The Depression Thing | Hacker News Reader

The Depression Thing

zachholman.com

841 pointsdarwhy328 comments

I was diagnosed with "major depression" when I was 14, did the medication and therapy thing for a bit but the medication made me a zombie. Therapy helped me learn to cope a little better, but I was never "cured" of my depression.

My 20s have been pretty bad, but in the last year and a half I've lost 100+lbs and have been running and lifting.

It turns out the common sense advice to depression was really what I needed all along.

* Sleep * Proper diet * Exercise

If you're struggling with depression like I was - try and take baby steps to improving those 3. You don't have to be perfect and it doesn't have to be all at once, but through continued effort it has only gotten better and better for me.

Have you tried regular voulentering, Gratitude letter writing, Holotropic breathwork or psychedelic therapy?

I found those to be the most useful.

I've never done psychedelic therapy but I do vape a decent amount of weed. I think at times it helped me be a little more introspective without bias, but it could have just been a side effect of maturing.

As far as breathwork, fitness is almost a form of meditation for me so I think there's some overlap. Running and lifting gives a lot of inner monologue and self reflection time.

Meditation (at least mindfulness meditation) is meant to rid you of inner monologue though. It can be immensely helpful considering depression is often caused by constant negative thoughts.

One psychedelic/psychoactive drug is not like another - not necessarily better or worse, just different. You may well be shocked by the degree of difference; I'd rather not resort to cheesy analogies because they're likely to create unhelpful preconceptions.

If you do experiment, avoid the enthusiast's trap of trying to sample as many different cocktails as you can. Whether it's a maturity or a cultural thing, there are many temptations to 'max out' on the intensity of the experience, which I think are unhelpful.

As for the therapy aspect, it's wiser to dose with an experienced person present who can help you if you feel distressed, but if a therapist is proposing to script the whole trip then it won't really be 'your' trip any more.

My perspective : marijuana is a pretty good palliative medicine, and perhaps in high single doses can be used for psychedelics type work, but generally it doesn't have the healing properties for mental health that the classic psychedelics do.

Breathwork < > fitness. Breathwork, specifically Holotropic Breathwork, was developed by an Md as an alternative to LSD psychotherapy after prohibition began.

I'm happy to discuss more privately as I know these things can be very personal.

a@175g.com

Volunteering is good. If you find that you focus attention on yourself too much, try shifting it to others. But keep the activities simple (manual and repetitive, like soup kitchen stuff.)

It’s also a good excuse to get out of the house, do minimum socialising and just observing the world around you. No expectations like performance measures and salaries either - your job is to just give a little.

I'd add one more to that list: * Meditation / Prayer

Just note that prayer can be a cause of depression if you find yourself in a religion that turns out not to work for you, so maybe try stopping praying, too.

Most of them have a contemplative style that can work.

- Catholic: adoration

- Protestant: centering prayer

- Buddhism: Zazen

- Islam: contemplation

Yep, for me personally religion was one of the major causes of my depression. And I've been happier as I cut it out of my life. Others find happiness in religion. Everyone is different, find what makes you happy.

That is probably why parent is dividing with Prayer and not multiplying with it.

I can't even express how much these simple things have changed my life (and the lives of those around me).

People who can just sleep, diet and exercise and the depression simply goes away, that's not real major depression. I really hate how people spread this stuff so condescendingly. No, it might have worked for you, but it does not work for millions of people who suffer from it.

Part of depression I had to reject is it became part of my identity, that it made me some kind of special. Because part of depression is self pity.

> Because part of depression is self pity.

Are you sure you are not one of those people who confuse being moody with clinically depressed? Self pity isn't really high on the list of symptoms.

Looking over the list of symptoms, I definitely had that. Very severe in my teens, got better in college, and now it rarely bothers me. Improvement seems to have come from numerous changes to my life, including the whole exercising thing. Being really fit was a big confidence boost, though I don't need to remain at that level of fitness to retain the benefits. But the biggest impact was my worldview and how it has changed.

Then you never had clinical depression.

Sounds like the no true Scotsman fallacy.

For instance my understanding of clinical depression is people often have suicidal ideation. I had that, would imagine throwing myself out a window, down the side of a mountain, etc. But I never would follow through because I noticed how my depression filtered my view of the world, and once the feeling passed things did not seem so bad. It would be horrible to make such a final decision as suicide, since it guaranteed my life would not improve, even though my depression told me it never would. Plus, believing I could go to hell for suicide helped keep me from doing it, and concern for how it would affect those I love. Finally, it seemed like such a selfish decision.

Everyone imagines own death, it's nothing abnormal. Moreover, it's not just depressed people who get suicidal, and far from all people depressed are suicidal.

Clinically depressed people are numb for life, they are not wailing in self pity.

Agreed. Those people have nothing to offer the depressed. I’m not sure if they really want to help anyways, saying “oh just excercise” is useful the same way saying “not my problem” is useful. But then, why say anything st all?

I'm not willing to categorically say those people were not suffering from major depression (who am I to judge), but it strikes me as the kind of fix that's not commonly going to help major depression, and to see it almost universally touted here as the cure-all is dismissive at best and counterproductive/condescending at worst. To me, it's not much better than saying "just smile more".

Thankfully it's not an issue for me anymore, but those "fixes" were total crap (for me) when it was.

People aren't saying that depression goes away, but sleep, diet and exercise are known to improve the symptoms of serious clinic depression, and would be recommended no matter if you're doing therapy and medication or not.

Yup same here. Clinical depression in high school, meds, therapy, suicide watch the whole shebang. Fun times, can’t remember two years of my life.

So far the only thing that’s actually worked has been staying busy/productive/creative, good nutrition, exercise etc.

Everyone always tells me I’m an insensitive dick when i suggest getting off their ass and doing stuff to treat their depression. But fuck it, that shit works. Yes it’s hard to get started and your depression makes it even harder, but that is literally irrelevant, you gotta do it anyway.

And yes dear downvoters, I will never stop saying this: Changing your lifestyle to treat depression works. If enduring your downvotes helps me get the message to at least 1 person, worth it.

And to the common criticism that "Oh you just had teenage depression that doesn't count". The scars all over my body that I get to look at for the rest of my life disagree with your "just".

> But fuck it, that shit works

for you -- you have no idea whether it'll work for anyone else.

Since depression is a potentially fatal illness, and you appear not to have any training in psychiatry, psychology, psychotherapy, medicine, pharmacology, you should maybe recognise your limits.

> Changing your lifestyle to treat depression works

Only for some people. you have no idea how many people it does work for, and you have no idea how many people it doesn't work for, so you might want to avoid judging people who don't take your advice.

The medical community calls what you're doing "terminal uniqueness" and I've noticed that this is very prevalent with people who suffer from depression: "Those therapies won't work on me, I am different, I need a special treatment".

Sleep, eat well, keep active. Nothing about that advice is dangerous. But it is hard to do if you aren't in the habit of doing it. (I know what you're going to say next, "but chemicals in the brain!" What do you think sleeping, healthy dieting, and keeping active are trying to fix?)

> Sleep, eat well, keep active. Nothing about that advice is dangerous

except if the response to "I tried, but it doesn't work for me" is "your depression makes it even harder, but that is literally irrelevant".

Your parent post didn't leave enough room for "try something else, but don't forget these once you're fit enough".

> except if the response to "I tried, but it doesn't work for me" is "your depression makes it even harder, but that is literally irrelevant"

In my experience dealing with depressed people, me included, there’s a huge spectrum in what “tried” means.

Doing it once won’t help much. Forcing yourself to consistently do it every day for 2 years? Now we’re talking.

If after 2 years of doing things that are known to up your spirits in at least some segment of the population every day you still don’t see absolutely any results, then you get to say it doesn’t work.

After all, you wouldn’t expect antidepressants to work unless you take them every day.

If you’re on meds and some days you feel like taking them and others you don’t, and you actually follow that schedule. Do you expect those meds to work?

It’s not the trying and it not working that doesn’t matter. It’s the not feeling like doing things that doesn’t matter. Gotta do it anyway. Whether it's exercise, taking meds, or going to therapy. If you don't do it, it can't help.

So did you try Rust for two years before deciding it didn’t help you? Your position on these things is across the board absurd

>if you’re on meds ...

Have you considered that the people in this thread saying it doesn’t work aren’t just saying “it’s hard”?

67% of college kids are suffering acute anxiety, is 67% of the college populations only problem a lack of excercise? Your insistence on these things is frustrating and obnoxious. The people who called you insensitive have very good cause, I hope that doesn’t make you proud.

Also, is discipline even a good thing? Do you think cave men said “well I have to hunt 5 hours a day...”? Probably not, or we wouldn’t have agriculture. Discipline seems like a substitute for ludditetism.

Also! Advice like this live and die by how hard they are to follow. If your advice is so hard to follow for te depressed that they won’t do it, it’s much harder to be proven wrong.

Sorry to rant but this advice is upsetting to me.

> Have you considered that the people in this thread saying it doesn’t work aren’t just saying “it’s hard”?

Yes I have.

My attitude is probably influenced by personal experience in dealing with depressed people. So far every time I’ve been observing someone long term, and they said “it doesn’t work”, they rarely kept at it for more than a month at a time here and there.

It is possible that everyone in this thread is different and kept at it for a long time consistently and it didn’t help.

And I never said “only exercise”, I said Do Things. Hang out with people, work on projects, make art, enjoy friends, go to a bar, see a movie, travel. Whatever as long as you’re not sitting on the couch giving in to your depression.

> this advice is upsetting to me

People I love sitting on the couch rotting from depression is upsetting to me.

Please stop this.

I have a genetic disorder. It was not properly diagnosed until I was nearly 36 years old. So, I spent the first 36 years of my life hearing that I was just lazy and not trying hard enough.

You being unable to fix someone else by brilliantly suggesting what worked for you is not definitive evidence that they simply aren't trying hard enough. That underlying attitude is monstrously arrogant and insulting to other people.

The world does not revolve around you. You being upset because someone else is "sitting on the couch rotting" does not give you the right to harangue people until they prove your pet theory correct that they just need to try harder.

Is there actual research that shows that the sleep/eat/exercise approach works by itself for everyone that is compliant? Most of the psychiatric community would absolutely agree that it helps, or couldn't hurt, but (anecdotally) I know athletes that control all of that stuff like a science because they have to in order to compete, but still suffer from depression, so I have trouble believing that's all there is to it.

> Is there actual research that shows that the sleep/eat/exercise approach works by itself for everyone that is compliant?

As far as I know, outside of crappy studies it's rare for a single intervention to even work for a majority of compliant patients/clients, let alone everyone. This is probably related to the notion of "depression" actually being multiple illnesses that share a common syndrome.

I wouldn't bring up chemicals in the brain, because that is a nonsense marketing term.

https://chriskresser.com/the-chemical-imbalance-myth/ http://www.brown.uk.com/diagnosis/france.pdf

You can't claim that sleeping, eating, and exercising are "fixing" chemicals in the bain any more than people can claim chemical imbalance causes mental illness. There is no baseline for what normal chemical levels are.

> The medical community calls what you're doing "terminal uniqueness"

No, the medical community calls it "evidence based medicine".

I've posted links to well run meta analysis by an organisation widely regarded as providing the gold standard for medical evidence.

other people are posting "it worked for me" - exactly what we hear from people who try crystal healing or homeopathy.

> Sleep, eat well, keep active. Nothing about that advice is dangerous.

Depression is a potentially fatal illness. If people are not getting evidence based treatment because they're following advice from people who don't know what they're talking about, those people may become more ill, and they may find it harder to seek help, and they may then die by suicide. suicide is a leading cause of death in men under 49, and in all people between ages 20-35 (in UK, and probably in us if they used same definition).

> (I know what you're going to say next, "but chemicals in the brain!"

A lazy assumption, I've never said "brain chemicals". I've always said "bio-psycho-social".

Thank you for writing that.

I was sleeping, exercising, eating well, just fine. My life was in order.

Starting to take an SSRI literally just switched off my mental illness.

A quick search on pubmed shows plenty of positive results.

https://www.ncbi.nlm.nih.gov/pubmed/21495519/

And a quick search of Cochrane shows that when you look at good quality research the benefits of exercise are hard to find.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

[...]

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

[...]

> The evidence about whether exercise for depression improves quality of life is inconclusive.

Authors' conclusions:

Exercise is moderately more effective than a control intervention for reducing symptoms of depression, but analysis of methodologically robust trials only shows a smaller effect in favour of exercise. When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials.

> Changing your lifestyle to treat depression works.

I did (and am still doing) all of those lifestyle changes and it didn't help me in the slightest. So much for that theory.

Not that people shouldn't try lifestyle changes but they are not the magic cure-all you're selling them as.

That’s awesome! Keep at it. It takes a few years.

And as other have pointed out, depression isn’t super curable, it’s more like going in remission. I liken it to addiction as well. Stop doing the things that keep it at bay? Boom there it is, comes right back.

Just like an addict makes an active decision every day to not do their thing, so too must I actively do things that keep the depression away.

No magic, just hard work,

Dude, screw you.

Seriously.

The biggest screw up we all make about mental health is the assumption that the thing that works for one person is the thing that works for another. I would have hoped that someone who has been through treatment would understand that, but here you are spouting the "get your life in order and it'll all be dandy, it worked for me!" crap that's so unhelpful in the first place to people with mental illness.

Everyone is different with this stuff. Everyone needs different treatment. You are not a mental health professional. Do not say shit like this and not expect to be called on it.

> "get your life in order and it'll all be dandy, it worked for me!"

No it won’t all be dandy. But it helps.

Or at least it’s what I’ve seen help the most people I know who are or have been depressed. At the end of the day, the main thing to do is to not give in to depression.

That thing wants you to sit on the couch and feel sorry for yourself. That’s like one of the main symptoms. Fighting that urge helps make it go away eventually.

I mean, shit, even the super-OP, Zach whose post we're commenting on, said that he had to keep taking meds and going to therapy for a few months before he saw results. Do you think doing it just once then saying "Fuck this shit, this doesn't work for me, therapy doesn't work. I tried it and it did nothing". Do you think that would've worked?

I think my other reply to you is relevant here, because your advice cannot be proven wrong. You’re replying to someone who tried what you said, saw no marginal improvements, and saying that means they have to keep trying the same thing regardless. If someone tries this for several years and it doesn’t help them, would you consider your theory thoroughly debunked?

> If someone tries this for several years and it doesn’t help them, would you consider your theory thoroughly debunked?

Yes.

Well then what do you say to the athletes in this thread who tried this for several years and felt no better? Have you been debunked? Does everyone have to spend 2 years of their life’s on your advice before they’re allowed to say “This doesn’t work for me”?

I can’t imagine you think that’s reasonable... I think it would be more helpful if people stopped throwing this sort of advice around like it’s useful to people

I’ve argued things like what you’re arguing before but really I was just afraid to think otherwise, could you be feeling the same way? I don’t think that’s a sustainable strategy though so here I am, arguing the other way. It was harder to think that way than this - less natural

> could you be feeling the same way?

Yeah you're probably right.

I guess what bothers me about the whole thing are the 2 or 3 years of my life I spent vehemently disagreeing with everyone who gave me This Advice and telling them that it doesn't work and they need to fuck right off. Then when I actually legit gave it a chance, it worked.

Maybe I just got lucky. Maybe the therapy worked more than I think and it's what enabled me to give This Advice a chance. I'll never know, it's not like I can A/B test.

I can relate, it worked for me too for a while. Still not really sure what I’m doing, but in a sense I’m back to where I was before I ever went doe that road... definitely might be totally wrong about things, I’m pretty afraid of that actually. This maybe won’t make sense to you but it basically forced me to lie about things, to pretend I didn’t understand people and I think that was cruel.

My perspective is that your approach here, talking about depression as an external influence that is not you - just an oppressive influence on you that must be fought off - was actively harmful for improving my mental state.

The day I stopped viewing myself as an ideality rather than reality, the day I realized everything I thought, felt, believed, and did was me and absolutely none of it wasn't, was the day I found an ability to change instead of deny.

Also, I'd say it is very easy to approach this with a defeatist attitude (consciously or unconsciously) if you have a belief that you are sick. Only time can fix a broken bone, so if your mind is broken, can you really change it - is it a futile effort to try?

Don't listen to a nut on the internet, though.

It sounds like you have really don't know deep depression can go. I can understand this attitude from someone who has never been there.

Your tips are a little insulting to someone truly suffering. There is a difference between feeling bummed out to feeling like you shouldn't be alive any longer.

> It takes a few years.

It's been a bit under three years already; no joy.

Your theory just plain doesn't hold water. Sure would be nice if it did, though.

And if you're doing all this and still depressed, there's no solution and you should kill yourself. That's how I read advice like yours when I was a college athlete. Fortunately, instead of walking in front of a bus I went to a doctor and got antidepressants, which helped tremendously.

Advice to seek professional help has exactly the same effect for people like me, for whom it makes things much worse. From my point of view it’s just the “safe” advice to give in public, because it has the argument from authority going for it.

People with major depression want to kill ourselves anyway. I don’t really see any style of tempered advice as being harmful in itself. What’s really harmful is socially pressuring anybody to stick to any approach they find to be harmful for themselves.

I 100% do not mean to point this at you in particular. I do not know your situation. But, in a general sense, a lot of the reason for the pressure is because these thing take time. There is no magic cure.

