depression were numerous and heterogeneous.

When I'm debugging a program, the bug can come from lots of places. When I see a bug, I should definitely see if I'm failing to validate input. If someone told me "I completely disagree. Bugs are caused by hardware failures" I would tell them "if you are saying that all bugs are caused by hardware failures, you are simply wrong. If you're saying that some bugs are caused by hardware failures, then that in no way contradicts the wisdom of seeing whether I'm not validating my inputs".

I think this is mostly about what the formal and informal definitions of being depressed are. Informally people describe depressive states, and feelings of sadness, loss of hope, desperation, and so on as "being depressed". Those feelings are awful, but if they are coherent with real circumstances like grief, or a job you hate, then those feelings are somewhat appropriate and changing circumstances should help. Depression, the disease, is not coherent with reality or circumstances. It unfortunate that the same word it's used for these related but different states.

>Depression, the disease, is not coherent with reality or circumstances.

Where are people getting this idea? I mean, I suppose I could accept it as a definitional exercise in the same way that I can accept the idea that "gurple" is a bluish tint of red. But if you look at, say, a recent DSM, it doesn't say that external circumstances preclude a diagnosis of depression.

I have in my life been very closely connected to several people with depression and maybe that experience is influencing my opinion too much, I will check out some resources and diagnostic criteria, as it has been a while!

It's likely not wise to have a one size fits all approach. I've been in depression in a really bad work/life situation before, definitely beyond the "sadness" you describe. My immune system was compromised, I had an autoimmune flare, I quit work, and slowly became better both physically and mentally.

Then again I think I was very fortunate to have an externally driven depression that I could distance myself from (if I were broke and didn't have parents to support me, who knows if I could have had the courage to quit).

"depression is a disease independent of external factors."

I'm not sure this is fair.

Depression can often come from bad or non-existent relationships.

Loneliness, being away from family, having toxic relations with family, esp. those with whom you live, can definitely be sources of depression.

I only get depressed when I'm away from family for too long, for example.

I understand one can possibly shape one's view and change that, but often the 'external' issue is a reasonable thing to address.

But of course, often it's not like this.

This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

Depression may be affected by real life problems but it is more life-enveloping than that. I've been the most depressed at times in my life when things were going objectively great. The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

>This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

There's no mention of that in the DSM or the ICD.

People with miserable lives can still be depressed; people can have miserable lives without recognising that their lives are miserable. There is no such thing as an "objectively great" life; attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself. Part of living a good life is developing an individual and personal sense of what is valuable and meaningful.

The current gold standard of treatment for depression, cognitive behavioural therapy, is in large part a coaching programme to encourage patients to do things to improve their lives. The cognitive aspect of CBT is secondary to the behavioural aspect - cognitive and metacognitive skills are taught in order to facilitate behavioural change.

"There's no mention of that in the DSM or the ICD."

Maybe not in those words, but the DSM does appear to distinguish between a depressive episode and e.g. bereavement: http://www.mental-health-today.com/dep/dsm.htm (I don't think this is the actual text, but it's the best I can find without a copy of the DSM-IV-TR on hand).

IANAPsychologist, but as an ordinary person, the article's distinction between sadness and depression seems reasonable and intuitive enough for a layperson to understand, and that's a step in the right direction in a world where laypeople (including people who might very well themselves have depression) rarely understand anything about the actual nature of depression.

Having a crappy job or psychotic boss is more long-term than an "episode" such as bereavement, and definitely can lead to depression.

Perhaps. This is probably why I ain't a psychologist :)

The definition linked above does seem to generally imply (and in some cases explicitly state) that depressive episode/disorder symptoms better explained by some other diagnosis or situation (like schizophrenia or bipolar disorder) should be taken as further symptoms of that disorder/situation rather than a separate diagnosis of MDE/MDD. I guess the question is whether or not symptoms induced primarily by external stimuli (as opposed to when the symptoms are expressed as irrational thoughts regardless of external stimuli) ought to be under a similar banner of "these are symptoms of $SOME_OTHER_CONDITION rather than depression". My (again: non-professional) opinion leans in favor of "yes" being the answer, since it likely has different treatment implications (remove patient from symptom-causing stimuli v. prescribe cognitive behavioral therapy and/or medication to patient), but that's the thing about brains: nobody really understands how the brain (and thus the mind) works, and thus it's unclear whether or not such a distinction would actually be useful.

It's difficult to determine whether or not depression is caused by life situation, unless there is something obvious like a recent bereavement.