Going to a mental health professional requires time to see results. It also requires being with the right person. Medication won't instantly make you feel better (for longer than the short term), it requires the correct dosage, correct type, etc. The "working out, eating right, plenty of sleep" method may show results but it also takes a lot of time and persistence to see those results.

I am not saying that any of these solutions will work for everyone. I am just saying that any of these solutions takes trial and error. Some people go see a therapist once, don't make a connection, and declare that it doesn't work for them. It will take time. It is a process. Again, everyone is different and need to find what works for them, but whatever it is, they need to stick with it. I know it can be overbearing, but it comes from a place of compassion and concern. No one who cares about you wants to see you depressed. How would you prefer that they approach it?

In my case, time and patience could not have been the problem, except in the unprovable Russell's Teapot sense. And that is the problem. I'd prefer that people did not place unwarranted high confidence in the medical model, such that after seeing 20 therapist, and trying 20 medications that all made you sick or did nothing, people were still saying, "But maybe the next one will work."

Yes it’s insensitive the way you put it, but being in motion is crucial. Don’t aim to “change lifestyle”, instead focus on doing very small things. When I had chronic depression, making my bed was a big thing. If you trip over again, nevermind, do another small thing like washing the cup you’ve just drank from. Or getting out of bed. But whatever action it is, pretend that you’re a robot and focus your consciousness to the task. Nothing else, because you’re a robot.

It might take a long time to build up but the hardest part really is the first part. Hope this helps someone :)

I don't think suggesting lifestyle changes to treat depression makes you an insensitive dick, but I do think implying that it works for every depressed person does.

And what do you say to people who have actually tried it and feel no better? Just try it more? And if that’s what you say, it seems you don’t hold this belief based on the fact that it works, but something unrelated entirely, and so I’d say it’s not useful to share it with me or anyone else.

Those three things seem to be the answer to so many health issues, physical as well as mental.

Same experiences here.

I've just noticed that sleeping, proper diet, and exercise are things that just keep me in motion. I guess one way to cope is to just build momentum.

At the very least, I can say that I feel satisfied about things that I've accomplished, even if I still don't feel great about myself. And that is at least enough to keep me getting out of bed every morning instead of moping around.

"An object in motion stays in motion" definitely fits here.

Although it’s not really true- you have to become depressed after all

Careful with that advice. It might have been good for you, it might be good for a lot of depressive people, but definitely not for all. Before I turned twenty I met two people my age who took your advice and exercised until ambulances had to pick them up (literally). Whatever you do to counter your depression, have a trustworthy, knowledgeable aid at your side: a therapist.

This is an almost absurd criticism ("be careful telling people to sleep, people I know who were depressed followed that advice and slept for 12-14 hours every day").

Let's fix it by being more specific, so we don't accidentally cause any more problems: "daily moderate-intensity cardiovascular exercise" (or, if you prefer, "resistance training 3x week"). Or even, "a healthy level of exercise".

I agree that therapy is a good idea, but you shouldn't need a therapist to figure this one out. A reasonable amount of exercise is good for pretty much everyone.

I don't think it is absurd. I have a genetic disorder. All of the standard diet and exercise advice failed me in every metric until I had a proper diagnosis.

Lots of people have unidentified health issues. Underlying health issues can cause low energy, which can be mistaken for depression.

> This is an almost absurd criticism. [...] A reasonable amount of exercise is good for pretty much everyone.

"Ok, if you say so" and "of course". But the general advice to do some exercises and the advice to exercise "to counter depression" are two completely different things.

I'm trying to be as neutral as possible here: If a friend of yours needs help, please don't tell them that they "shouldn't need a therapist to figure [out a way out]". Psychology ain't an exact science even though most "science journalism" wants you make to believe that. So, whatever "wisdom" one picks up, treat it with a grain^Wbag of salt.

EDIT: parent was edited the substantially & while my principal response still holds, I would not even have responded to a response as hyperbolic as the parent is now.

Sometimes you need a therapist and/or meds to figure out that you need to (or even can) figure it out, and it's possible to overdo just about anything, certainly including exercise and sleep. Depression puts you at the bottom of a well, and by definition not thinking clearly. You're dangerously close to telling people to just deal with it on their own, which is harmful and cold.

Certainly. I have been in the position before where I was at the bottom of my own personal pit and was unable to begin exercising on my own (severely depressed and obese, not a great combination to begin an exercise program). It's not an easy thing to get started doing _anything_ when you're depressed, habits are hard to change. People shouldn't be expected to change these things (purely) on their own, as a lot is a function of environment/genetics/overall life situation, but...

I can recall clearly what it would have been like (for me personally at least) were I in a strongly depressive state: I'd read the comment warning me about exercise, then I'd be afraid to exercise at all.

By framing exercise as a risky behavior based on a few exceptional anecdotes, the poster does depressed readers a disservice. It's relatively established that depressed people are more risk averse in general[1][2], and exercise also has well established benefits in treating symptoms of depression (I shouldn't have to cite sources for this one). The benefits far outweigh the risks.

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2590786/

2: https://www.nesda.nl/nesda/wp-content/uploads/2015/07/Wiersm...

No need to treat depressed people like children and withhold info about risks. They’re still humans after all.

I believe you misunderstood the point. The problem is that the "risks" of exercise are blown out of proportion.

I didn't read the criticism that way; seemed like a warning against "one size fits all" thinking when dealing with a complex system like a human brain.

Maybe you are both right!

> you shouldn't need a therapist to figure this one out. A reasonable amount of exercise is good for pretty much everyone.

People with clinical depression aren't those who _can_ easily hit the gym for that dopamine rush. "Some sport is usually not a bad idea" is not the hard part, getting to the point where it can be implemented is.

And if that is the problem, and none of the pep talks on hacker news over the last few years helped, why not try the therapist?

> People with clinical depression aren't those who _can_ easily hit the gym for that dopamine rush.

This is not accurate, depression is just not clear cut like that. A depressed person can be fully high-functioning from the outside, even...

Quite a few people don't exercise for other reasons (time, aversion), in fact, I'd say those are all much more likely reasons than depression, but may also lead to depression.

It's almost like there's not a single good answer like saying "all ya gotta do is go out there and buck up and excercise!!".

Like any sickness, you talk to a health professional and figure out what treatments work. Going your own sucks and is a bad time regardless of how highly-functioning you are.

I understand where you're coming from, but I'll just point out that you can reverse the activities and make the same point:

"People with depression aren't those who can easily just hit up a therapist and continue going and get well. If that's too much of a social burden, why not try just going for a bike ride?"

keywords: "And if [getting sports implemented] is the problem"

I never said not to do sports (neither did the article: it merely pointed out that telling people to "_just_ do sports" may not be helpful) and I never tried to sell a silver bullet.

This is unlike the inevitable influx of comments in the style of "ignore therapy, just imitate my sports routine, and if you can't, just try harder". Those appear under _every_ depression-related submission on hacker news.

Those comments are harmful: therapy already comes with stigma, so it's not the obvious route - unlike, as you can see here, sports. Everybody proposes sports, healthy eating habits and regular sleep (btw: what about the depressed who can easily sleep 20 hours a day, should they just get one more nap?). Reinforcing the stigma around therapy discourages folks from taking a route that might help them.

The "just try harder" angle that's all too often seen in such comments is also harmful: What do you think did those people do (often for years) before they consciously consider that something might be wrong with them? Exactly: they buckled up and tried harder - and they will continue until they crack unless something changes fundamentally.

I agree it was phrased poorly. What I took him to mean is:

If you have depression, and regular exercise and good diet doesn't help you, look for other solutions.

Too many people assume that getting the right balance of both will solve the problem, so they keep tweaking and tweaking the wrong solution.

Agreed. Not to mention hitting the gym for an hour every night closes a lot of access to self-medication.

We're treating psychological problem like pathological ones. Mental health is not a pathological problem necessarily, but rather an physiological responsive one. As such giving medications as to "treat mental health" is the wrong perspective, and more proper perspective would one were certain physiological responses to certain environmental conditions are deemed as negative. As such to an extent the physiological responses and the interpretation of whether those responses are good or bad are dependent on social perspectives.

Therapy can work entirely without medication.

There's a difference between psychologists and psychiatrists, and the article even spells it out.

Therapy works on the physiological aspects of the human by influencing the environment. Again it's not pathological.

This is the most ridiculous and irrelevant warning I can imagine. Almost nobody us at risk of over exercising if they haven't started yet.

It's like saying "Don't eat salad, I know someone that ate so much lettuce they got sick."

I fail to see the connection between ~"don't see exercising as a golden bullet against depression" and what you claim I've said.

you said "[exercise] might be good for a lot of depressive people, but definitely not for all."

Which is dead wrong. Exercise is good for humans, depressed or not.

You also said, "Before I turned twenty I met two people my age who took your advice and exercised until ambulances had to pick them up (literally). "

...apparently as a warning that exercise is dangerous. But as you can see, it's a ridiculous statement.

Sure, people should see a therapist. They should also exercise. Go for a walk. Move around. They should also gain some sleep discipline. Those are easy to start with. There's no mutual exclusion here. Just because someone is exercising and sleeping right, does not mean they cannot talk to a therapist.

i read it as "might be good enough", which is entirely closer to the meaning that parent was trying to get at, I think.

Also I don’t think gp was trying very hard (at all?) to understand this point

It's easy to become dependent on exercising, push too hard, get injured, and struggle while you can't exercise. Moderation can be difficult for some of us even with something like running.

Here is where the benefits of promoting exercise far outweigh any risks that people who exercise may experience. There is no need to hedge here. Exercise might not cure your depression or even help it, but in general, exercise has been shown over and over again to be one of the most effective things that you can do for mental and physical health.

I can't really agree with this, there are definitely lots of negative avenues from exercise if not done right.

Generally, hopefully, most people will do exercise more or less "right", but this is not a safe assumption.

That could be said of almost any healthy thing.

It's very easy to over exercise if you haven't started yet, I seriously hurt myself after a couple of weeks of running, as my body was nowhere near prepared for it.

> Careful with that advice. [...] Whatever you do to counter your depression, have a trustworthy, knowledgeable aid at your side: a therapist.

Quoting the UiA, "One [1988] study indicates that 70% of therapists had seen for treatment at least one patient who had had sex with a previous therapist. Of the latter, 96% were male." [1]

I guess the moral of my comment is - be careful giving advice (period)

1: http://encyclopedia.uia.org/en/problem/143464

I'm not sure how this page is meant to work but I can't find the study this claim came from? It's linking to a book?

The source is a training book on how to sue psychiatrists, I can't find the study anywhere. Even if it does exist, it's saying that a lot of therapists have seen a client who had sex with a therapist. If someone wanted to have sex with a therapist, they would visit a lot of therapists.

This explores the topic in a more meaningful way, and links sources. https://kspope.com/sexiss/research5.php#a8studies

I assumed the study is referenced in the book (and that the quote is from the book) -- but honestly I have no idea

I've tried to find help for something like depression for almost two decades from therapy. As much as I have wanted it to be, I haven't found therapy to be particularly powerful.

Running is weak also, but insomuch as all you can do is fight and claw your way out of depression[^], long runs, in my experience, can aid to some degree.

[^]Which may very well be a symptom of something(s) we don't understand yet, rather than a disease.

Have you tried not fighting?

What does not fighting look like on a practical level?

For me, it was months jobless and isolated at a parent's house in the middle of nowhere.

For others, not battling means not getting out of bed, and for people facing other "demons" (what a bad word) not fighting might mean to continue to consume drugs or alcohol, or to keep not eating, or eating too much.

> What does not fighting look like on a practical level?

For me, it goes "I'm feeling depressed. Okay, I feel depressed. That's interesting. Now what is it that I must do right now at this moment? Get out of bed. Okay, done. I'm still depressed, but what's next?"

In other words, I don't bother fighting it or avoiding it. I just acknowledge it and then figure what needs to be done next.

I think we are in agreement that taking constant little actions is the wise course.

To me, that is fighting.

For me depression comes from thinking I should feel differently than I do, so fighting only makes that worse, whereas not fighting is better.

Could be this is a cultural problem. In our culture we’re supposed to like work and everybody is expected to shut up.

Yes, I was quite annoyed by them calling out, and seeming to try to shame, the advice of going for a run. Mental stuff can be pretty bad my way, and these days sticking to a good workout routine is doing wonders for keeping me grounded. Depressed people should try going for a run.

Yes, I was quite annoyed by them calling out, and seeming to try to shame, the advice of going for a run.

People mean well, and I never try to belittle people trying to do good, but in these situations people project their own feelings and motivations and then declare what needs to change in the other person's situation. But physical exercise and taking the trouble to eat right itself is a major barrier when you find it tough just getting out of bed.

It is essentially saying "stop being depressed and you won't be depressed".

When I was depressed I went for lots of runs, walks, bike rides, did plenty of sets. All it did was make me feel worse because it caused massive amounts of physical pain, and not in a "good" way.

I think diet and exercise can do wonders for mild and maybe even moderate depression but the odds that it can cure severe depression are very, very small. It's dangerously simplistic to say "you just need some exercise, man."

All along, or after 10 years of physiological/mental changes from your 20s? Just because it takes when you're 30 doesn't mean it would have taken in your 20s.

It's a fair point, and I can't really know how much of it was just me maturing as a person.

I can say, though, that making these changes at any point in my life would have been a vast improvement. Sleep and nutrition help me view life in a much better lens and exercise gives me a structured, constructive outlet and scheduled time for reflection.

That’s one of those things that enables a lot of empathy I find - given the people I was around and what my life was like before my 20s, I certainly found it near impossible to actually make healthier life choices. Wanting to make the choices doesn’t matter as much as having the skill set and self knowledge to put yourself in a position to do them - powering through as a rule for me just leads to burnout, and ends up being incredibly unkind to myself which leads to worse habits.

It's also a viscous cycle once you stop doing these things. I had everything going well for me, but then a bunch kinda blew up at once and I stopped eating healthy, quit working out, and was losing sleep because I was trying to solve all these other problems and felt those things were pointless. "Oh, I can't get in the mindset to lift today I'm too stressed out and depressed/hopeless." That led me from only skipping a few days to skipping months.

I ended up going into some escapism mentality where if I'm not working I'm going to play video games/watch TV. It was a terrible rut until one morning I looked in the mirror and realized I'm letting life slip away. I'm not growing (well at least not in the productive way). Mind you most of those "explosive" problems were solved, but I wasn't. I freaked out, threw on some gym clothes, went to the gym, and ran. I don't even know what I was running toward. But I was running. I began lifting again, doing meal prep, back to studying, programming pet projects, reading, and it all came together.

It can hit you in waves, but one of the best ways to keep your head above water is to make sure those three things ElatedOwl mentioned are in check.

>It's also a viscous cycle once you stop doing these things.

It is also gosh dang terrifying. I am not so much curing my depression + anxiety as much as I am running away and trying put enough stuff behind me that it can't catch me.

But when it does, it is difficult to get started again.

> I am running away and trying put enough stuff behind me that it can't catch me

I'm not sure I like that way of looking at it. I choose to look at it like I'm an addict. Addicts, even once they're sober, consider themselves to be addicts their entire life. Any day they can fall off the wagon, even after years of sobriety, so they're constantly vigilant. I look at my depression the same way, only not doing the necessary things that keep me well is my version of falling off the wagon. Just like addicts do, I try to keep my streak of "sober" days going as long as possible. And when I slip up, I try not to beat myself up and just try to start an even longer new streak.

It's somewhat empowering to gain a little measure of control over it, even if it's really, really hard. But it's also important, I think, to realize I'll always be a depressive my entire life, even if I'm not feeling it at the moment.

>I am running away and trying put enough stuff behind me that it can't catch me.

I'm a runner with depression. I track my mileage, diet and general mood very closely and have started to brace myself for a depressive periods after major races.

I need redundancy with coping mechanisms, and the OCD nature of distance running is potentially setting people up for a fragile system should an injury occur or low-mileage phase crop up.

I spent my twenties running long distance, but gave up four years ago. The frequent injuries were just too much. A bad injury once had me off training for four months. Going from feeling like a machine to someone who can't manage a jog in the space of an afternoon seriously messed with my emotional state.

I'm writing this on a recumbent bike. I've averaged ninety minutes a day for four years without injury. I've also read a ton of books on my kindle.

And that's where therapy supports the physical care aspect: It can provide you with the tools to deal with these traps. It can provide you with the tools to identify these traps long before your mirror tells you.

Mere therapy isn't everything, but neither is only taking care of the non-brain parts of your body.

I recently had a similar encounter where I was slipping back into a bag routine and then looked in the mirror and freaked out. I'm back on track to being healthier and happier. It ends up taking way more of my time to prep my food in a healthy manner, go to the gym, and shower again but I think it is all worth it for both my mental and physical health to be in a good place.

A viscous cycle? [https://cdn1.medicalnewstoday.com/content/images/articles/31...]

Sorry, not a grammar nazi, this one just always makes me grin :)

I can't support this enough. I'd add laying off alcohol. I haven't been diagnosed with depression but I can get in a serious funk if I haven't been exercising, sleeping enough, eating right, or if I've been drinking too much. Again this isn't a one size fits all cure for depression but it's worth a shot.

I always wished I was one of those people who loved working out. Some folks comment on how miserable they feel if they don't work out for a few days. I feel AWESOME if I get that much time free to relax and just enjoy myself and not feel obligated to work out :)

I bike commute and also work out before work every day, but I can't say it has a particularly large effect on my mood.

My darkest days were long before I drank; then again, adolescence is a particularly hard time anyway.

Bare in mind what the post talks about that for some people, telling them to go running just makes them feel worse because they can't even get up the energy to get off the sofa.

I think it depends on how deep down the hole you are, plus clearly some things work better for others.

Or maybe they don’t believe you when you say it would help

Did you feel like these three variables reinforced themselves ?

Exercise makes you eat differently and sleep out of exhaustion earlier, you also wake up a bit sore but somehow replenished; which makes you seek slightly more active things.

I can only believe you when you say you cured yourself, but I just want to point out for others that this sometimes can be symptoms of hypomania (bipolar II).

As an example, consider the following author’s self-cure for his bipolar II:

https://www.forbes.com/sites/michaelellsberg/2011/07/18/how-...

Sounds pretty easy and awesome, right?

Then, read his follow-up several years later:

http://www.ellsberg.com/bipolar-ii-follow-up

In particular, notice the change in tone of his writing. Very different people speaking in each of the articles.

I want to point this out because mood cycles can sometimes last several years, and bipolar sufferers are at a higher risk of suicide. It’s not stuff that I would self-diagnose or self-treat.

He said "seeing if I could go without" medication, which I think is different than saying he's cured.

But your point about bipolar II is really important. Taking anti-depressants (SSRIs) when bipolar can induce rapid cycling--a speeding up and intensifying of the depressed-elated cycle, which can be very dangerous, as I learned the hard way after being misdiagnosed. Bipolar II is often treatable (I'm deeply grateful that mine is), but with different approaches and medications than depression.

Prescribed Zoloft before I was diagnosed Bipolar II, without lamotrigine & methylphenidate I've lost jobs, been kicked out of college, spent 6 months with major depressive episodes (~20 down days, 4 up days on avg,) and Zoloft was absolutely insane. My ideology is already if you're not successful by 29 and still depressed, might as well suicide. Zoloft brought that down to thinking "41 steps to the loaded shotgun" and a lot of preparation for it. Lamotrigine & methylpheniate have been good for me for the 6 months I've been prescribed them, but recently methylphenidate has not been helping, and i'm starting to spiral again.

Whoa, cool. I guess I ought to go visit a psychiatrist. Thank you.

as others have noted, these things are a negative feedback loop when you start slacking on them. so i think its important to make them as easy as possible, and externally enforced as possible. i think they truly do help alot of people, of course not all, but many. im really not sure how to solve that chicken and egg problem tho- you dont do these three things because you are depressed, which begets more of the same. for me, basketball was a panacea, since i discovered i enjoyed playing it immensely. so i got exercise without having to force myself. i got so hungry from exercise that i couldn't avoid eating alot (for me, eating regularly and enough was the challenge), and of course, being so tired from exercise helped me sleep. i guess its a parable in treating depression as much as its a parable in how valuable sports can be.

I’m pretty sure depressed people don’t believe these things will help them. If they did, they would just force themselves into it despite feeling bad. The idea that there’s a problem here, rather than that exercise is just actually worthless, is ridiculous.

Most mentally healthy people can't force themselves to meet their exercise goals. Many mentally healthy people fail to meet their nutrition goals too.

you arent wrong. i can conjure old mental states that were basically proof of your point. its a tough nut to crack, hence it plagues us to this day.

Personal anecdote, semen retention has some surprising benefits and make your a more social being. Recommend trying this method to see if it benefits any depressed folks.

Disclaimer: I'm not a doc, don't take my word on anything or listen to me.

Is that when you store it in bottles for later?

To put it nicely, it's when you don't release it via manually stimulating your genital nerve endings. This practice is derived from ancient Chinese medicine I believe, may be wrong.

One of the symptoms of major depression is psychomotor retardation which causes people great difficulty in performing even simple tasks, like brushing one's teeth, doing the laundry, or showering. Advocating exercise as a cure for a disorder marked by the inability to exercise seems short sighted.

"I can't get out of bed" "You should exercise" Ugh...

I have psychomotor retardation (thanks for putting a name to one of my biggest struggles!) due to major depression but exercise really does help more than anything else. It's definitely hard to exercise, but often it's not that I can't do anything at all, it's that I use up all my willpower doing one thing in a day. But if I make that one thing exercise, then for the rest of the day it's like my psychomotor retardation goes away completely and then other tasks are manageable. I actually brush my teeth, do the laundry that's been piling up, make a healthy dinner and clean up the kitchen after, etc.

Those three things are good and can go a long way towards helping out, but they are not perfect. Most especially they suffer from a bootstrapping problem. If you're too depressed to take care of yourself by keeping your sleep on schedule, eating right, and exercising regularly you absolutely will not have the energy or motivation to get back into them easily. Additionally, some people have other issues that make those things harder, such as medical or physical reasons they can't exercise, or sleep disorders (which have a high degree of comorbidity with depression and bipolar).

I'd highly suggest that people look at mindfulness based cognitive therapy. That can build the tools that will make it possible to get back on track. It can also make a huge mental difference to bring people from "kinda sad but doing ok because of good sleep/diet/exercise habits" to actually being able to enjoy life.

I was going to post this exact same thing. I was """diagnosed""" by multiple psychs as having major depression and general anxiety. At the lowest points, I tried to kill myself using fake nembutal ordered from some stranger in Mexico, and about a year after that I quit my high-paying dev job, burning a ton of bridges, and literally did not leave my apartment or brush my teeth for 2 months. I had previously tried every variety of medication and they did nothing or made it worse.

A friend who had been through something similar recommended the simple fix of sleep, diet (basically just more plants, more animal protein, way less sugar, and way less alcohol), weightlifting, and sunlight. After about a year or so I felt completely fine. I look great, feel great, and my career is back on track. It's obviously just a single person's experience but I'm inclined to believe the majority of "depression" cases can be fixed by this.

Furthermore, treating it as a disease rather than just a bad mood made it _way_ worse, as I was able to rationalize the fact that my life was crippled by it and that was ok because it was a disease and my hands were tied. Once I treated it as something I could fix I made vast improvements.

I struggle with depression. I haven't had any therapy, but taking my bike out to the forest and going for a good long ride in the trees does wonders for me. The adrenaline of a cross country ride and the deep fatigue after a couple of hours on the bike both help me to quiet my overactive mind.

This is really good advice. Anyone strugging with depression should definitely start with the basics:

- Regular good sleep. Go to bed and wake up at the same time every day.

- Good exercise every day. This will help with the sleep too.

- Eat healthy food on a consistent schedule

- Avoid alcohol

- If you don't get much sun, check your Vit D levels and take supplements if needed

These things will almost always make big difference. If you're still strugging you need to see a psychologist or try some medication. Medication is hit and miss so you'll probably need to experiment with different types to find something that works for you. And of course some people just don't respond to depression medication at all. Cognitive behavioural therapy is often helpful and there are other therapy options too.

Depression is multi-faceted and you will usually need a variety of treatments to get the best results.

Some people recover and go back to normal, but many sufferers will have manage it for their whole lives.

CBR wasn't helpful for me at all.

The only thing I really do on that list is avoid alcohol. If I am in a good swing, I can sleep at regular times, but I don't exercise. I eat whatever is around really, and in severe down times I've been kicked out of college or lost jobs because I couldn't leave bed to eat or use the bathroom until it was unbearable, let alone leave my house. I also normally ate around a meal a day, at 5pm or so and might have had some apple slices, grapes, or something similar before.

The only thing that has ever helped is medication. I have bouts of severe paranoia & hallucinations, but haven't mentioned it to anyone. Lamotrigine & Methylphenidate have been the most helpful, taking me from 5-15% functioning on an average day to 80% or higher. That's worked for me for 5-6 months, but over a month I noticed that my methylphenidate became less effective, and to improve it I had to redose during the day. This was a self-medicating (horrible, i know) method, but then it came to me running out of it for the rest of the month (10 or so days.) So I was low functioning then, but I still had my lamotrigine, so I was around 30%. Then I got my refill and started my day out, and ended up feeling nothing... So I redosed, and still after an appropriate amount of time felt nothing. I kept redosing for the next 40 hours until I had taken 500+ mgs of methylphenidate. I even spent time researching and turned it into IR methylphenidate, and even boofed 81mg of it at one point. Not my greatest hour. I finally passed out at about 60 hours or so, thank god. Then I woke up and realized what happened. That was yesterday. I'm still trying to find out what to do. I've been looking for people with my combination of bipolar II and adhd for input, but I fear that with my hallucinations and paranoia that have come and gone my entire life, there may be more wrong. I don't see an issue with upping my dosage of methylphenidate, but swapping to another med is what I feel may be a better option, but I also fear that my condition will worsen, as only the combination of methylphenidate & lamotrigine helps. I've been considering dexmethylphenidate, but definitely am trying to find more answers.

Sounds a lot like my mom's condition. I don't know the specifics of her treatment, but she made it through. Don't give up.

Very much agreed on the exercise.

I've been writing an article in the past few days that explain why movement is so critical to fighting depression.

Still, this author's experience resonates with me in the sense that I get that taking drugs is a way to fix the depression problem.

When depression is that crippling and intense, it just doesn't seem like any one thing can help. Like you said, it's baby steps, and if drugs and therapy are on the menu along with exercise and nutrition, then all the better.

At some point, I'll be exploring the really hard causes of depression, those that come from society's own anguish.

In any case, being personally fit will add immeasurably to your mental fortitude, and events that would otherwise bowl you over won't.

https://medium.com/@geoffrey.ducharme/depression-you-can-cur...

Great to hear you've overcome (which is even better than being "cured") what is so very often debilitating and insidiously caustic. I read this as "hope," so ty.

Exercise is great. I just came back from a trip and where I was killing myself for 5 days straight. The feel-goods after the exertion ended lasted about 4-5 days. Had a sweet workout on day 3, but a bit of anxiety set in day 5 with the subsequent drink to squash it..

I KNOW continuous exercise helps, however outside of the above forced circumstance I'm suspicious at this point that I exercise when I'm feeling better and not the other way around..

That's the problem people without depression don't necessarily understand; feeling good often precipitates exercise, and feeling bad often precipitates lethargy. Lethargy so bad you can feel it. I mean REALLY feel it. You can actually feel this lack of motivation working against your desire to do stuff. It's identifiable, experienceable, and yet so oppressive you can't work against it. I would liken it to people freezing in a life-or-death situation; it doesn't make much sense and you wouldn't think it would happen to you, but it's right there and real for no good reason.

EDIT: I would be happy to answer any questions about how depression/anxiety has affected me or my thoughts on it.

I was fighting this with my depression.

I used to say to myself "just put your running gear on. You don't have to leave the house. But you can put your running gear on".

then "OK, now go outside. You don't have to run. Just go outside"

some days I would turn around and go back in. And I've have to be OK with that, too. No point beating myself up for it. Some days were not running days.

once outside, I'd be "OK, now run to the end of the street". If I could do that, then most of the time I'd be off and could do 5 km's.

Some days I'd get to the end of the street and stop.

The temptation to beat myself up for the bad days was immense. Huge. Everything in my schooling and upbringing told me that I should just push through the reluctance and "just do it!". But for me, down that road lies worse depression. Being able to say to myself "today is not a running day, and that's OK" was a path out of the intense self-criticism that got me depressed in the first place.

It didn't help that exercise had been used as a punishment in school - "you boy, you're late, run twice around the field!". My schooling had taught me that exercise was punishment. I found it hard to run because I felt like I was punishing myself for something. But if I didn't run then I would criticise myself.

I've got a better handle on it now. Some days I run. Some days I don't. It's up to me. I enjoy running, and enjoy how it makes me feel, so I do it more often than not. But if I don't want to, I won't, and no-one has the right to criticise me for that. Not even me ;)

Could it be also change in your environment? I had depression for most of the 00s. Changed jobs, and six months later it was gone. Company that helped me not be depressed was Google, and I’ll be forever thankful for that. I took up exercise later, but mostly it was just reduced anxiety and a better working environment.

Let me add more of the lesser known “quick-fix” things that work for me:

- Magnesium has been shown to improve „untreatable“ depression, and for me it does wonders. I use it transdermally because oral Mg gives me diarrhea. This can turn my mood around 100% in minutes.

- Near Infrared light is generally really really good for you, and I expect it to become a standard (or at least auxiliary) treatment for many diseases. Most studies have been done with LLLT (lasers), but literature suggests that standard LED diodes work almost as well, at least for cells at the surface. Buy a 850nm CCTV infrared floodlight and point it at various organs and your forehead; and buy some 250W infrared lamps, screw them into a wood board and sit in front of this for a couple of minutes naked. Add sthg like the Vitalux lamp for the extra Vit D kick. Insta mood and energy improvement that lasts up to several days—it feels like having been at the beach.

- If you are a low serotonin type, you could get your md to prescribe serotonin tablets (I haven’t), but in the meantime, dark chocolate could also do it. The crucial thing though is to keep the supply steady. I have to wean off the chocolate after a few days.

- PEMF (haven’t tried that yet) has also been reported to work: https://www.ncbi.nlm.nih.gov/m/pubmed/20385376/

There is a PEMF device called ICES that is affordable (about $400 last time I looked).

Glad to see this comment top of the pile here. I'm almost inclined to believe that people who are depressed AND choose not to do anything about it are likely to have an entitlement and/or victimhood mentality. The problem with that? It'll lead you deeper down the rabbit hole and inside within your head; things that'll only make you feel worse than better.

That may be a little like saying "People with asthma just aren't trying hard enough to breathe. If they just wanted it bad enough, the wheezing would stop. Go ahead, take a deep breath now."

Depression makes it hard to do anything and can be rooted in other issues that physically make it hard to do anything.

Some people find their way out, but there is a reason why the doldrums has come to have the meaning it has.

The doldrums is a colloquial expression derived from historical maritime usage, which refers to those parts of the Atlantic Ocean and the Pacific Ocean affected by the Intertropical Convergence Zone, a low-pressure area around the equator where the prevailing winds are calm. The doldrums are also noted for calm periods when the winds disappear altogether, trapping sailing ships for periods of days or weeks.

https://en.m.wikipedia.org/wiki/Doldrums

Just like sailors once got stuck due to lack of winds, people with depression sometimes just get stuck. If they can find a means to get unstuck, awesome! But we don't know how to readily fix this. We know some things that sometimes help some people. But there is no slam dunk solution guaranteed to work.

I am glad to hear that you found something that worked for you. But to add to your anecdote..

"sleep, proper diet, exercise" are necessary, but may often not be sufficient. Medication, when assessed by a qualified psychiatrist may be required. Therapy (if the depression is due to an event in the past) may also be required,

Finding which drugs work for you is hit or miss; finding a therapist who can guide you is also hit or miss; they can take time. But please don't dismiss medication & therapy. They are often required for many people.

So if i understand it you were quite overweight and this was the primary source of your depression?

Overweight child, healthy weight as a teenager, early 20s gained a lot of weight.

I don't know that I'd say I have a source of depression, I'm not sure my circumstances have an effect.

Hmmm okay, was just wondering, thanks.

See, I both agree and disagree with your statement.

Exercise itself has never produced results for me. Generally, it meant I was still stuck in the house doing something I hated. I haven't always had the luxury of going on regular walks or anything like that. I don't get a rush from being physical. Until recently, I couldn't even afford sports bras for running. Without the bras, anything too "jumpy" was physically painful. (I wear a special size, even when thin like I am now, and they generally cost between $60 and $100 when I can find them. Pre-internet, I simply couldn't find them).

All this said, having better physical health does help a bit. But eating well and feeling some pride that you've changed your diet for good? Yeah, that has benefits. The hardest part was finding the combination that worked for me (mostly vegetarian with the exception of fish). Losing weight? Yeah, that had definitely helped (I, too, have lost a great deal of weight and kept it off for years). Walking as a main form of transportation? That is my physical activity and I take some pride in being able to do it regularly. I still hate exercise for the sake of exercise, though.

It definitely wasn't a cure at all - that took actually changing my life. And it was hard. And i'm gonna guess that your exercise was a combination of things - like being able to use the coping mechanisms better. Simply growing up (I started a lot of my life changes in my late 20's, and I'm 39 now) I got out of a bad, stressful relationship with a schizophrenic man. I learned that a lot of the negative feedback I had gotten from others over the years wasn't necessarily true and the few friends I have are positive influence. Heck, I actually have a couple friends that aren't family.

Some of it was pure luck - I wound up moving overseas to a place that I fit in better than I did in small-to-medium towns in the midwest. I'm able to completely be myself at home: A weird bisexual artist that spends a lot of free time at home. I learned how to relax.

Admittedly, I'd not recommend some of what I've done to folks since I'm pretty partial to hallucinogens and visit Amsterdam every once in a while, both with my spouse and by myself. I'm gonna guess some of my crap wasn't depression, though - I completely understand why MDMA is seeming like a wonder drug to the researchers. I had a marked change in thought process after doing it once. By the time I tried it, though, I had already come a long way.

I had issues with depression when I was younger. Self-harm, severe depression, suicide attempts, the whole gamut. Wasn't hospitalised, but that was the next step.