It seems likely that both external stressors and internal thought processes can both be the cause of depression (and in many cases, a combination). CBT addresses the internal thought processes, but doesn't do anything to address external factors. My wife underwent CBT and took antidepressants, but they didn't really cure the depression. Quitting her crappy job fixed it for good.

Much has been written about the removal of the "bereavement exclusion" from the DSM 5.

Good to know. The vast majority of what little knowledge I have of psychology is based around the DSM-IV, so that's where I tend to stick.

Do the other factors in that particular condition still apply? Namely, "the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation."?

> attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself

Isn't this merely inaccurate rather than pathological, since external criteria are almost never fixed? (cf. inflation)

"There's no mention of that in the DSM"

The DSM changes so often that I wouldn't really rely upon it for a definition.

Our understanding of psychology and the human brain changes so often that I'd have a hard time trusting a source that hasn't been recently updated.

Even with that said, the average time between DSM revisions is, what, every 15 years, give or take? I wouldn't exactly call that "often".

I can't trust the DSM because so many studies, experiments, and results regarding psychology and psychiatry simply cannot be reproduced or repeated with any degree of reliability.

I try to be very respectful about the topic of depression precisely because of the many things you write. That said, there has to be some more gradation between the extremes of "sad" and "depressed". I say this because there were many times in life I was "sad" for a very long period of time and it took a lot more effort to exit that nose dive than going to bed and waking up with a fresh perspective on life.

The problem is that long-term sadness and depression feel very similar and they can be difficult to distinguish. Sometimes you can feel sad about some situation in your life and not even realize it. Or feel sad about something but you're suppressing it because of social pressure. These can look like depression.

Take a really hard look to find things that are making you sad. Especially things you're telling yourself that you're not sad about. If you find it, fix it like GP says. If you don't find it, pursue depression treatments such as the post.

> The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

As someone who lives with someone depressed, I find myself guilty of doing this and I don't know any other way to be present for that person. What kind of approaches have you found helpful?

Depression is a sort of severe introspection where your thoughts (often negative) take over. The solution tends to be getting your mind off things.

Instead of asking "why sad," try to simply do things with the person that will get their mind off their own negative feedback loop. This is easier said than done, and if the depression is lasting for weeks or months, I suggest seeing a mental care professional.

I agree. The best way to deal with true depressions (which is not caused by circumstance) is to simply do things.

Anything. (But not passive things like watch something, or read something.)

Make something, drive, hike, volunteer, clean, garden. Whatever.

You can help them by thinking of what activity they often do, and doing it with them. But remember to think of what they do, not what you do.

I've found Zoloft helpful for my depression.

These terms are tricky. I wrote the above because I wish a message like that had gotten through to me (probably just saying it isn't sufficient) at any point in the ~half my life so far where I was, according to this terminology, sad by some circumstance like the above, but also depressed basically I think as a result of being sad and basically having surrendered to it as an inevitable thing: life was by any reasonable measure going well, but I was never happy with it. Some of the above examples reflect my experience, some the experiences of other depressed people I've known. Likely this does not apply to all (maybe most) cases of depression, maybe it wouldn't have helped mine. But I basically feel now, with most of it behind me - I hope - that I never really realized that these sorts of problems could be addressed, or felt ashamed of being unhappy with my situation and therefore decided they didn't deserve to be fixed.

The article clearly shows that in his case, his depression was caused/triggered by life events. Clearly in his case things weren't "going well", as he had just been fired from his job.

That quote seemed wrong, the parent comment actually tries to make that correct.

> The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

That's why parent comment says to seek professional help. I believe they wouldn't ask or say those things.

Agreed, although it's worth noting that even if you can climb out, it's going to be a lot harder to stay out of depression if the next rung up is something like Freud's "ordinary misery", as opposed to your "objectively great".

- This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

That just means you cannot identify the reason you're feeling depressed. If everything was going well (including your own health), you would not be depressed.

I understand what you are saying sounds reasonable as a person who doesn't have depression, but it is not correct. I mean, unless you're defining "going well" to include "not having depression", at which point I agree, but then what are we even discussing?

This is a good starting point for the medical definition of depression (https://www.nimh.nih.gov/health/topics/depression/index.shtm...). Note the variety of treatments proposed that don't involve psychotherapy. These treatments aren't people taking the easy way out, these treatments are for people treating chemical imbalances in their brain that make it difficult for them to function in their daily lives.