Looking back on it from my thirties, I've come to the conclusion that most of my problem was disturbed sleep patterns, and the rest was unhealthy thought patterns that became self-perpetuating.

Medication didn't help me in the slightest, just made me worse. Getting some sleep and engaging with the world around me is what made all the difference. I'm skeptical of the value of anti-depressants, and some of the side-effects are deeply troubling.

The problem is that when I was in the midst of a depressive episode, I wasn't capable of fixing those things. Telling a depressed person that they just need to think happier thoughts, get some sleep, take a bath, go for a walk is utterly pointless.

Can you elaborate on "disturbed sleep patterns"? In my case lack of sleep actually results in better mood, but is not a sustainable strategy.

This is because it resets the default mode network. Luckily other things do as well.

lack of sleep causes euphoria (endorphins I think, not sure). but messed up sleeping is related to mental issues.

The article makes an opaque reference to "the oft-quoted David Foster Wallace passage on suicide and burning buildings". Here's the actual quote from Infinite Jest for those who have not yet had seen it quoted enough to know by heart:

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

And here's a longer excerpt from the book that includes the quote, with some discussion: http://theviewfromhell.blogspot.com/2011/04/elements-of-suic...

Throwaway for reasons that will become obvious.

Imagine that you met a friend you hadn't seen in years. They seemed really down, and you ask what's up. They say, "My job is to collect tolls in a tollbooth in Alaska. For 9 months a year it's freezing, and the heater breaks every day, and I'm stuck outside wrenching on the thing with one hand while Googling "how to fix a heater" on my phone with the other while I slowly lose my fingertips to frostbite."

Now recall a few weeks ago when someone posted an interesting article about a board game full of ridiculous, fiddling little rules that would take years and years to complete [0]. The reason no one has ever played this game through is not because there is _no way_ to play it through. It's not because a reasonably-intelligent person would be _incapable_ of coming up with a strategy for getting through the game. It's because so far, no one has thought it worth that time. There's no payoff.

When you talk to a depresssed person like me, you are talking to someone whose body is that tollbooth, and whose life feels like that game. You can say "exercise." You can say "talk to someone." But when you say those things, you are describing a strategy for getting through a 1500-hour board game with no payoff. You are describing to me how to fix a heater in a toll booth in Alaska where I may be stuck for maybe the rest of my life, constantly worried that the damn thing is going to break again.

So please, please, use that understanding when you talk to someone like me. Empathize. You can do that. You can say "that sounds awful." You can say "If you want someone to talk to I'm here." You can even say "Hey, let's go to the aquarium!" But be really, really careful about saying "go exercise" or "go talk to a therapist" and never, ever say it's going to be ok.

ok?

[0] https://kotaku.com/the-notorious-board-game-that-takes-1500-...

I've been in your shoes earlier this year. Or maybe I didn't come even close. I just want to say, I felt like what you describe.

Then I read an article about the microbiome of dirt [0]. In the moment I read this on my smartphone I sat in the grass on a hill and I thought to myself, fuck it, what can go wrong, I'm going to stick my finger in dirt, put it in my mouth and eat a little bit of dirt. And that's what I did.

I don't know if this was what changed my mood, but what I can say, that my mood was changed in less than a week.

All the best to you.

[0] https://qz.com/993258/dirt-has-a-microbiome-and-it-may-doubl...

Probably not a great idea to start eating dirt because it may contain M. vaccae. Let's not forget that clostridium botulinum is also present in soil.

Let's not forget that Clostridium botulinum produces its neurotoxin only in anaerobical conditions, which are not met in soil.

Um. Please be careful, ingesting soil can lead to stuff like Botulism. As for the GP - I've also been there, for many years. I'm not going to suggest treatments because you have a whole thread full of it, and it wouldn't do a damn bit of good unless you happen to be in the right state of mind for it anyhow. I don't know you, but if you do happen to need someone to chat to, I'm down.

No it can't, botulism happens under anaerobical conditions. Two people doing the same mistake, where does this misconception come from ?! Maybe you guys are mixing it up with tetanus, which can indeed be contracted through soil on a wound (because of Clostridium tetani).

I fully believe that there is no treatment or regimen on the planet that can ease the burden of some people suffering from severe depression. But the thing is, there are levels of severity to mental illness and depression. And exercise, diet, proper sleep, mindfulness, CBT - all these things have shown to help many depressed people.

Will it help all depressed people? Of course not. But by saying be careful what advice we give because it might not apply to you is not a strong enough argument to stop giving this advice. There are undoubtedly people out there that think depressed people should just "get it together" and that way of thinking is not a constructive way to approach this at all. But it is also not constructive for people who are tyring to help (and whose job it is to help) be forced to parse every word they say, scared of recommending something that could help, just because it might hurt feelings. There is a fine line here, of being sensitive and being helpful, and I understand your point and how it can be tiring to listen to people who think they have all the answers to a problem you have suffered from all your life. I have also hung out on r/depression long enough to know there are people who could be helped but have convinced themselves (and others have convinced them) that they are unhelpable because they are depressed and that's that. That is not a healthy mindset, even if that is the case.

I'm not sure what you mean by "whose job it is to help." In what sense is it your job? Were you asked to help? If so, by all means do your best, and be grateful that you are trusted. If not, I would recommend asking "is there something I can do to help" and really listening to the answer.

In my own experience, the people I love offer me support in many ways. Sometimes they listen to me when I'm having a bad day. Sometimes they ask if I want to go to the gym with them. Sometimes they just check in with me so I know they're there. Those are all kind things, and I appreciate them. But there are two caveats:

1. Those are people I love, not strangers on the internet. They have earned my trust and my attention and consideration. It's not impossible to do that to some extent as a stranger on the internet, but the way to start is by listening and asking questions, not by prescribing things.

2. Even when offering help, my friends are mindful of my feelings. There is a world of difference between "hey, do you want to go to the gym with me?" and "you seem depressed, you should try exercising." The former is an offer of companionship and encouragement. The latter is an alienating statement ("I can tell that there is something wrong with you") and an invitation to self-consciousness and guilt.

I guess what I am saying is: most people who are depressed have probably already considered the possibility that diet, exercise, and therapy might help. Before you recommend those things, you should consider whether the circumstances really make you the right person to offer that advice.

I never said it was my job, but I know people whose job it is to help (though as someone who is planning to match to a psychiatry residency this coming year, my job will be to help people with depression, among other things). You are right in that when offering advice one needs to be mindful in how they frame it, something that I find much easier to do in person than in an anonymous online forum, hence me not able to consider your personal circumstances when giving general advice.

You, an individual commenting on Hacker News, might have already considered that diet, exercise, mindfulness and therapy might actually help, but believe me, many people out there don't consider these factors and don't know the overwhelming scientific evidence out there showing their benefit. In fact, the author of the blog post that we are commenting on himself said it took him a while to get around to therapy. Sometimes it takes uncomfortable prodding to get people to do things. Like I said, it doesn't work for everyone, but it has for enough people that I will always make sure to recommend it and make sure eating healthy and having an active lifestyle is something that is prioritized because the myriad of benefits it provides.

Do you see value to asking if a person wants help before offering advice? Is that something you usually do?

Of course I see the value to asking a person if they want help before offering advice. I don't go around telling random people around me to go exercise and meditate more. I don't even tell that to friends who I suspect might benefit from it. When I am on an internet forum talking about mental health, I do bring it up because the context seemed perfectly fine. I also bring up those topics when I am having conversations about health, which I have regularly, but in a very general manner... like recently with a friend I had a conversation about how mindfulness seems to be a very effective way to manage emotions and was asking for feedback on ways to make it more appealing to people.

Do you see the value in advocating people prioritize their diet, sleep habits, exercise, and mindfulness more (while also trying to provide tangible ways they can do that)? Do you see the value in making it seem OK for people to go seek out therapy, and "normalizing" conversations about it? Because I notice there is still this ridiculous stigma many people have when it comes to seeking help for mental health, which prevents people from doing so, or even having conversations about it. And having a conversation about it is all I am trying to do here. I hope you have noticed that throughout this discussion I never gave my advice to you or anyone else on how they should deal with their depression.

People: PLEASE STOP recommending depressed people to take psychedelics. There is no such thing as "psychedelic therapy." Psychedelics can easily make people with mental health issues MUCH WORSE. Nobody needs a full blown existential crisis on top of major depression.

I get it if you like the idea of doing psychedelics, but they are mind-altering in significant and poorly understood ways, and can easily cause others harm - even if you feel they've done good for you.

There is ketamine therapy, which has shown a lot of promise. But I agree, it's important to do it as "therapy" under supervision of a doctor and a qualified therapist, and not just jumping into a K-hole on your own. Just going off and doing psychedelics willy nilly can do more harm than good.

There is indeed a thing called "psychedelic therapy", however it is not developed enough to recommend it to nearly [1] anyone at this stage.

Pilot studies and clinical trials are being done and more prepared [2] for treating treatment-resistant depression with psychedelic therapy and there is a growing body of literature suggesting it really might be a significant help, we are not just there yet.

[1] A relevant quote from: Robin L Carhart-Harris and Guy M Goodwin, The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future:

"However, there is an important corollary to the continuing illegal status of psychedelics. It seems to me paradoxical, even incredible, that such drugs should not be available for medical use in conditions for which euthanasia is already available. In Belgium, neuropsychiatric disorders were first reported under euthanasia legislation in 2004/5. Of the first such 100 patients considered for euthanasia between 2007 and 2011, 58 had depression. Forty-eight of the total were accepted for euthanasia (35 completed) and 6 others had died by suicide within 12 months from the end of the study. Most patients were female, aged 40-60 years. Euthanasia for psychological suffering is similarly available in the Netherlands and Luxemburg."

[2] https://www.ft.com/content/16209090-9589-11e7-a652-cde3f882d...

It's a hackernews meme. Just ignore it and move on.

I think we can assume that any suggested treatment has the potential to make things worse, and psychedelic therapy is no exception.

Furthermore, in a scenario where one ends up in a "full blown existential crisis", it's likely that one did not undergo psychedelic therapy, one merely took psychedelics.

Finally, just because you have an existential crisis doesn't mean it didn't work. Sometimes that's part of the healing process. Just like with physical therapy, our wounds can make certain movements painful, and we make them natural again through deliberate practice.

I think what GP is getting at (somewhat anyway) is the people who say, "Drop acid or do shrooms at home. You'll come out a changed man." That's not psychedelic therapy. As you said, that's taking psychedelics in hopes of therapeutic benefits.

I've seen people say that a non-trivial amount of time in threads like these. It could work, but that's a huge gamble.

There's overwhelming scientific scientific evidence that supports the potential of psychedelic therapy. Enough for the various governments to give the Multidisciplinary association for psychedelic research the legal right to study scheduled psychedelic compounds like ayahuasca, lsd, mdma and psilocybin.

http://www.maps.org/research

Psychedelic therapy is very real. MDMA was recently deemed a "breakthrough therapy" by the FDA, which means Phase 3 trials are being fast-tracked as they have shown so far to treat PTSD far better than anything currently on the market.

This is just the beginning of rigorous research into psychedelic therapy. We don't have good non-anecdotal data on how it treats depression yet, but we'll get there. And the data is compelling enough so far that to completely dismiss the entire idea is closing your eyes to very valuable tools that we're just beginning to understand.

A big part of psychedelic therapy is the second part - "therapy". Psychedelics by themselves may help or may hurt, it's a bit of a roll of the dice. The thing being fast tracked by the FDA includes guidance by a therapist and isn't just taking E in your bedroom. These treatments can _absolutely_ be helpful, but it needs to be done the right way. The GP comment isn't saying that they aren't helpful (and neither am I!), only that it isn't a magic bullet. Set and setting are important.

I think it's important to point a critical eye at any treatment you consider. The pharma industry is not exactly someone I'd trust, either.

As a counterpoint, ayahausca is a big part of the reason I'm alive today. In a few trips I achieved more than in a lifetime of therapy and antidepressants. I say, if you're on the verge of suicide, what have you got to lose?

You can say the same thing about anti-depressants too, especially the part about it making thing MUCH WORSE. I lost a decade of my life before I realized they were just numbing me to my situation and allowing me to not deal with it. There is no right answer when it comes to depression and almost everything that works for someone will be counterproductive for someone else. Having been through it, the absolute wrong approach is to play it safe and be sure that you don't make it worse. We only have one life and I can't imagine anything worse then going through 80 years depressed. Better to risk making it worse, IMHO.

Some of the best ways to deal with depression:

1) Address any known health issues you have.

2) Dietary changes. There are studies on this.

3) Problem solve. If you are depressed because of terrible personal issues, work on resolving them. (The article mentions that a run won't pay his bill or fix other problems. Overwhelming problems are a legitimate cause of depression.)

4) If you are suicidal, seek company. If you know someone suicidal, spend time with them.

You do not necessarily have to talk about their suicidal ideation or the problems causing it. You can play games together, have lunch, be pleasant. Suicides generally occur alone. Just physically being there goes a long way towards preventing suicide.

If you do want to help them, help them fix problems. Feelings come from somewhere. Just massaging emotions does not work. Do not "help" them by preaching at them ("Just go for a run!").

I 100% agree. But I want to highlight problem solving is so key to this.

Like most things in life there is no silver bullet. Just running / working out won't fix everything. But it's a good start so that it's not adding to the issues going on. And if you are getting good results you can make it the foundation.

That's the thing with clinical depression. You can be doing all the rights things and still be depressed. The worst moment of my live have been during periods where I was at my fittest and healthiest.

You think to yourself :

"I am hitting the gym three time a week. I've not eaten any junk food in months. I meditate and sleep full nights.

Why is everything still seen through a haze?

What am I doing wrong if everything should be fine? Am I broken? Who would want to speak to me. I am a fraud. I look healthy but I'm a husk of my former self. Everything is so exhausting."

I have no answer as to how to deal with it. All I can say is that cookie cutter answers rarely apply and can even make someone miserable.

I am not suggesting this guarantees results, and I also absolutely did not say that physical fitness approaches alone are some magic cure all. These are the best answers I know of that actually get results for some people, some of the time.

I rarely suffer depression, but I have a genetic disorder and other serious personal problems (such as: I just got off the street after 5.66 years on it and I was molested and raped as a child). My medical condition sometimes causes me to become suddenly suicidal. My two adult sons, ages 30 and 27, make sure I am not left alone when I am suddenly suicidal. They know other things to do, but a big thing is we just do not let me be alone when I am at my worst.

Getting healthier has reduced the frequency and severity of my bouts. Figuring out how to make money online so I can be functional in spite of my genetic disorder empowered me to get off the street. I am still quite poor in terms of overall income, but I have some pieces in place for my life that are usually reserved for only the very privileged. It is having a positive effect on my mood and mindset.

I am still stressing about money and I still have days when I get nothing done, but my life is vastly better than it has ever been. I am 52.

So, I am speaking from firsthand experience, in some sense. I don't suffer depression per se, but I do wrestle a lot with frequently being suicidal. It often comes on suddenly. It always involves whackadoodle brain chemistry, a side effect of whackadoodle body chemistry. I try to put out useful information to the best of my ability. I do my best to couch it in nonjudgmental, non-blamey terms.

Holy shit, this. I'm going through this right now, it's never been as difficult as when I'm doing mostly everything right. :/

Ignoring the content for a moment, I really liked how the background color changes with the mood of the content. I don't think I've seen that before, but it's refreshing from the wall of black text on white backgrounds which sometimes scare me away.

Really enjoyed the post though. I think a lot articles which give advice without personal experience don't ever really resonate. This one actually makes me feel hopeful.

health insurance problems (yay 🇺🇸, home of the brave, land of the shit health system)

Not sure about other countries with universal healthcare, but seeking therapy for depression in Canada isn’t exactly that much better.

Such treatments aren’t covered by public health insurance so you’ll be spending $100/hr CAD, likely more, out-of-pocket.

When I sought therapy, and this is probably due to unfortunate timing or being in an underserved city (but highly doubt it being Ottawa), I had to wait 3+ months before any therapist near me had room. By that time I had largely remedied my depression myself out of necessity.

EDIT: Realized I’m conflating psychiatry and psychotherapy with my comment. The former is covered by our system but due to the demand you’re looking at several months before seeing someone. My example of waiting 3+ months was just for a psychotherapist.

Check with your local mental health outpatient care. They most likely have a 10 week CBT group program. You'll also most likely be assigned to a staff psychiatrist or therapist.

I did the program through my local outpatient, and it was awesome. It wasn't a total fix, but it did help me to become aware of some toxic patterns, triggers, and responses.

In BC there are other groups after the 10 week course that are offered during the day, but that's not realistic for most people.

I could only see a therapist in the UK because my job's private medical insurance gave me £1500/year to spend.

Those I knew who tried to get help on the NHS were just prescribed drugs by their doctor without being referred to a psychiatrist or a psychotherapist.

This is the same Zac Holman who was fired from GitHub [0] when he was having tough times.

It's great how open he is about it. I'm waiting until we see going to the doctor to talk about pain in your brain the same as going to talk about pain in say your colon. That is, perhaps not something you'd talk about to everyone but at least you'll be able to see someone for free in Europe or with minimal insurance costs in the US.

[0]: https://zachholman.com/talk/firing-people

I suffered from depression and anxiety for most of my life, and it's not something cured by lifestyle changes alone for every person.

Despite exploring and keeping up with alternative treatments -- like therapy, CBT, meditation, regular exercise, a proper diet -- I was still anxious and depressed. These helped me manage the anxiety and depression, but they were still there, and, internally, quite overwhelming. It was a daily fight.

The only thing that eventually pushed it from 'I'm managing' to 'I finally feel okay' was medication. I don't feel like a zombie, or numb; I just feel normal for the first time in as long as I can remember. It's not something that is manageable any other way for some, and the stigma associated with medication is only hurting those who need it.

It's anecdotal, but I've found my cure for depression: it's called Stoicism. I hear it's been useful to people for a couple thousand years, and is pretty much 'confirmed' by modern cognitive psychology.

I experienced depression on and off for about 20 years, between 12ish and 34 (2016). Then shit really hit the fan, the perfect storm so to speak, and I was shattered to the core of my being and my values. Honestly it felt as though dying would pretty much be a non-event (although I'm not suicidal so it wasn't really an option, but survival instincts kicked in at some point and were all that prompted me to feed once in a while each week for a couple months; it took half a year before I even wanted to get better, to cope).

Then I read "The Obstacle Is The Way" by Ryan Holiday. This book pretty much changed my life. I guess it came at just the right time.

I underwent a sort of 'quantum change' as some psychologists call it: a profound, meaningful, lasting and massive change of my core personality and values, even thought processes and emotional responses. I am me, I mean I do recognize myself and so do my friends and family, but I am also a truly different being, it's like my biology has changed and my mind with it, or the other way around, idk. People confirm that I do look different, in the eyes, in what they feel around me. I certainly feel like my old self was flawed beyond salvation and has died on a psychological level. I feel like I salvaged as little as possible and proceeded on reinventing myself. It is still an ongoing process, although slowly stabilizing (it will be a year in December).

Overall I am now able to create from scratch all the joy and motivation I always longed for, to accept reality easily in ways that keep surprising me, and to remain positive (or neutral) in most circumstances. Nothing's perfect and that's good to me. I still have habits to master (dwelling on past circumstances that provoked this major episode last year), but it's night and day with what I used to be.

Considering what I went through before this change, and during it, I consider myself lucky, even blessed on some level (atheist here, with some scientific awe for existence and the cosmos).

Feel free to ask for more details and suggestions, I'd be happy to oblige, otherwise you know the book. Best of hope to everyone.

I'm curious about how you've come to realize you've changed as profoundly as you did, was it an instantaneous observation or something that revealed itself over time?

I read the book in one shot (audio+text), and something clicked inside. Immediately. I recognized a potential solution, so to speak. I was aware of being exposed to something that was touching me pretty deep. But with my usual skepticism (scientific mind), I did not know if the 'magic' explained by the author(s) would work (I have no other word to qualify how prodigious Stoicism appears to be when you first encounter its teachings, seen by a rather depressed mind).

At the time I wad coping with life, trying to pass each day. I did not know if I would ever get better, I was in survival/automatic mode. However because of that I was blindly following advice from a few online mentors (Ralph Smart from "Infinite Waters" on YouTube, Ali from "The perception trainers", and John Sonmez from "Simple Programmer"). These three channels were my lifelines.

So I just added Ryan Holiday's precepts into the mix, no thinking whatsoever beyond trying to assimilate his Stoicism. I pretty much read the book a second time that week. Again, it clicked, it felt like a relief, soothing, I began to see that it worked on a very basic level—like buttons to control/process emotions using your rational thought. It wasn't the things I lived through that were hurting me but what I thought of them, that part became very clear very fast. Suddenly I had some degree of control, it was more bearable. So that first part was almost instantaneous (days).

Then I trained my mind further. Do note that I was as close as I've ever been to a blank slate since my childhood at that moment, because most of my ideas had been shattered by real life, real people (notably my illusions about "being good" to a woman, my values that higher moral standards do yield positive results etc; and my disease, cluster headache, was in full-blown suffering mode and attacks were related to being emotionally upset, so anything that gave me even the slightest tad of serenity was very much welcome).

Within days, perhaps a few weeks, I began to see a more profound change. I had been searching for decades for a way to control my depressive tendencies, I had admittedly real reasons to be very down at that time (grieving family members + breakup + disease), and yet I was climbing back up. I began to wonder if I had finally found a "cure".

This was days before 2017, and I decided to read books this year, a lot. Entrepreneur mindset and all that. I had read Napoleon Hill's Think And Grow Rich in November, it had moved me quite a lot as well.

The rest is history. I went to see a neurologist in February for my disease and we found a med that worked, by May I was almost free of pain and I had means to deal with attacks; I'm still finishing the treatment until November but no attack in months.

I've grown exponentially since, reprogramming my mind with the best material I could find on topics of interest to me (if you look at Tom Bilyeu's reading list on impacttheory.com, you'll get a fairly good idea).

I'm still in process of discovering this change of mine. The best proof I have is emotional. I've discovered a bunch of rather negative facts about my ex (she has sociopathic tendencies, I now see that, complete with revelations that could make more than one burst in rage or despair etc). I've cut all contact with her (she was still playing mind games afterwards). But you know what? I now choose not to be affected. I'd say the emotional shield is ~90% effective, what little feelings I have thinking of all the shit she did to me are rather empathy for her (she's a really troubled individual and I wish she sought professional help, but personally? I shrug it off, it's not my cross to bear). Believe me when I say that I would have been incredibly emotional and in a victim mindset before. Now I don't care emotionally, and rationally I dismiss it whenever I think of these years 'lost' with her. I simply accept that it's my past and I can actually feel grateful because it made me who I am today; "amor fati".

As for deaths in my family, I've accepted these too and I simply try to uphold the moral standards of these important people in my life (father and grandmother). I live true to what they gave me, I feel no sorrow, I just use this as energy to move forward in my own life.

I am still evolving, actually it's become a trait. Growth, growth, growth mindset; learn, evolve, better yourself, etc. It's a wonderful feeling. I appreciate failure for what it teaches me, I'm actually happy regardless of outcomes. I never feel sad or bored or upset, whatever reality throws at me I'm happy to deal with. I actually find it weird when people get upset at something because I hardly ever do that anymore.

Mind you I'm not perfect, not by a long shot, I still have so much to learn and live, so I find joy every day in simply living my life. I now have a purpose, much greater than myself, so it's all about that. I, personally, will be OK somehow, I know it because I will it. In that sense, change is still ongoing but I don't think it will stop any time soon. Probably when I'm dead! And that will be just, too. :)

Does that answer your question? Sorry for the delay, busy weekend. I maintain an Instagram account where I write long posts about this change, among other topics, if you wish to know more.

I'm glad that you're better now. :)

Yes it did, thank you for the explainer. It's a good example of the fact that changing how our minds work for the better is a multi-modal, multi-disciplinary endeavor.

Would be interesting to see if there are doctors out there who can practice a more integrated approach rather than just focusing on one avenue of getting better.

I love you for writing this. I spent thirty years either trying and failing to fix myself, or being misdiagnosed (turns out treating bipolarity with antidepressants can do more harm than good). It wasn't until I had kids that I tried once again to get out of my hole, and got correct treatment. Luckily my kids were still little and the only dad they'll know is someone much better equipped to to be fully present and loving for them, in a way that was often buried before.

To anyone needing help, if it's easier to take action for someone else, do it for their sake. And hopefully you'll see that it's ok to have given yourself that kindness too.

Understandably, these threads are full of anecdotal cases of effective depression treatments. But why should we assume the there is is a one-size fits all treatment (or even 3)?

I think depression is akin to a common error code in the mind (and maybe body too). If the mind is at least as complicated as the biggest program we can imagine, why should we imagine one thing will likely fix this problem?

This is like suggesting the same code would always fix a given common error.

It seems more likely to me that there are many causes of depression. While there will be many commonly effective treatments, they will vary based on context. Sometimes the effective treatment will be very specific / personal.

Here is a lengthy compilation of ideas towards coping with depression that I submitted elsewhere but it unfortunately got flagged as spam by Disqus and so was not published in the original context: https://sbindependent.org/depression-and-anxiety-in-college/

It very much reflects your suggestion that there are many causes of depression and many possible coping and/or healing strategies, so I am posting it here. [It just got a "that comment is too long" error message on hn, so I need to split it up...]

====

Hi Jennifer (and any SB Independent readers struggling with depression for themselves or a loved one),

Here is a collection of advice I've posted elsewhere for other people about overcoming depression and other forms of mental illness (or at least coping better with it). I hope this can help. I wish I had know this all when I was an undergrad at SUNY SB a long time ago. Perhaps it might overlap the readings you said a professor suggested to you.

First, remember, the brain is mostly fat. You need to be eating healthy fats (like walnuts, avocado, omega 3s, etc.) for brain health. But that is just a start on what good nutrition involves to get lots of micronutrients (more veggies, fruits, beans, nuts, seeds, whole grains as in "you can see the grain"). Be sure you are getting enough vitamin D3 (which is almost impossible for most people without supplements given our indoor lifestyle and other lifestyle factors). And get enough iodine, like from sea vegetables. And also enough high quality B-complex vitamins.

From Dr. Joel Fuhrman: "Depression doesn't have one specific cause; environmental and genetic factors may be at play, as well as psychosocial stressors, however, a major factor causing depression is unhealthy dietary factors. Fast-food and commercial baked goods are linked to depression in a dose dependent manner, and dietary excellence can be the solution for many suffering individuals. A feeling of a depressed mood can also be a symptom of other medical conditions or a side effect from a medication, so to be sure of what is causing your symptoms, you may need to discuss your depression with your doctor."

Search also on "The UltraMind Solution: The Simple Way to Defeat Depression, Overcome Anxiety, and Sharpen Your Mind" by Dr. Mark Hyman, again focusing on nutrition.

Water-only fasting helps in some cases of mental illness too (especially if brain inflammation is caused by some food allergy). The Russians did a lot of research and practice on that.

Obviously, good mood is more complex than just nutrition. Look at Dr. Andrew Weil for a broader perspective.

Or see an essay by Philip Hickey, Ph.D called: "Depression Is Not An Illness: It is an Adaptive Mechanism"; quoting from that:

    "In order to feel good, the following eight factors must be present in our lives.
   * good nutrition
   * fresh air
   * sunshine (in moderation)
   * physical activity
   * purposeful activity with regular experiences of success
   * good relationships
   * adequate and regular sleep
   * ability to avoid destructive social entanglements, while remaining receptive to positive encounters"

[And when any one or more of those factors are missing -- it can lead to depression, with the likelihood increasing if multiple factors are missing.]

Also, check out: "The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time Paperback" by Alex Korb PhD.

There are lots more resources like that. There are lots of alternatives to placebo-like mental drugs...

Search also on "Sleep deprivation can effectively treat depression" for another option to consider.

Our society is also all too quick to label a "spiritual crisis" as mental illness (see Wikipedia on that term).

Thanks for your series of essays on these mental health topics. I learned something from them, especially about how depression and anxiety can cycle together, where anxiety becomes the only force that can counter depression as far as getting anything done. That doesn't mean that is a happy or health way to be -- but it is informative to understand that cycle, and in that context of depression, the "benefit" of anxiety.

As with Chester Bennington (who I learned about from the article you posted for someone else on that, leading me to your series -- and then watched his band's "Numb" video and a couple others), sometimes if we dwell on the negative, it does not really get us healthier overall. As in helping create the "Numb" video, Chester built on his strength of music and it at least sustained him for a time and helped him help others and in other ways connect with other people like with the rest of the Linkin Park band. And in that "Numb" video, one might hope for the same for the protagonist as there are certainly a lot of people out there who do appreciate art or can be moved by it or who take joy in creating it together with others.

For my generation, Robin Williams is a bit of the same symbol as Chris Bennington -- although he used humor instead of music to connect to people and to manage pain (but not totally cure it). Like all helpful drugs, music and humor can make a difference in sustaining us as we cope with pain, but we still need to address the underlying issues as best we can. And even if both artists lost that battle with pain in the end, they at least had much longer and better lives from building on those strengths -- and the community around them was much better for their long-term willingness to do what they could with what they had. While most of us may never have that level of comedic or musical talent, or the opportunities to refine that talent by years of practice, "the woods would be pretty quiet if no bird sang there but the best". Someone with even a fraction of their level of talent could make the lives of many people around them a lot better with just a little humor or song added to every-day interactions. You can also use a talent as a volunteer or as a hobbyist sharing with others even if you do something else as a day-job.

[continued in a part 2 reply to this...]

[part 2 to go with the above]

Look into "Positive Psychology" about building on our strengths -- like you are doing with your writing.

See the movie "It's a Wonderful Life" -- which, at the very least, can make us wonder if there is any chance we could make things even just a tiny bit better for ourselves and/or a few people around us by engaging with life?

There is an insightful comment by "Brian" on Hugh Howey's website under "Our Silos Leak" I saw just last week where he talks about how figuring out why you feel so badly doesn't usually help that much and may even just deepen the traumas. It is focusing on what you want, what makes you happy (within realistic limits) and taking steps toward that which get you to a better place. The comedy "Cold Comfort Farm" has an interesting angle on that.

The main essay on "Silos" is also good in talking about how it is reasonable to minimize our interactions with vexatious people (of any political persuasion) and we can still have occasions to experience new ideas and reflect on them in a less knee-jerk way. And those vexatious interactions can also include (and probably do) much or all of television, "news", and social media.

Search also on "On the Trail of the Orchid Child" for a Scientific American Article on how whether some people's genes can either be a great benefit or a great detriment depending on their environment.

We all have inclinations, habits, preferences, and reactions that can be strengths or weaknesses depending on the situation. Stony Brook itself is like a small city -- it has many different social environments that can be better or worse for different people.

Finding the right niche(s) from all the possibilities that works for you can be a bit of trial and error. But finding the best matches of groups to be part of (including from family, neighbors, clubs, classes, volunteerism, jobs, online, etc.) is essential. All of the above is much easier said than done, and it is more feasible to be healthy when part of a group of others also striving towards health. For example, if you try to eat well and you are surrounded by people eating junk food who are always offering that junk to you and denying its health cost, that just is so much harder than if you are part of a community all trying to eat healthier and supporting each other on that journey with all its ups and downs.

"Bluezones" is another positive touchstone to see how happy people live for a long time -- and a lot of it is just about getting the basics right like in the Philip Hickey quote above.

And then when things get going well (or even before), watch out for "Supernormal Stimuli", "The Pleasure Trap", and "The Acceleration of Addictiveness" (see two books and an essay by those names).

One nurse who was critical of one of Dr. Andrew Weil's books on Amazon pointed out that much ill health is caused by poverty (and I might add, ignorance, which good journalism can help dispel). Like in "A Christmas Carol", "This boy is Ignorance. This girl is Want. Beware them both, and all of their degree, but most of all beware this boy, for on his brow I see that written which is Doom, unless the writing be erased." It is hard to eat well, say, when you can't afford fresh vegetables or don't have the time or place for preparing them -- and also if you just don't know why eating healthier is so important or how to do it.

Long term, social and technical changes like from a basic income, improved subsistence by personal robotics for gardening and preparing healthy food (e.g. Farmbot or Moley Robotics), better organizational planning and governmental accountability, and more gift giving of knowledge via the internet, may help alleviate some of the worst causes of day-to-day pain and worry in the modern age. So, those can be positive changes to work for -- and working towards such things can provide some hope and bring us together with other hopeful and caring people. And underlying all of that is a cultural change and a "global mindshift" towards abundance thinking and favoring cooperation over competition (see Alfie Kohn) which journalism can help with.

And, when all else fails even when we seem to be doing everything we can, consider: "Dark Nights of the Soul: A Guide to Finding Your Way Through Life's Ordeals" by Thomas Moore for finding meaning and even personal growth in the darkness.

Good luck!

While I did not mention this in that original contribution, here is a 200 page essay I wrote in 2008 on re-envisioning another university I attended as a post-scarcity institution -- hopefully one which countered depression and other pathologies with positive psychology, healthy action, and hope: "Post-Scarcity Princeton, or, Reading between the lines of PAW for prospective Princeton students, or, the Health Risks of Heart Disease" http://pdfernhout.net/reading-between-the-lines.html

From the introduction: "With Princeton-praising articles titled "Jumping From the Ivory Tower", it seems like PAW [Princeton Alumni Weekly] is not helping answer these deep questions. If anything, PAW is helping bury them under inappropriate humor. This essay is not intended in any way to condone violence or the abdication of personal responsibility. But it is intended to help understand some of these issues of suicide and alienation in a university context, and to make suggestions for improvements to the social part of these issues. It even tries to use humor in relation to suicide and morbid themes a bit more appropriately (satirically about PU in this case, discussing options like its voluntary peaceful self-dissolution to help a billion poor children get an education, or its metaphorical death and rebirth as an agent of global economic transcendence to a post-scarcity society of abundance for all). It is always easier to destroy than to create, so this essay includes some specific suggestions for improving the situation at Princeton University, which is a mythologically-troubled institution (even as it is filled with many wonderful and caring people)."