For a more lighthearted discussion of depression, the new podcast "The Hilarious World of Depression" features interviews with comedians who suffer from depression, and how they've struggled with and managed from the disease.

I include physical health in "going well". You clearly do too, hence "chemical imbalances in their brain". I think the problem is, we're trying to parse the world into discrete categories (this is a disease, this is not, this is an external factor, this is not), when the world is not really that easily parsable. All abstractions leak eventually.

> If everything was going well (including your own health), you would not be depressed.

This is tautological, and hence true, but an uninteresting point. Just pretend it says "... Depression is when you feel down even when all is going well except of course for the disorder in your brain."

No, I'm saying depression is when you feel down but cannot account for the cause.

- Depression is when you feel down even when all is going well except of course for the disorder in your brain."

I'm saying this is not a possible situation. The disorder is a result of things not going well, including your own physical health.

Oh. Well, no, that's not what depression is. That's what sometimes causes people who are not clinically depressed to say "I'm depressed about X," but that's not what depression is.

> If everything was going well (including your own health), you would not be depressed.

Sorry, but that just isn't true. People can be depressed for no reason whatsoever. See my reply here: https://news.ycombinator.com/item?id=13367913

Sometimes the reason you are feeling depressed has nothing to do with how things are going. My depression was caused by things that had happened in the past and that I didn't spend any time consciously thinking about. Dealing with that stuff took some work, but once I did, my depression lifted and hasn't returned.

Depression means, even if things are going well, you can't feel good about it.

Every effect is caused by something that happened in the past. The physical trauma of past situations reared its head. Sounds like an external factor to me.

I agree with the other poster. Either your point of view is tautological, or you aren't really talking about depression.

> "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

Sadness is the feeling you get when something bad happens and you are upset about it.

Depression is the feeling you get from brain inflammation, which might feel qualitatively similar to sadness, but which is usually caused by one or more of: chronic stress, lack of exercise, nutritional deficiency, poor sleep habits, lack of sensory stimulation, infection, or twenty other things.

Once you can differentiate between them, depression isn't actually that hard to fix, at least at the early stages. It's like right now if I were to gain five pounds I'd get acid reflux, but I know that, so if that starts happening I just stop eating as much for a couple days and the problem fixes itself. Same deal with mental states.

[citation needed] ^

In particular, it looks like you're mixing up cause and effect, and I haven't the slightest idea from where you're getting the "brain inflammation" thing (it sure as hell ain't in the DSM-IV, last I checked (it's been awhile, granted, but still)).

> I haven't the slightest idea where you're getting the "brain inflammation" thing from

http://lmgtfy.com/?q=inflammation+depression

You shouldn't post this way on this site.

You're claiming matter-of-factly that brain inflammation causes depression. Well, I (we) don't believe you, because that's a far from widely accepted theory. Your condescending google links don't help.

> Your condescending google links don't help

Which I posted in response to getting blatantly gaslighted.

I don't care if you disagree with me, but pretending you don't know how to use Google to try to discredit someone is a lame debating technique.

You weren't gaslighted. That's not what that word means. And everyone here knows how to use google. The problem here is that you said "Depression is the feeling you get from brain inflammation" instead of "there's a theory that depression is sometimes linked to brain inflammation". The former is far from factual, and it's dead wrong to claim it matter-of-factly.

Totally not surprisingly, when you google brain inflammation and depression, you get lots of references that suggest a possible link and none that justify claiming it as a fact. So, [citation still needed], and it's not because we're bad at using google.

> You weren't gaslighted. That's not what that word means.

Gaslighting is a form of personal attack that's designed to make someone doubt the validity of their own senses or personal experience. The reason I took yellowapple's comment as gaslighting is that he was calling into question the existence of a large body of research that shows up with even the most trivial Google search. If you don't buy into the cytokine theory of depression or think that my summary of the theory/research was false or whatever then that's fine. But by implicitly claiming that the research itself doesn't exist and is just something I invented, then at point I take it as a personal attack.

> The former is far from factual, and it's dead wrong to claim it matter-of-factly.

This 2008 paper is already one of the most cited journal articles on depression of all time:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/

"It has been established that pro-inflammatory cytokines induce not only symptoms of sickness, but also true major depressive disorders in physically ill patients with no previous history of mental disorders. Some of the mechanisms that might be responsible for inflammation-mediated sickness and depression have now been elucidated."