One issue I explore is that the virtues of elitism, competition, and excellence that Princeton University celebrates all have shadow sides like alienation, destructiveness, and perfectionism which can lead to depression, anxiety, and a host of other illnesses from extremism (including heart disease possibly from an extreme fat-free diet which killed a classmate at an early age), such as when I wrote: "I can also hope that many of these issues at PU continue to slowly change. There is some hopeful news now and then in PAW (like more profiles of alternative alumni careers), even as the deep issues about "elitism" (alienation?), "competition" (destructiveness?), and "excellence" (dissatisfaction? perfectionism? excessive self-criticism?) usually remain unspoken."

Here is also some more recent (as-yet-mostly-unrealized) ideas (put together for a 2013 Knight News Challenge) towards helping people make sense of their own health issues (depression or whatever they may be) when confronted with a mass of often conflicting information often dispensed by people with undisclosed conflicts of interest:

https://web.archive.org/web/20161104203536/https://www.newsc... "We want to improve public health through free and open source public intelligence tools for individual and collective sensemaking about health topics -- especially related to nutrition and lifestyle... When confronted with a health issue, many people turn to their doctor, the internet, or friends for advice. But then what do you and your family do with all the advice you receive? What do even health professionals do with all the often conflicting information out there when they research a patient's health issues? We want to create software that helps with that challenge by making it easier for individuals and communites to collect health information (from whatever public sources including the internet), organize it, prioritize it, reason about it, act on it, and feed back the results of action into a next iteration as a learning experience."

Here is a motivational example about salt intake from that proposal, but it could just as well be about understanding depression and various options as they apply in your own life:

====

For example, consider the question of how much salt of what type is good for a specific person (you) to eat every day? How easy is it to begin to research that for yourself? How long would it take, even with a web browser and search engine at your finger tips? How would you know which study to trust and how much -- including based on who funded them or how carefully the work was done? How could the online community help organize all that information for you? If it was organized, how would any general advice you found about salt consumption apply to your own specific situation and lifestyle and family history? Would the amount of salt you needed matter based on how much you exercised, or where you lived, or whether you went outdoors a lot, or whether you ate a lot of fruits and vegetables? How would you answer the question of whether there other health factors in play that may make some people sensitive to salt, and perhaps if you improve those, maybe salt intake won't matter much? How have opinions about that changed over time? If you try changing how much salt you eat, how should you interpret any changes in how you feel?

There may well be "experts" out there who know good answers for these questions specifically about salt, but they probably are not you personally. Statistically there might be a small number of experts out of billions of people, so most people thinking about how much salt to eat are not going to be experts. So, almost everyone is left wondering which experts to trust? Even if all the experts agree, they could still be wrong, or their general advice might be easy to misinterpret for your particular situation. And if you specifically by chance are an expert on salt intake, then you probably are not an expert on phytonutrient intake or cancer treatments, and so you would be faced with this same issue in some other area of personal health. So, there can be a gap between what an expert (or community of experts) know, and what an individual or local community knows and then acts on. Part of the value of better software tools, including educational aspects, may be to help bridge that gap between expert knowledge and individual practice.

This recently temporarily "withdrawn" article on "Reduced dietary salt for the prevention of cardiovascular disease" due to "doubts raised about the integrity of research" is an a example of how dynamic the medical publication landscape can be. Withdrawal of one article does not mean other similar articles are not valid though, or that a general concept is not valid. The research landscape can seem very dynamic and conflicted, even if there may often eventually emerge broad agreement on some truths. Could better tools help even subject matter experts track all these changes? So, whether you are an expert in a field or just an individual with a health issue, there is a challenge to make sense of this all for yourself at any point in time (even if the challenges may differ somewhat for expert and patient). It is also hard to draw conclusions from small numbers of studies in a mass of large numbers of publications on complex topics (something somewhat analogous to "weak signal detection" in the intelligence community). Yet, ultimately, each of us still personally needs to decide how much salt to eat each day (or broccoli or sugar or barley), so we can't avoid the issue (even if we can ignore the issue or any new information and just keep on eating as we have in the past).

Ideally, one might imagine authoritative sources on every aspect of health (including salt consumption) which supply the best health advice for every locality specific to every person. For example, imagine the archetypal old-fashioned-but-up-to-date grizzled "country doctor" who knows entire families in a community from birth for multiple generations in a personal way and provides the best specific health advice for the area and the individual. That might range perhaps from "Salt killed your grandpap!" to "Ain't too much to worry about salt since you exercise so much working outside in the Arizona sunshine." But such a health practitioner and community is mostly just a fantasy. There may be such health practitioners and stable communities out there, but they would seem at best few and far between these days in today's highly mobile society.

Compared to the ideal mentioned above, in practice a typical real-life health interaction for all too many people is more likely to be ten minutes spent with a new physician (perhaps due to insurance plan coverage changes) who recently moved to the area, has big worries about repaying US$200K in newly-minted student loans, and has limited experience with a specific health complaint and the individual's life history (including what is not said). In regards to an issue like advice on salt consumption, even if the physician knows that in theory someone who exercises outdoors a lot probably needs to take in more salt, is there going to be time to get around to discussing that level of detail about lifestyle with the patient or how it might relate to some health issue? Would there be time to explore and address a digestive complaint perhaps unknowingly from weak stomach acid from low salt levels? It may well be that many people eat too much salt, but perhaps this specific person perhaps eats too little for his or her situation?

In practice, there are a variety of sources of health information we encounter each with various conflicts of interest and with limitations in focus, experience, time, and continuity. A person with a health issue is confronted by all that complexity, even if they may choose to delegate the authority for all their health decisions to some chosen medical practitioner. Ultimately, we can delegate "authority", but not "responsibility"; in that sense a competent adult remains responsible for his or her health regardless of who has been asked for advice or who we let perform procedures on us.

====

There is the vaguest beginning of that in a GitHub project linked here and in some other projects called Twirlip (but they've been eclipsed by a need to do other things for income): https://github.com/pdfernhout/health-decision-support-tools

Although, as in the example there using IBIS to explore choices for dental health issue, it is possible that the IBIS methodology may be good enough to get a lot of people fairly far. Likely we can do better than IBIS, but I can acknowledge it is hard to do better than IBIS for several reasons (including simplicity, learnability, speed, and collaborativeness). For more on IBIS, Dialog Mapping, and Wicked Problems, see the references I've collected here (among others on a larger topic): https://github.com/pdfernhout/High-Performance-Organizations...

The solution is that every one of you listen to a friend who is in need and empathize and say, yeah -- i'm here.

Kudos to Zach for opening up about this. I'm going through a similar shit show and I'm hoping that folks who grok it stick close and the others just sway with.

REMINDER: we're talking about something sensitive here.

Some conundrums I have with this article and other folk here saying that you should get a therapist, that everyone should see a therapist, and you should listen to your therapist:

1. How do you find a good therapist, and given the disparity in their quality, why would you trust yours all that much?

2. Therapists can get very very expensive. Yes, including insurance. Very very expensive.

3. Therapists often can't meet you outside of business hours when you're often working.

These are very real questions that we as a society really need to think about solutions for. Very good to point them out...

With respect, and as pure anecdote based on myself, "run a mile" is really good advice. I've dealt with depression since puberty and the main thing that helps me is excercise.

Lifting, getting punched with gloves or preparing for a marathon works wonders for me (not said as an opposite opinion than the author, but as a datapoint).

And please, if you're dealing with depression, you need to find out what works for you. Friends and family can help you find your way back, but they can't make the decision. When you decide - you - to take steps for coping with it nothing is impossible.

The author has sound advice on where to start. I'd just like to add that it can take quite some time, and that's ok, because life is long and you'll look back at this period and thank yourself for acting on it.

Saying my family history is significant for depression is an extreme understatement. My parents and grandparents shared the sunny disposition of Henrik Ibsen. It was no surprise that I too suffered from major depressive episodes and dysthymia (persistent depressed mood over a long period of time).

It has been a long strange journey but by taking advantage of what the medical community has to offer I now am happier than I ever thought possible. One really important moment for me was the realization that everything is biology. There is no difference between physical and mental health. Migraine pain and the pain of depression both hurt. A heart attack and suicide make you the very same dead. Everything you think feel and do is modulated by the soup between your ears. If the soup is short of some ingredient or another it manifests as emotion or behavior.

The book Behave by Robert M. Sapolosky is a fantastic journey into the chemical basis for behavior. While the book is admittedly dense, Sapolosky clearly explains how neuroanatomy and neurochemistry form the basis of experience and consciousness. The writings of the late Oliver Sacks also illuminate how when the physical seat of perception and cognition, the brain, is disrupted in some way, our ability to perceive or what we perceive is fundamentally altered. A patient with a visual field disruption was only able to perceive half the food on their plate. Turn the plate around and the other half was experienced by the patient.

The human organism is insanely complex and nuanced. Human life is in cosmic terms is a trace of a blink. For anyone suffering from depression I would urge you to put aside any misgivings you have about labels and stigma, find the best doctor you can and start to address your depression. It's pretty great not to be miserable. I've tried both.

Zen and buddhism. (Zen is not really buddhism).

Among many others things (therapy, running, playing high level piano, amazing remote job), Zen rewired and helps me to deal with this every day.

I'd recommend this authors with all my heart to anyone:

- Thich Nhat Hanh ("You are here")

- Alan Watts

- Eckhart Tolle ("Stillness Speaks")

- Shunryū Suzuki ("Zen mind beginner's mind")

- Ryan Holiday ("Ego is the enemy")

Piano helped me quite a lot. First my teacher, I could even say my piano teacher played a more important role in helping me, more than my family ever could. Musically I felt in love with Chopin and I really hope someday to be able to play Ballade 4 op. 52. It puts me at least decade long goal (yup, it is really really hard to play that).

Running, eating healthy, etc sure. But I think it works better to have the brain thinking better first. Otherwise we'll stick in the same trap over and over, with the same bad thoughts and habits we want to break.

We need to get beyond thinking and feeling. Training ourselves to see them, observer them and letting them go. It takes a lot of time. But you can do it.

Hope something of this help someone.

One thing for certain can be gleaned from reading all the responses in this thread: We have no idea neither what the cause of depression is, nor what the solution is.

Everyone here has posted something different. Exercise, diet, sleep, medication x, medication y, prayer, water, gluten, meditation, losing weight, socializing... the list goes on, and on.

If this weren't heavily susceptible to placebo, you'd expect that list to be much shorter. My guess is that just doing SOMETHING makes people feel better.

Cutting gluten out of my life basically "cured" my depression, which sounds crazy, since it is just something I'm eating...

I'm not allergic, but probably intolerant. I ate wheat for most of my life. I'm pretty sure it is related to inflammation, and how eating wheat products probably screwed my digestion up. I also rarely get sick anymore.

Not trying to suggest that medicine, therapy, etc. does or does not work, just that there may be some other things that people can consider and experiment with.

Did you ever feel like gluten was affecting you? Or was this a random change you made that happened to have a noticeable effect?

Definitely gluten. I've experimented with eating it, not eating it, and now have been gluten free for over 5 years since. My brother stopped eating gluten a few years after I did, and it also had a major impact on his mental and physical wellbeing.

Not sure for gblain, but for me I actually broke out in pimples when eating excessive wheat/bread. Under a certain limit, I just felt bad.

However, I'm not sure if it's just gluten or glyphosate toxicity [1] (being concentrated in GMO wheat as that includes "roundup ready wheat" which, clearly gets more roundup on it).

[1] https://www.ncbi.nlm.nih.gov/pubmed/15862083

It's crazy, isn't it? Cutting gluten has become somewhat of a meme, but a meme repeated enough times must have some kind of truth to it.

I've self diagnosed myself to a combination of depression/cyclothymia/bipolar disorder. Basically, I've been working at 50% potential, on a good day, for the past 10 years.

Interested in the science behind ketogenic diets, I've tried to cut all grains and processed food for many month-long stretches, and I've always noticed my brain being sharper, and moving farther and farther away from the "black dog". But eventually I get back in the trap and it's extremely hard to pull myself up again — impossibly hard cutting grains with Italian friends and family.

Keto probably isn't the solution, but I'm more and more convinced the key lies in our gut, not in our brain chemistry.

EDIT: depression is a common modern "disease", and in my ignorant opinion, I'm convinced there's two types of depression:

You might be depressed if your life is in the shitter, and there's no sane way of getting out of it. Think bad marriage or crippling loneliness.

You might also be depressed because your chemistry isn't optimal, because of what you eat or bad health.

I believe most modern depression is of the latter type, and in both cases medication treats the symptoms, not the actual cause. We need to do more work on this.

Again, this is my personal opinion, and I might be talking out of my arse.

I've been gluten free for 10 months. To start with I thought it made a difference - sharper mind, not constantly bloated (and I'm not talking minor, but '8 months pregnant' bloating after any meal).

The mind maybe, but the bloating and sluggishness has come back, along with the apathy, lethargy and a touch of depression. Gluten (I've tried introducing it back this last week) or no gluten, the bloating's the same and sometimes worse when avoiding gluten.

Back to the drawing board, but for those reading, YMMV.

> Not trying to suggest that medicine, therapy, etc. does or does not work, just that there may be some other things that people can consider and experiment with.

Why not suggest this? It is so funny to see people been so skeptical about religion and always so believer in anything called science.

Cutting gluten probably is a net-positive, for most people, if for no other reason than it drastically reduces the amount of simple carbohydrates that you consume, and more often than not, the total number of calories consumed. Whether or not that it is actually the gluten that makes any difference, for non-celiacs, I'm less certain. I feel much better when I get closer to a ketogenic diet of eggs, meat, and green vegetables, but, again, I'm probably consuming on the order of 1000 to 1500 calories less per day when I do so.

1 hour hold account 1 hour old comment. I am not trying to be negative but i have seen no science to state that cutting gluten is going to do anything at all for anyone unless they have Celiac disease.

You want to back that up with study or something? Its just WOO if i am wrong i will be happy to eat some crow.

Further more the comment near this one about some imaginary threshold of MEME count gives something legitimacy. REALLY?

WHERE AM I!!

I believe there are a few other conditions besides Celiacs which are pretty serious that make eating gluten a bad look, though less prominent.

It's also impossible to know that you don't have celiac disease unless you've had an immunoassay that comes up negative. Not all celiac cases show severe GI symptoms. As such assuming that someone does not have celiac disease who has not been tested has a 1-2% false negative rate.

Secondly, gluten can aggravate FODMAPs sensitivity:

http://www.gastrojournal.org/article/S0016-5085(13)00702-6/f...

This study is often cited to "prove" that non-celiac gluten sensitivity does not exist, but what it actually shows is that most "NCGS" cases are caused by FODMAPs and that gluten can aggravate the symptoms in a person who has not cut out FODMAPs:

>In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.

Gluten increases GI residence time in everybody, which is not an unhealthy effect on its own, but which can increase the duration of exposure to any dietary irritant:

http://www.gastrojournal.org/article/0016-5085(83)90374-8/pd...

>Hydrolyzed gluten prolonged intestinal transit time, and this effect was reversed by concomitant administration of naloxone

It's seriously that easy to just look up "gluten sensitivity" on Google Scholar or SciFinder or (insert academic search site here) to find these sort of studies. And frankly it's kind of annoying to see people who won't even go to that level of effort degrading the actual personal experiences of someone who is simply trying to improve their own life.

Thank you for the links. As to laziness on searching for gluten sensitivity" i wasn't the one making the claim that it cures depression.

Have an upvote anyways for your efforts.

I don't want anyone in my professional life to know I have suffered severely from depression, so I made a throwaway account.

Regarding science and evidence, this is anecdotal, and just my personal experience. It has 100% changed my life, so I thought I would share.

Honest question, you attribute all of that to simply removing gluten for your diet?

edit: typo's

Yes, pretty much the only thing I have changed. I don't exercise much, and my work more stressful than it ever has been.

I'm also fairly lactose intolerant, and cut out dairy years before the gluten thing, and that also had a huge impact on my health.

God forbid someone mentions their own experience, especially if they have a disclaimer it's only their own experience!

My naturopath put me on a neurotransmitter (which I'm intentionally not naming, seek help if you are depressed). My depression was caused by anxiety, that was caused by, evidently, something with my chemical balance.

Scientifically speaking, administration of my supplement is inconclusive. Don't take natural medicines for chronic conditions unless a qualified professional is looking out for you.

One thing I want to mention in addition to what everyone else says is that community is essential. Even if you sleep well, eat right and exercise, without community it's likely depression will find you eventually.

As someone who has suffered from, at times, significant symptoms of bipolar disorder, I glad to see prominent members of the community coming forward to discuss mental health. I think the best way to break the stigma around mental illness is open discussion.

I wonder if there is a higher rate of mental illness in the software development industry compared with the population as a whole

Not a sufferer myself but I really enjoyed the book Rob Delaney: Mother. Wife. Sister. Human. Warrior. Falcon. Yardstick. Turban. Cabbage.[1] Very funny but also touches on his severe, near-fatal depression and alcoholism in an enlightened manner. Talks about medication, how he talked himself into getting help, the unfathomable experience of clinical depression itself, lots of the things Holman mentions. Now he's the "funniest guy on Twitter" and has a brilliant show on the BBC / Amazon (Catastrophe).

[1] https://www.amazon.com/Rob-Delaney-Warrior-Yardstick-Cabbage...

Following generic ideas as to how to improve your life is what makes people depressed in the first place. You MUST do this, you MUST do that, become rich, retire early, make the world a better place, do something for humanity, healthy diet, exercise, you name it... Sure this all makes you depressed - it's surprising there's still someone not depressed out there. And now what? More diet, more exercise? Come up with a list of things you enjoy. Be contrarian. Stop listening to anyone, and especially - to your "inner voice" - he is lying to you.

In my experience, exercise was helpful, but mostly only after I realized what I could learn about myself from it. Primarily, it allowed me to better understand and manage 2 types of “automatic” thought processes that I have constantly: (1) Intrusive Thoughts - unpleasant thoughts that pop into my head (2) Motivated Reasoning - mind trying to draw logical but untrue conclusions in line with my current feelings at the time

As an example of how the 2 may combine in normal life, an internal dialogue might look like this: (1) Intrusive thought: “I can’t accomplish this goal” (2) Motivated reasoning: “Because I’m a failure and I’m worthless” The most insidious thing is that these motivated conclusions feel so right, feel so self evident.

With exercise, similar thought processes will arise. The difference is, because you are dealing with a simple physical task, there is the possibility of immediate physical evidence to demonstrate to yourself your intrusive thought, and the reasoning for it, are simply wrong.

The analogous thought processes during exercise might look like this: (1) Intrusive thought: “I can’t finish this workout” (2) Motivated reasoning: “Because I’m not in good enough shape and it hurts too much, I can’t take it, I need to stop” There is a point where I feel like I want to stop, and at first it seems so reasonable to stop, to not overwork myself and hurt myself. But if I push on past that point, there is a realization “Huh - I’m still here, I’m still doing this, I thought I didn’t have it in me, but irrefutably I did because I am here still doing this after I thought I was done.”

I always thought I was naturally unathletic; I was never good at sports and hated exercise until I became an adult. Looking back now, I realized the only reason I was unathletic was because I believed I was, and my power of belief made it a reality.

As I’ve grown older, the intrusive thoughts and motivated reasoning are still here, but where in the past they stopped me dead in my tracks, now I have learned to see them for what they are and not let them define me.

Everyone has different experiences, and I mean no disrespect to anyone who hasn’t found value in exercise; I believe there are many ways to learn these types of lessons; for me, it just happened to be exercise, but it could have been anything.

It's just about impossible to fix your brain on your own. The only tool you have is the one that's broken. How do you fix a hammer with a broken hammer? Seek external help first.

A question for the author or anyone who has been through a similar experience: Can you better describe what life is like without the "haze"?

One thing that I see consistently in these kinds of writeups is the author describing living life "through a haze". Then later, after the therapy/drugs helps them out of the depressive pit, they say how much clearer things are. This worries me because I have plenty of days where I feel "hazy", but have always though it to be normal.

I have nearly life-long chronic major depression that can’t be cured with socialization, sex, money, sleep, diet, exercise or various forms of therapy. I’ll take a random stab that it is mostly genetic and partly by having had a tyrannical, histrionic, screaming father whom caused frequent stress: this then setup poor vagal tone and “walking-on-egg-shells” hyper-vigilance which then neuroplasticized towards reinforcing pain-depression complex of the military-industrial kind.

I now have depression again after mirtazapine tachyphylaxis. It’s a widely-hitting NaSSA and powerful antihistamine (which also means hypnotic). It’s also the most effective antidepressant (I was on a heavy dose, 60 mg) but it causes weight gain (+25% body mass) and G.I. slow-down. That’s great when it works, but now I’m letting the old black dog have another ride as buproprion XL 300 mg isn’t doing anything useful so far. Maybe, still really foggy, confused and increased pain perception.

Not being depressed is awesome: like the clouds parted, quieted inward observation, less reading, less writing, less sleeping-in, pain set aside, more energy, enjoyment and orderly thinking; almost manic but, presumably, not bet-kid’s-education-fund-on-18 far.

Looking at next alternatives:

* Bupropion XL 450mg

* AXS-05 (60 mg DM with bupropion)

* Venlafaxine ER

* Venlafaxine ER + Lamotrigine

* Venlafaxine ER + Mirtazapine

PS: Paxil gave me serotonin syndrome and Zoloft did jack shit.

I'm on Buproprion as well. I'd recommend ketamine, tianeptine, possibly MAOis. The latter are remarkably effective but underprescribed for a number of reasons, including an overblown fear of hypertensive crisis.

There is a lot of advice regarding depression and a lot of things people say may be helpful to many others.

There is, however, also the chance that someone's life really is FUBAR and no amount of exercise, therapy, drugs, and whatnot will change anything. And then everybody says that the one who is suffering "does not want any help", "is not suffering enough to accept help", "is happy with his suffering", etc.

Well, pardon my language, but that's such a giant pile of bullshit! All that's happening there is that the one giving advice is helpless and not willing to admit it. And that's especially true of psychologists and other "professionals".

Source: have lost three people who committed suicide and in two cases I would say that there really was no other way. We, as a species, totally suck at helping.

And, yes, there probably would have been ways to help above people, but it would have taken time and dedication and who is willing to invest that? It's so much easier to try a quick fix and when it does not work, blame it on the sufferer. Unfortunately I was young back then and did not understand that...

Thanks for posting this, right around Worldwide Mental Health Awareness Day too.

To anyone reading this who is struggling but hasn't had the time to talk to a human therapist, I'm working on an accessible AI therapist to provide at least some experimentally verified help. I've got a prototype up at facebook.com/mindfulmarsha and would love feedback from yall. I work on this bot at night after work and am a ways out from doing anything to monetize it, so if you're interested in helping with dev time, message Marsha on FB or contribute to our patreon: www.patreon.com/mindfulmarsha

I was diagnosed with Generalized Anxiety Disorder after a panic attack in 2014, ironically during a time that it looked like the startup I was at was going to be unable to raise a round and my girlfriend at the time was suffering from severe depression. It has taken me years to be functional despite my appearances, and I literally, while working on adding the PHQ-9 Depression screener to the bot, realized that I had also been suffering from depression. Trying to turn this pain into a platform though. Looking forward to feedback!

I spent several years paralyzed with depression, it got to the point that all I could do was stare at the ceiling - wasn't even worth the effort to commit suicide I might as well just wait until I die.

Self destruction is a natural thing, a part of the growing process, you just have to channel it somewhere. Some do tattoos or something, I like yoga, but whatever works I guess.

What I've started to realize is that we hold on to our ego with all our might until nothing else is left. However, embracing new perspectives is a prerequisite to growth and whether you do that through religion, drugs, therapy or meditation the fact is when you're suicidal you desperately need a new perspective.

Letting go of your past self to become the next version is a metaphorical death and sometimes it can be confused with the desire for actual death. This is what I mean by channeling the self destruction, maybe you do it in a way that leaves a scar so you can be reminded of your older self. That may be necessary if you've been completely conquered by your ego.. but for most 'normal' people it's enough to "take action" so to speak and start behaving differently (exercise, food, socializing, etc.)

Just never ever ever let yourself feel self pity. Self pity is a feedback loop and the worst thing you can do to yourself, if you can just stop that one thing you will eventually fix things on your own.

Edit: That first step getting out of depression is difficult, you may need a nudge but be sure not to let yourself go back there!! You need to keep "self destructing" constructively or you will sink again, there is no cure-all that lasts forever. You need to keep living cause the living never give up - that choice isn't going anywhere, it's called death.

Our society puts a strong onus on people suffering from depression to seek out treatment. Which, don't get me wrong, oftentimes works and can genuinely improve people's lives.

But what if depression is a sign of a deeper societal / cultural / teleological incompatibilities with what naturally makes us happy or fulfilled? What if the real solution isn't to (just) treat individuals but to build the kind of world where depression is less prevalent. I'll repeat myself to avoid misunderstanding, every person should seek out and has the right to be provided with best possible treatment if that's what they need, my point is that it's a start but not enough to address the root cause. There are statistical relationships between rates of depression and modern "developed world" lifestyles.

Zach was one of the developers I idolized when I moved to San Francisco in 2011. From what I saw, he had everything going for him. Sub 10th employee at one of the hottest startups, amazing blog posts, amazing talks, great developer, ability to travel the world. He was the man. After the whole GitHub shakeup, I started hearing less and less from him and since I didn't know him personally, I never reached out. After reading this, I'm happy to see that he's in a really good place.

I hope your best days are a head of you and I wish you the best Zach!

I've been on a ketogenic diet for the past two months, and I've noticed less "down days", negative thoughts, and a more positive outlook on life in general.

In my teenage years what really helped with my depression was going out and getting involved in the local music scene. Becoming a "personality" of sorts did wonders. Especially the punk scene- those are some upbeat people they will literally kick the depression out of you simply because its not widely tolerated at their shows. Live a little, create your own strange fiction, give yourself something to remember.

In general, if one has a serious decision to make, it's probably wise to seek out expert counsel (not that you should blindly follow that counsel either). Same goes with your health.

[Avoiding getting into some kind of discussion about anecdotes, scientific evidence, etiology, qualifications, etc. I am glad for remissions and worried about those still suffering.]

while on the subject, highly recommend this video on depression from Stanford's Sapolsky to understanding the underlying biological aspect of it: https://www.youtube.com/watch?v=NOAgplgTxfc&t=1216s

Anti-depressants have done wonders for me (sertraline) and also for people I know with depression. On the flip side, I've read stories that they make people more suicidal. You won't know till you try different treatments. Some things work better than others for different people.

Depression is a killer, and that's even without stress. My husband works in politics and he goes through this depression and happiness cycle. The less stress he has (read: The more stress I can take off his plate) the better he performs and is able to manage his depression.

Here is a great lecture by Stanford's Sapolsky On Depression, that explains clinical depression fairly well.

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

If you are not religious I find it hard to find a reason to try to continue or to get out of the hole. The biggest problem is the lack of goals, or feeling like you have done everything already. Then you ask: Why bother?

I was pretty depressed for a while. Swimming & surfing fixed that. Started surfing age 34, so it's never too late. There really is something about it that hits all the right neurotransmitters.

MDMA assisted therapy helped heal this in me entirely. I found depression was resistance to feeling and accepting my emotions fully and that I could instead make space to engage with and be with emotions.

Is there a legal, accepted MDMA assisted treatment path or something you fashioned yourself? Any references you could share?

Maps.org is the best place to get the latest resources and to learn of current clinical trials (mostly for PTSD).

I did my work on my own with a trusted guide. Though I have been asked to write up my experience to serve as a starting point for more research.

Basic format was 100mg + 50mg booster at 2 hour mark. Eye mask, couch, blanket, music.

My interface with western psychiatry was a diagnosis of schizophrenia (at 18) and later bipolar (at 33). And I've experienced everything from anxiety, paranoia, depersonalization, depression, suicidailty, panic attacks, etc.

I'm med free, feeling very healthy inside, in love with a wonderful woman. My relationships are nourishing and my internal compass is much more trustable. I'm 36 now, so it took a couple years once I decided to "fix" the problem. I also feel like I let go of a lot of the defenses I was hiding behind and quite enjoy life from a vulnerable and honest place.

My biggest challenge now is just cleaning up the debts and general mess left by my healing process expenses and getting a bit more consistent income. But both of those seem possible and manageable. And I also have been able to help / coach a lot of other people along the way.

How did you deal with the come downs?

Good question. I typically would use 5HTP and some other supplements for 3 days before and after the sessions.

But I also learned that the "come down" was also a useful state of consciousness for me.

It was like the water level was lower and I could see / feel the topography of my subcocious more clearly. So sensitive points in the following days became useful if I was able to go more deeply into the difficult experience, just like what the medicine allowed me to do.

I often would feel like the medicine would give me a preview of the work I'd need to do in the coming weeks internally, and then when I encountered similar emotions in the weeks after, it was like the training wheels were off.

So in short, the "come down"c which honestly was never anything major, was something I was able to use for further healing and exploration.

"I want transparent discussion of mental problems in society."

Me too. I am still in the same league Zach was.

Meta (sorry mods, feel free to delete):

Is anyone else getting insta-downvoted on every comment?

It's a pattern I've seen on occasion.

I don't know why all of your comments are getting heavily downvoted. You're making reasonable points, politely. I've upvoted them.

Some people don't share your views. So what? Why do you care?

I've got the karma to burn that I don't really care about the points. But aside from the "downvote is not a disagree button," twice in a row I clicked submit on a comment and by the time the page loaded I was at 0. I mean it was so quick that I wondered if 0 was the new default!

I noticed a few other people with perfectly reasonable comments that were grey, too. It seemed unusual. I've been around long enough to have a sense of what's usual.

There are a lot of comments here about their depression, so I thought I'd throw my experience in here since it's slightly different.

Last year, after having these episodes that I didn't recognize for a while that were seizures, I went to the doctor, had an MRI, and was started on the anti-seizure drug Keppra. The seizures went away, and I thought it was half funny this whole experience. Time ticked on for a month or so and things started going downhill. I have a programming and a golf blog, and I didn't have the energy to keep writing. I loved going to the gym and I just stopped being able to go. I love watching the Brewers every night on tv, but I half stopped being able to do that. It got to the point where for a few days in a row, I'd get back at around 5 and just sit in my living room chair in the dark until 9 and then I'd feel legit going to sleep.

I knew I was having issues, issues that I thought were "natural", so I'd force myself to get out of the house. The biggest point was when I told myself to go out and buy some tea or something. So I took the train down there, made myself be friendly to the person working, and then decided to walk back. About halfway to the house I lived in I couldn't move, didn't have any of the energy, so I sat on a stoop for over an hour just unable to get up.

There are so many side effects of anti-seizure pills which list everything you can think of mentally. And at some point I figured the pills could be the cause. I contacted the doctor who said stop taking the pills and made an appointment for a few days after to get a new drug.

The morning after I didn't take the nighttime dose, I woke up and I could feel the depression going away. It's impossible to describe the feeling of knowing the issues were evaporating. I was out in the sun and felt happier. I could move. I could stand. The desire to do things was coming back. Three days later the depression was completely gone.

It's tough for me to know if my feelings exactly match other people's depressions. I've never been the person to give advice to people with depression; It's obviously impossible to relate if you haven't experienced it yourself. There still isn't any advice I'd be able to give because it's just sitting there, being in control of you, and even when your head knows that you need to be active, knows that sitting there isn't the right thing to do, depression will still win that battle. I was so lucky that my issues were caused by a drug that I could stop taking, and that the issues vanished so quickly. I think back and can't imagine how difficult a life is when your actions aren't causing the depression, but be stuck with the depression thing caused by nature.

Wow this shit is a bigger downer than I thought...

Thoughtful and brilliant... on many levels.

Good read and gutsy publish.

What worked for me was a combination of things:

Physical exercise. 2 years ago I got scared because my bad back condition got worse. When I went to a therapy, I noticed exercises (with swiss ball) seemed to help me the most. I'm supposed to do them daily (they take 40 minutes each time), but by trial and error I figured out 4 is the sweet spot. Anything more and I get overtraining.

To answer the article: how do you even start ? You simply start small. Performing the required number of repetitions is not important at all, and sometimes even counterproductive because you're tempted to use bad form to achieve your goal. Keeping your schedule is SUPER important. Exercise yields best results when it's regular, and this in turn tadaa!! builds character. No, really. I would argue working out even a little is more about willpower than anything else. Then I started adding other exercises to feed my vanity and make up for my insecurities. I always looked like a nerd. I added push-ups. Then squats (both 3 times per week). Quick tip: wall facing squats make it impossible to cheat. If you can't do them, do some stretching exercises and look up some progression exercices. I don't recommend running to beginners because everyone can do running half-assedly, but you need good technique to avoid permanent injury. I got permanent injury and squats compensate for this. I have an exoskeleton of muscles around my spine and knee now. I recommend cycling to beginners. Much harder to get an injury unless you like pedalling downhill (all the cases where I had an accident where while pedalling downhill).

But this post already looks depth-first while my escape from the black hole was breadth-first.

Music. I always liked music very much. Finding new music you like provides a short mood boost. I found funk. The trouble with music is searching for something you like requires time, and I need novelty constanty. But every little bit helps.

Friends. If you don't have friends, and it's safe to say I didn't 2 years ago, go somewhere where people with similar interests gather. I found a place where people play board games. A small monthly fee and you can play one of nearly hundred board games with other male nerds. Board games are similar to computer games, but thrive on innovation in game mechanic department. Very good if you like strategy games. Board games are the most refined kind of multiplayer game, they are designed to be finished in one seating and the better ones are built about interesting decisions. Unlike with modern multiplayer where you are shoveled around with complete strangers by a matchmaking system, you get to play with the same group. It's like dedicated servers are back ! Even better, only one person needs to own a board game. It's like StarCraft 1 multiplayer "Spawn" feature is back!! Also, you get to see and meet people, and disconnects are very rare because it's more awkward to disconnect from people you're seeing face to face. No one would like to play with that jerk again. Automatic self-moderation system ! No need to appoint moderators, referees or implement a voting system that 2 pals can abuse to kick you because you killed them, or that never gets through because it needs 50%+ people and they're happy you're stuck with a bad teammate because it will make them win. I still don't have many friends, and I only really meet them every Wednesday - but every little bit helps.

Get out of your flat. Simply go for a walk and see a changing view instead of the same 4 walls. No need to talk to anyone. This always helped me for a short while. Every little bit helps.