"A role for cytokines in depression was first proposed by Smith in the form of the ‘macrophage theory of depression’ and further studied by Maes in the early 1990s. [...] Despite its originality, especially at a time when depression was thought to be associated with decreased rather than increased immunity, this hypothesis failed to attract the interest of the psychiatry community. Because biomarkers of inflammation in clinically depressed patients are not always elevated, the postulate that common pathophysiological mechanisms link depression to inflammation was limited. Other key components that would support this postulate were also missing, such as a demonstration that stimulation of the immune system induces depression-like disorders; identification of a possible common pathophysiological mechanism between the effects of cytokines in the brain and the neurobiological basis of depression; and proof that decreasing the inflammatory response attenuates symptoms of depression. As discussed below, research in this field has now supplied these key components."

"A growing amount of clinical data point to the importance of the relationship between inflammation and depression in physically ill patients and in conditions that are associated with increased activity of the innate immune system, including ageing and obesity. For instance, the prevalence of co-morbid depression in patients with coronary heart disease, a disease in which inflammation is now recognized as a major contributing factor, is three times higher than in the general population."

In order to say definitively that inflammation causes depression there is a lot of stuff we'd need to know that we don't currently know. However, in order for it not to be true, there is a lot of stuff that would need to be false that we know is true. That's why I don't think it's inappropriate to claim it matter-of-factly, even though there are still a lot of missing details that need to be filled in.

> Gaslighting is a form of personal attack that's designed to make someone doubt the validity of their own senses or personal experience.

Asking someone for a source (ie. "citation needed") isn't the same as 'gaslighting'.

There is no need to feel offended when someone asks for a source when you boldly claim something.

Using the website 'lmgtfy' and using this as source however is condescending. Say you are writing a paper. Would you then provide a Google search link as source? You wouldn't. That is why (indirect) Google links are not a source. Google is a tool to find a source.

No one's questioning the claim that research shows there's a connection. You're being rejected because you claimed it was a 100%, if-and-only-if connection. Even if depression is frequently caused by brain inflammation, it is definitely not the case that current science shows depression is always (or always minus epsilon) caused by brain inflammation, so what you said is still wrong.

No one's trying to make you question the validity of your senses. You just need to make claims that are corroborated by reality, at least approximately. It's fine to say there's a connection. It's not fine to say that depression is always caused by brain inflammation, and if you try to do that you'll be downvoted and ignored unless you make an extremely compelling argument (which you didn't).

Based on the research I've perused from google / your references, if you matter-of-factly claimed that some depression is caused by inflammation (or causes brain inflammation? how to tell?) you'd be fine. But to claim depression as a whole -- all of it -- is caused by inflammation? that's still wildly unscientific.

For reference: https://en.wikipedia.org/wiki/Gaslighting

"Gaslighting or gas-lighting is a form of manipulation through persistent denial, misdirection, contradiction, and lying in an attempt to destabilize and delegitimize a target."

There's a clear difference between that and calling out (EDIT for clarification: what I believe to be) incorrect information, and my admittedly-biased opinion is that my previous two comments in response to your own are squarely in the latter camp versus the former. I'd also hardly call one or two comments "persistent", though - again - my viewpoint is obviously biased in my favor.

I'll admit that pulling a [citation needed] was excessively snarky, though. I'm sorry. I ought to know better than to be a jerk, no matter how right I think I am.

----

With that said, "just Google it" (and similar approaches, like linking to a search engine query or some snarky wrapper thereof) is a very poor rhetorical technique in general; as I've already demonstrated, it's not guaranteed to actually prove one's point, and it reeks of either or both of two hidden meanings:

1. "I don't really care enough about the topic to give a meaningful citation, so I'm just going to tell the other party to find citations oneself"

2. "I don't actually have any source for the information I've provided (maybe I did once upon a time, but I sure don't anymore), so I'm going to tell the other party to 'just Google it' and hope that said other party is somehow impressed by the number of search results regardless of the sites in question or what the linked pages actually say"

Thus, it's generally a good idea to avoid those potential hidden meanings and just provide an actual source.

From your Google query: http://www.medicalnewstoday.com/news/severe-depression-linke...

"The Duke team concluded that depression, therefore, is more likely to contribute to inflammation in the body as opposed to arising as a consequence of inflammation."

The Duke research is interesting.

But saying that because they didn't find a pathway that inflammation is unlikely to cause depression doesn't really make any sense, given that major triggers for depression are surgery, infection, autoimmune diseases, etc.

I don't think anyone is disputing that depression also causes inflammation, but the idea that the causality only goes one way just seems very counter to everything else we know.

The point is that there's no clear causation in either direction, and certainly not in even a significant minority of cases (let alone all or even a majority). We just don't know nearly enough about how the brain works to be able to chalk up something as complex as major depressive disorder to "your brain's inflamed; take some Aleve".

In fact, the DSM definition of major depressive disorder/episode (or at least this summary thereof (I unfortunately don't have a copy of any DSM version on hand): http://www.mental-health-today.com/dep/dsm.htm ) explicitly excludes cases where the symptoms are caused by some other physical case:

"Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations."

I would think brain inflammation would count as a "general medical condition" in this context, though whether or not "clearly" is applicable is admittedly very unlikely. Regardless, the DSM seems to maintain a distinction between "depression symptoms caused by some other disorder, whether psychological or physical" v. "only exhibiting symptoms of one or more major depressive episode(s)". In the former case, yeah, totally work on fixing that inflammation with lifestyle changes or whatever. In the latter case, it ain't really that simple.

> The point is that there's no clear causation in either direction

C.f. my other comment. I think there is good evidence for causation in both directions.

> In fact, the DSM definition of major depressive disorder/episode

I wouldn't use the DSM definitions of depression due to, among other reasons, the fact that there is very little iter-rater reliability:

http://behaviorismandmentalhealth.com/2013/03/30/dsm-5-inter...

I think the article I linked to in my other comment has it correct, where depression should be considered as something that exists within all people on a spectrum rather than as a mental illness. Now obviously if depression gets to the point where it's causing health problems and interfering with your ability to work and enjoy life then that may be a diagnosable issue, but it's a mistake to think of depression as being something that you either have or don't have in the more general case.

What do you guys think is the point of all our activities if people eventually die?

Most mainstream Judaeo-Christian postulates the immortality of the soul. But it seems to come up against mainstream history and science.

Hasn't anyone here felt these existential questions? Even if you accomplish so much, in the end you can't even answer basic questions about the meaning of it all. You can consile yourself with the idea that this is all there is. But it seems like when you go, it goes back to how it was before you were born. All this knowledge you've accumulated and even more, your continued day-to-day consciousness, it seems this world exists only because you do.

It just seems like such a waste if this was all there was. And consciousness is really amazing, it is at the root of it all.

This isn't exactly depression but an awareness that while the world might go on, you will not always be around to experience it. And everything you do will eventually fade away.

Against that cosmic backdrop, one can conclude that doing something is pretty much like not doing it. That fun party you went to at 17, that sex you had at 28, what trace has it left? So why do the same job day after day? Only because you love it.

I think this is an important point. As a person with foresight such as yourself it is very hard to simply ignore your natural self. Some people can “believe” in a method that allows them to only focus on the present or feel content that a superior entity is in control. I wish I could trick myself in to believing in one of these systems as people who do in fact seem content.

I have however arrived at what I believe to be a meaning of life. I think it may appeal to other science types. The main purpose of human life simply seems to be able to persist and gain complexity. You can play a small role in either part. Help life persist or help build complexity. Right now in this time, we simply don’t have enough complexity to even take a stab at the overall meaning. So saying you have the definitive answer is akin to giving up. Thank you for your contribution to the persisting camp though. Your offspring may help us build some complexity.

But, you can believe that one day we ( mankind, machine kind) will know the answer. So why can’t your belief simply be faith in that one day we will find answers and right now you simply don’t know. Help put the next piece in the puzzle while you are here so the next person has a shot .

E.G. help us get off this freaken Rock! :)

This is the kind of thinking that has, in the past, led me to being depressed. It promotes an unhealthy fixation with the future that sends me into a nihilistic, self-perpetuating spiral of inaction.

My answer has been something closer to Buddhist thinking than western religions. It's an intense effort to focus on the current moment. The past is done and cannot be changed. The future will happen, but it's largely beyond our control. It's much more productive and fulfilling to devote all of one's energy and attention to the present. Out of the past, present and future, only the present is real and open to unbiased observation. And practicing removing one's own bias when observing the present moment feels, to me, like the point of life.

Depression is a chemical or structural issue in the brain. Having existential thoughts did not change the structure of your brain or alter its chemistry.

Suggesting you can "lead yourself" to depression by simply thinking is just as wrong as suggesting those with real depression can just "snap out of it."

I've had a diagnosed depression that I treated for many years with medication. And that course of treatment prolonged my illness and didn't ultimately work. What did work was to alter the way that I thought in the way I described above. And I'm not alone...research has shown that CBT and mindfulness training can be more effective than medication in treating depression.

The view that depression has only biological causes is dangerously naive, if not flat out wrong. Depression absolutely can be caused by unhealthy thought patterns.

> Having existential thoughts did not change the structure of your brain or alter its chemistry.

Of course it did - that's what thoughts are.

> Having existential thoughts did not change the structure of your brain or alter its chemistry.

This seems like a really strong statement that can't possibly be absolutely true. Isn't there some literature on this?

I remember seeing some "self care twitter" posts with lists of things that "don't cure depression" (thinking happy thoughts, sunshine, Vitamin D) but obviously some of those do send it into remission in many people. Isn't that enough?

I don't really see what's controversial about saying that thinking can lead you to real clinical depression.

It's something that happens over time it's not like a switch.

This is called "existential angst", and it comes up on HN every year or so. The best treatment is fill your life with distracting obligations.

I had this realization years ago. Yet somehow, I was fine with it - my mentality was, "When I'm dead I'll be too busy being dead to care that I'm dead."

Then six or so months ago this realization struck me again. Every day since, I wrestle through the same exact thoughts that you posted.

I just want to be content.

There is no point to any of it, and its beautiful. I'm thankful that I'm going to eventually turn to dust and be forgotten. It's such a relief.

There is something very Douglas Adams about your response and I absolutely love it.

I mean, sure, for a religious person touching base with God or exploring existential questions might be fruitful but for a non-believer, focusing on these large questions while being in a depression is not your way out of it, because those questions are too grand. A quite healthy person might end up in a depression dwelling on unsolvable mysteries for too long.

If you find yourself in a depression, your thoughts constantly searching for answers to questions about the universe and why we are here, try to do something more akin to what the person in TFA tell about: create. Your real problem is certainly not that you don't have those answers, it's something else.

Look I create all the time. I don't think I have symptoms of depression at all.

However I am saying that what's happening is similar to depression.

I work hard on building something and scaled back on social hangouts all the time, so I can finish it. But it has been years.

I am dating but never sure if I should settle down with this one, or that one.

I think deeply about what is the meaning of it all, and I see that most people are just trying to distract themselves with work or drinks or whatever else. But ultimately I see everything as being very limited. I guess people with depression feel similar things but far more acutely.

Creating stuff doesn't turn off that thought process. Any more than a videogame character adding currency and amassing items means that the video game won't end. What good are all your virtual points then?

There is also the business of just living, accepting reality and the struggle to make things better... for me when I had kids did that sink in. So you can put "hope" in that context. Some find existential relief in altruism in the sense that helping others makes us feel better. Then there is the discovery process itself that can be rewarding. I think we evolved to be curious and seek intellectual stimulation so those are the activities we seek out. Knowledge itself transcends the generations.

> What do you guys think is the point of all our activities if people eventually die?

For me it's to spend your time being happy. Nothing else really matters. If you spend your life being unhappy and feeling bad, remember that you will die and that will be it.

"Most mainstream Judaeo-Christian postulates the immortality of the soul. But it seems to come up against mainstream history and science."

Does it? Science does not answer questions that defy empirical inquiry.

I have been told that we are spirits first and that we are having a temporary in-body experience. We don't currently remember our time before because this period of our eternal existence is a special test. It's a time of development and preparation. After death we will resume our real lives and eventually get our bodies back, permanently, thanks to Jesus Christ.

My whole life I've been considering ways to either prove or disprove that narrative, but it turns out to be strictly unfalsifiable thanks to the part about forgetting our previous experiences. Does that mean the narrative is false? Certainly not. Does that mean it's true? Again, certainly not.

Should I discard that narrative because it's unfalsifiable? Well, I can't prove empirically that my mother loves me, but I hold on to that belief anyway because I think it's right.

It's wrong to burden science with every important question. When we torture science into answering unfalsifiable questions, we change its definition and confuse everyone. I love that the domain of science is constantly expanding and more questions are becoming empirically answerable every day, but we need to maintain our humility and recognize that science still has little to say about the basic questions of our existence.

I wholeheartedly agree that if this life is all there is, there's something seriously wrong. My wife, my children, my parents, my family, and my friends deserve more than just this. I see evidence of their infinite potential. What can I do to help them reach their true, immortal potential?

I don't think I'm the first person to recognize the infinite potential of others. I think more intelligent people figured this stuff out long before I did. I think some of those smart people decided to do something about all the wasted potential in the universe. I think we are all beneficiaries of those smart people and that life isn't anywhere near as bleak as it seems.

If not, someone somewhere is eventually going to be in the right place at the right time and they will set things in motion so that future people will have eternal lives. They will probably decide that eternal beings should have extraordinary experiences such as 100 year long blind tests in planet-sized classrooms. Oh wait. :-)

Anyway, forgive my ramble. Life is extraordinary and hard to pin down.

I mean like for example the archaeology and genetic tracing of native americans building cities 5000 years ago, Egyptian pyramids built 4500 years ago, vs the story that everything on earth got wiped out by a giant flood 4100 years ago. They can't both be true.

Similarly if the Exodus happened Egypt would have been devastated and overrun by Hittites etc.

Or Herod's killing of all the children. Or the mass resurrection of the saints in Matthew. It would have left behind some independent accounts.

Where is all the evidence? That's what I mean.

It can all still be true theologically. But who wrote these books and if it happens that at least some of stories are embellished then doesn't that kind of throw a monkey wrench into it? On what basis are you sure about what to believe?

I think it's more productive to look at the question of consciousness and immortality outside the context of religious doctrines and narratives. Religion provides answers to this question, as does Science, but they don't exhaust all of the possibilities. There's a deeper epistemological issue here about what we know about consciousness and what we can say with certainty about first-person experience.

If this life is a classroom, as I have been told, then there are teachers and test administrators. The administrators withhold certain evidence of the past in order to help us focus on more important things. They want to help us grow in faith, charity, and other values, not just analytical ability.

People are not perfect and prophets are people. I know of a prophet who said Jesus was born in Jerusalem. Jesus was born in Bethlehem, not Jerusalem. Does that invalidate that prophet? No, he was addressing a people who didn't know the eastern lands very well and he was simplifying. Context is everything, even though we don't always know the full context.

If I were sure about what to believe, it wouldn't be belief anymore; it would be knowledge. If I only acted on things I am certain about, I would do almost nothing, since there is very little I am absolutely certain about. Life became more fulfilling and interesting when I learned to act on not only things I know, but also things I believe. Acting on belief leads to growth and ever increasing certainty that I am making choices that benefit me and my family.

> When you are depressed, see if there's a serious problem in your life that is causing you to be depressed

You are under the common delusion that depression is caused by something in a person's life/environment.

This is NOT TRUE!

Depression is often caused by nothing whatsoever. Someone is simply depressed with absolutely no reason at all.

Depression that is caused by something is not strictly depression, it is a semi-normal response to difficultly and people will automatically fight to try to make life better - you don't have to tell them to do that. (The problem comes when they aren't able, or don't know how, to fix things.)

Depression is caused by nothing. The brain is just not working right. You just have to wait it out, learn coping methods, sometimes drugs, or sometimes you may be able to do a physical activity that gets the brain working right again.

If you can internalize that depression is not caused by circumstance you will go a long way toward understanding people with depression.

Right but your assertion here is completely unfounded. It is a theory. Quantifying that nothing in someones life (or their past) is causing them depression is near impossible. This charade is completely scientifically unprovable.

Edit: changed the word sadness to depression.

No, it is a fact. If you actually spoke to people with depression you would know that.

> Quantifying that nothing in someones life (or their past) is causing them sadness

I didn't say sadness, I said depression. They are not the same.

> This charade

Wow.

I'll give you the benefit of the doubt and assume you've never experienced depression, and don't know anyone with it.

If that should change you'll quickly realize just how mistaken you were, and you'll feel bad for ever saying things like this.

To put it in context: It's like telling someone blind who still has physical eyes "You can see, stop pretending."

Sometimes depression does have a cause. Some long-standing cognitive dissonance. I finally found some relief when I left the religion of my upbringing and embraced agnostic atheism/humanism. Don't let the true fact that depression often seems causeless stop you from making life improvements or searching for hidden burdens.

Because peoples interpretations of the situation are believable enough to call fact. Subjective interpretations are not reality. If you think they are then we dont have much to argue here. I have experienced depression for most of my adult life.

Is your username based on your depression?

Depression is not sadness; to the extent that it hmay have environmental or experiential contributing factors, the relation between them and the resulting depression is very different than the relation between circumstances causing sadness and the emotion of sadness, and treating depression is generally not a matter of dealing with issues producing an emotional response.

> "Depression is often caused by nothing whatsoever.

I don't agree or like that statement. You're alluding to something approaching a faith-based illness, whereby you fight against anyone looking for causes, insisting there is no cause. "It just is".

But that doesn't fit with what we know about how stuff works in this universe. If the brain is not functioning as it should regardless of good life circumstances including health, family, lifestyle, then something is definitely causing that malfunction. Don't shoot down someone looking for causes to a problem.

caused by nothing [external]

This is probably the worst advice about depression I have ever read. "Spend time thinking about how to fix your problems" is about the last thing someone with depression needs to be told.

Sorry. I tried to be careful to say 'see if it's this' - I think people who have spent time depressed either completely agree with what I've said, or completely disagree. Probably there's two distinct things we're calling depression.

Someone with psychiatric history bigger than bible I say it's not a bad advice. People are nowadays oversensitive, you don't need ta apologize front and backwards for anyone who might feel offended.

But your advice works if people have support network, it's tough alone.

And when you realize doctors diagnose everyone out of their ass, you get more depressed. After 10 minutes she claims you lack serotonin. On what bases? I even don't know what to say, life is bullshit but stop with being so sensitive, even if you're wrong, dsm and all your doctors use as much as real science than your average hn commenter.

> Probably there's two distinct things we're calling depression.

If you haven't been formally diagnosed, please for the love of god stop talking about "depression". You have no idea what it actually is.

On the one hand, there's the formal monopoly on the term that you cite. On the other, one is constantly reminded that "millions of Americans..." have undiagnosed cases of this thing. If not depression, what do I call this condition that grounded me for a decade, and did the same to many people I've known for comparable periods? Getting out of the house to get a formal diagnose wasn't even possible. It may be that I have no idea what it actually is. In that case I'd like to communicate with whoever is in a state like the one I was in, but I don't know what to call them. "Being depressed?"

It takes less than 15min to be formally diagnosed with depression and prescribed SSRIs in the US.

If you're bored you can watch the commercials on TV to learn that it's a chemical imbalance, and then repeat that fact every time a discussion about depression surfaces.

Even a formally diagnosed depression can be many different things. Depression (in the formal and clinical sense) can have myriad causes, symptoms, and cures. Everyone who reads about any of these causes, symptoms, and cures needs to be aware that it may not apply to their specific depression. That doesn't mean we should stop talking about the various causes, symptoms, and cures that are out there, just because we fear giving someone with depression the wrong information.

I disagree. Depression is like being caught in a loop. You need to find a way to break out of that by introducing something new. Creating something can give you at least a small sense of purpose and at least from my own experience I depression has emerged when I start to lose that sense of purpose.

A lot of these issues can stem from overthinking/staying within your own bauble of thoughts (for example, no job in a developed country can be described as "hell", so if one thinks that, he's clearly too sensitive or too inwardly focused). Making something can help in that it can make someone stop thinking those harmful thoughts.

> no job in a developed country can be described as "hell"

I know it's fashionable to look down on ourselves, but sleep deprivation is used as a torture device. I and many others have been in a position where we had to undergo it in order to pay our rent.

> no job in a developed country can be described as "hell"

Telling a depressed person that they've really no right to be is, however true, certainly not going to help.

Good point. Solutions to the problem include making it not-a-problem anymore.

Or just making it not-a-problem temporarily. Or even just less-of-a-problem temporarily. Enough difference for you to look up from the rut you've been digging yourself into, assess the situation with a clearer head, and start towards a longer term plan to address the cause as well as the symptoms.

Of course a common problem causing recurrent depression is mistaking a short term fix for something more substantial, so people need to be careful to make sure they correctly identify that when it is in danger of happening.

Excellent post and list. I would only add to that: "Am I with a partner that I want to be with?" or just "Am I overall happy with my partner?".

If the answer is more "No" than "Yes" then you need to figure out the specifics of why that is and either have a long conversation with your partner or find a new one.

Remember: you can't change your partner, but if your requests are reasonable and they truly care about you, then they can change themselves.

Renowned clinical psychologist Jordan Peterson said that if someone tell him that he is depressed he always ask them 5 questions: 1.Do you have a job? 2.Do you have a friend? 3.Do you have a romantic partner? 4.Do you have a serious physical illness? 5.Do you have a addiction? and if you answer on 3 of 5 with yes he can't help you because something of that problems will always again bring you down so first you should solve that problems. So external factors really matter a lot. Here is related video: http://www.youtube.com/watch?v=2c3m0tt5KcE&t=44m44s

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