Hypericum pills. Herbal meds that according to some clinical tests are as effective as synthetic meds, with much fewer side effects. Notably, they don't cloud your thoughts, which is important for a programmer. The one notable downside is phototoxicity. You want to stay away from sunlight, or you'll get permanent dark spots on skin. I accomplish this by covering my skin. I understand this is not an option in Australia, but every little bit helps. Note: for hypericum you want either pills, or oil/alcohol based extracts, because the key component doesn't dissolve in water. Don't waste money on "tea".

Reading books, watching a movie. There are times when my anxiety overpowers me and I can't even focus on that, but a good movie puts me in a good mood and I don't necessarily mean a movie with a good ending.

Meditation. Supposedly improves concentration, memory and stress resistance by 30-40%ish. Just what I need. I only recently started so it's hard to estimate if it's helping me, but it's free and harmless and easy. 2 times a day, 15 minutes. You simply go into standby mode, close your eyes, try to throw out all thoughts from your mind. In particular, don't think about the past and don't make plans. If you must focus on something, focus on the present, like your breath or sounds (but human speech is very distracting). Every little bit helps.

Merely reading about your condition can be helpful. I started to feel better and gradually solve my problems once I read a bit about my behavior and motivation. It's like some barriers fade away and you slowly start exploring areas of your life you've never tried, things you were too shy to try, etc. It takes time.

Tips on sleep: I have an alarm set to 23:00 every day. When it rings, I go to bed. Actually recently I started going to bed even earlier. Turn off TV if you have one, stay away from computer monitor, smartphones, tablets. There's something about the blue light they emit that makes people not realize how tired they are. When I go to bed, I read a book or a newspaper. This doesn't interfere with my natural exhaustion sensor and the extra mental fatigue helps me fall asleep faster. If I have insomnia and really can't fall asleep, I turn on the light and read. Then I try going to sleep 1 hour later or so. If you still can't sleep, just lie with eyes closed and try to relax. Lying with eyes closed will still make you much more fresh in the morning than going out of bed or watching something and pretending you had no rest.

Also, I don't remember the source, but a recent study I read about found that sugar intake makes you feel better in the short run but causes anxiety and depression the long run. Foul stuff!

To do all these things (acting is the hardest part of depression) I used observation and logic. Observation to identify activities that make me feel marginally better. Logic, to tell myself it will be worse if I never do them. See, it's like the female zombie in Return of the Living Dead says. You don't eat brains to feel good. You do that to make the pain go away. Do tell yourself it will make the pain go away, just a little. Keep repeating that.

Humanity has a long way to go before it can actually treat depression properly. Granted, some things have improved drastically, but there's a lot left to be desired.

Awareness around clinical depression is a lot better than it was just decades ago, and that's great for the millions who are clinically depressed. Yet I've been seeing us going down this destructive path of seeing all depression as a physiological condition, which is often not the case and delegitimizes actual issues that are causing a person to be depressed. I can tell because too often the answer is either "just eat/sleep/exercise better" or "see a therapist and get medicated". What wonderfully simple solutions to a complex problem.

In LA, my sort of city, the culture has an emphasis on being happy or "good" all the time. If someone asks you how you're doing and you reply "I'm doing okay", there's a good chance that person will cock an eyebrow and assume that something's wrong because you didn't say you were good or great. I suspect this is a phenomenon in a lot of places in America, but I think it's especially prevalent in SoCal where superficiality is through the roof. Sure, asking people about their day is mostly a form of social lubricant, but such language subtly tells the unconscious mind that something is socially wrong with broadcasting unhappiness of any kind.

In actually, I'd say the unconscious mind is correct in its interpretation; people generally don't want to help you, let alone hear what you have to say, if something is genuinely wrong with your life or even if it's merely hum-drum. This can even be true with your closest friends and family, and even if they are receptive, you may be motivated to be stoic in order to maintain your role in your circle. Nobody wants to be the one who has problems or is "crazy" because everyone knows deep down that opening up could mean you'll be treated as lesser than you were when you held it all in.

Social media is an amplification of this phenomenon. The vast majority of what you see on social media is people posting the very best of that they've got, creating a misleading image that they and everyone else are having splendid lives. Why aren't you one of those beautiful chiclet-teethed young people constantly traveling and partying? Something must be wrong if your life isn't like that. /sarcasm

Therapy is great, and medication can be great for those who really need it. It just sucks that we've not created a world for ourselves where we can talk to each other about our problems. It's not about providing solutions, but about being heard and understood by someone. Maybe sometimes people are depressed for real reasons, and telling them that their feelings are akin to a disease can serve to harm them rather than help. I believe I'm open to hearing out my friend's problems, but I know that they think they'll be a burden unto others and be outcast. This I assume from hearing my friends mention going to therapy, but they rarely if ever have anything particularly troubling or deep to say to me. It may not even be conscious, but instinctual, to want not to seem like a burden – for the consequences can be hard to bear.

It's about time we allow each other to be a burden every once and a while.

My view is that depression is a treatable medical illness.

I've never been depressed, but I've lost friends to depression.

Edit: to the down voters, I'm not implying it's any easier than, say, beating cancer.

Are there legitimate other views of depression?

Some psychologists reject any hint of medical modal, and say it's only social factors.

(that's not what I think. But these psychologists are reasonably common.)

Ok, citation needed on that one. Some crackpots think that way, sure, but "reasonably common"?

there's a whole organisation for them in the UK.

All the "mad in america" stuff: https://www.madinamerica.com/about-us/

> one that emphasizes psychosocial care, and de-emphasizes the use of psychiatric medications, particularly over the long-term.

https://twitter.com/ClinpsychLucy/status/918029768951500801

> It's not about 'illness.' It's about being human. http://peerlyhuman.blogspot.co.uk/2017/10/why-i-oppose-world... … #WorldMentalHealthDay #WMHD17

https://twitter.com/Shrink_at_Large/status/91765521415652966...

> on World Mental Health Day, Let's remember structural inequalities and oppressions are behind many/most mental health problems

https://twitter.com/AnneCooke14

https://twitter.com/DrDJWilde

https://twitter.com/peterkinderman

etc etc.

I mean, you said they reject ANY HINT of medical modal, and say it's ONLY social factors. I didn't see that there.

I don't know if you've been through the system or not, but in the US MUCH of the time you tell your GP you've got the blues, and they say oh hey well take this zoloft/xanax and see how you feel. On the first visit. It happened to me, it happened to my wife, it's happened to more friends than I can count, all of us on great, private insurance. Anyway, that's the kind of thing mad in america is talking about, not ANY HINT of biology.

I haven't been through the US system.

I currently work in the bureaucratic end of the English system. I meet very many people who have been through, or are going through, treatment for mental ill health. This includes all settings, from secure (forensic) units, through regular MH hospitals, or community treatment, to primary care. It includes common "mild to moderate" illnesses and severe and enduring mental illness, and also personality disorder.

I talk to a wide range of mental health professionals: health care assistants, registered nurses, AMHPs, doctors (consultants, T3 and other junior doctors), speech and language therapists, occupational therapists, art therapists, psychological staff. I talk to people from band 4 (NHS England agenda for change pay banding) through to band 8d, and also directors.

I'm a member of the South of England Collaborative for Mental Health Quality and Patient Safety Improvement. https://iqmentalhealth.co.uk/

I'm a member of the Q community. https://q.health.org.uk/

Being polite: I know more about this than you do.

The reason I linked to specific twitter accounts is so that you can ask them what their opinion is. You don't have to take my word for it - maybe I would distort their views.

> you tell your GP

I was very clearly only talking about psychologists. I wasn't talking about GPs. If you had asked me about GPs I would have spoken about the frustration I have that they rely too much on medication, and not enough on talking therapy. Even though in England talking therapy is free and easily available.

I believe depression often involves some developmental or shock traumas that prevent or inhibit the full feeling of emotions.

The idea that depression is "anger directed inward" was a useful tool for me.

The view that we can release these old traumas and form new pathways and responses helped me heal after a diagnosis of schizophrenia and bipolar (which included suicidal depression and panic attacks, anxiety).

Do you believe in Austrian economics or Young Earth Creationism too?

I mean, it's within your rights...

This is too dismissive, I think you are reading too much into words like "release".

Learning to love yourself and to let go of things gives you a new perspective. A new perspective leads to new thinking and new experiences, and we all know our brains are plastic and are constantly changing.

You are the fool, not he.

For me the experience often went like:

1) notice I'm depressed 2) create space to feel emotions more and use something like Breathwork to loosen up my ego enough to get out of my default mode of shutting down / numbing out.

3) having a deeply personal / visionary like experience of seeing old events in my life or relationships or choosing to forgive someone.

4) am actually emotional release, like crying and feeling like I was able to be back in my body vs being stuck in a painful loop in my head.

What I know is that I was diagnosed with bipolar / depression after being suicidal and was offered nothing but medication from Western Psychiatry.

My entire life up until that point had been based around avoiding emotions. From chasing fame, money, success,drugs, sex, criticizing, creating drama, etc.

At the time I was consulting for a Peter Thiel backed startup focusing on finding alternative cures for western diagnosis.

I took what the doctors there were showing me and began to look at alternative perspectives.

What I found was shocking. That antidepressants didn't really work and outcomes for most people were pretty terrible in general.

The view of depression that is it is unfelt anger allowed me to begin to make more space to feel anger vs. stuffing it down or projecting it onto others. There has been a little research into this that doesn't contradict it.

I followed the experience of anger back inside and it opened up an entirely new part of my mind. I was able to see past events in my life where I was hurt and scared and shut down. And how I learned to supress my emotions.

Through a combination of psychedelics, breathwork and NARM therapy, I learned how to stay with my emotions and how to make space to heal older traumas when I was feeling triggered or overwhelmed.

I was able to be with even more extreme states like paranoia or psychosis and every time I'd go to the heart of the emotional experience, in the moment I'd find some unprocessed event from my life that needed attention.

So, yeah. That way of thinking was very useful for me and was supported by a variety of resources that helped me along the way. Including some psychiatrists, doctors, and therapists.

I take no medication and now have access to a very deep, soft, warm and loving center in myself that I had never experienced before.

If something happens (like my grandmother dying last month), and I noticed I'm feeling depresssed, I use those same tools and get closer to the hurt or pain vs my old default of numbing, avoidance, depression or mania.

I'm an N of 1, of course but I've been able to help other people do the same and this approach feels healthier and more useful than purely symptom management.

We are all unique, and I certainly have access to some exotic states of consciousness, but as I said I feel connected, loving, content, solid and welcoming of all emotions including love and happiness.

Happy to discuss more privately if you prefer: a@175g.com

Cheers.

Depression is often caused by life sucking. When depression is amply explained by this model, you become depressed when both (a) the present is unenjoyable AND (b) you have no hope that the future will be better.

I know that this is sometimes the case because I've struggled with depression on-and-off and it tracks 1:1 with my physical health and ability to live a normal, enjoyable life.

It's a condition that can largely be controlled through medication, but based on my wife's experience it's a condition that has a horrible tendency to rear it's ugly head without notice and for seemingly no apparent reason so I'm not sure I'd generalize it as being "treatable" for everyone.

I feel like it's treatable the way cancer is treatable -- lots of times we can totally 'cure' it, and sometimes we can't. But that doesn't mean you don't try, and we're getting better every day.

Now that I write that out I guess it's like every other health disorder. We're pretty good at a subset of them, so-so at another set, and have no flipping clue what to do about the last set.

I'm learning more and more about this by talking to my wife's doctors, and you're right in the sense that there are some forms of depression that can be cured, but sadly not all.

I'm broadly generalizing here, but depression caused by a physical condition (e.g. an autoimmune deficiency) can typically be cured by attacking the underlying cause, but depression caused by a psychiatric condition is much harder to "cure" in the traditional sense and instead can be managed via modern pharmaceuticals. Now, those drugs come with some strings attached, but if they help a patient get out of the bed and function in the morning (as they do with my wife) then that's a net positive, but we're realistic about the fact this is likely a life-long battle that will require constant work to stay on top of.

It currently feels like we're stuck in the stone-age when it comes to treating depression and mental illness in general with drugs.

Things do seem to be improving however. For example, second generation antipsychotics like aripiprazole seem to be a significant leap.

From my experience, we're in the stone age when it comes to treating depression without drugs as well. I reached out to my PCP at my HMO, they made me talk to a specialist who cleared me for treatment and referred me back to my PCP. My PCP seemed skeptical that anything was wrong and went against the recommendation that I had been given by the specialist office by strongly recommending that I don't try anti-depressants. He referred me to get therapy but the internal office is understaffed with a 3 month waitlist, so I had to fill out forms to try to find a approved out of network provider. I do all that to find out that I absolutely hate therapy (socially anxious and bad at discussing emotions). I'd like to try a cognitive behavioral therapist instead but it's really not worth the institutional barriers.

Meanwhile my cancer screenings for a large lump that required 4 visits were done in 2 weeks and super straightforward.

> I absolutely hate therapy (socially anxious and bad at discussing emotions). I'd like to try a cognitive behavioral therapist instead

Respectfully, please don't give up. Continuing to go to your therapist would be exposure therapy for your social anxiety, which _is_ a form of CBT. Maybe just switching therapists will work for you.

Please specifically seek out a psychologist who can give you a better evaluation than a therapist could.

I'm waiting for the day that anti-psychotics and some SSRIs don't cause extreme fatigue. I have ended up using my drugs as spot therapy rather than continuous. It isn't necessarily safe but at least I can somewhat function during the day. Otherwise I become almost completely useless and is even with adding Adderall to keep me up. I fall asleep at my desk and only want to sleep when I get home. It gets to the point where the symptoms are better than the side effects, which is scary considering my symptoms are violent in nature.

The way we talk about dealing with problems can often be a cultural limitation. Americans are constantly talking about fighting and beating cancer rather than treating it, for example, as if it were some antagonistic entity that had taken a personal dislike to them.

As far as depression goes, the list of potential causal factors is long and our ability to measure brain states is extremely limited. For many people it's a condition to be managed rather than a disease that can be cured. Compare the case of a bereaved person; the intensity of their grief may fade and be replaced by acceptance, but there's no going back to the state of mind prior to the bereavement.

Let's say I post on a relevant article that I think P equals NP, and that I've seen some NP problems that don't yet have polynomial-time solutions. That's it; no justification for the statement, no further elaboration. Would you say my comment was interesting, or valuable, or really added anything to the discussion whatsoever? Or would you think that I was just posting a random, unsubstantiated opinion that actually distracted from productive conversation on the issue at hand?

Psychologists are much better trained than therapists. If at all possible, see a psychologist.

Therapists are minimally trained, and do not understand neurological conditions on nearly the same level. If your issues are beyond basic depression, a therapist will not be able to tell.

I'm probably biased (my wife is a therapist), but I disagree with you.

Therapists require a lot of training (depends on state/specialization). Thousands of hours of supervision and a Masters degree in the field. I would not say that is minimally trained. Less so than a psychologist however.

Therapists are trained in understanding systems and the why/how something is. You are very much right about psychologists understanding neurological conditions far better than a therapist. Therapists with a bachelor degree in psychology (like my wife) mostly agree that it is useless for a lot of therapy.

Depression is a tough one. I'd just see both a therapist and a psychologist. Probably go for a therapist first and try to get some understanding of what is going on. It may help a lot! Or maybe not at all, with the nature of depression. Then see a psychologist and get some medication.

(OP here). I don't necessarily want to disagree with you, but I think the answer with all of these things is "well, it depends". It really depends on the person, the situation, and everything.

I think some people are perfectly fine seeing a therapist. My therapist was a psychologist as well, so that opened up some avenues that we might not have been able to explore otherwise, but when it came to any brain chemistry thing he was very quick to say, hey, go see a specialist in this area.

I think that's kind of the commonality here; I know people who have seen different people (of varying professional degrees) and they hated their person. Sometimes it just depends on if you click or not.

(Unfortunately, "hey go see a therapist/psychologist/psychiatrist, but also it might take you a few months and people before you're comfortable!" is not a great rallying cry for people who are really depressed. But unfortunately that's how it goes sometimes.)

In either case, I do agree with you that it's important to know what type of person you're seeking out, and whether you think that'll jive with what will help.

In the same way pain can indicate something is wrong with our body, depression indicates something is wrong with our psyche. Lifestyle changes have helped me, but reasoning about the pain, trying to release it to God, and getting my life right have also helped. An older Catholic told me mental illness increased dramatically when people stopped going to confession regularly. Looking back, a lot of my depression came from guilt, and still does. Ignoring and rationalizing the guilt by believing free will did not exist did not help, it just made me unable to accept responsibility and fix the problems in my life.

Just some mellow "Brain Shock" side effects and he was on his way.

Terrifying.

It’s extremely minor, and is a very common side effect. I’ll take these for a week or two over how I was feeling 100% of the time, every time.

Yeah it's not as bad as it sounds. Hard to describe, but it's sorta like if somebody flashed a light in your face, you'd probably wince and kinda lose your train of thought. It's like that but without any obvious stimulus (and obviously without the retinal damage). And (at least for me) only happened when I was sort of sitting "idle" - not while I was standing or walking or actively programming, more just when I was half-heartedly reading some boring news article or whatever.

I assume the drug here is Venlafaxine/Effexor or another SNRI. I've had similar effects when withdrawing from SNRIs.

An important subject ruined by incredibly bad writing. Do not write in this style. It is not funny, nor smart, but it is very bad.

Please be advised that taking SSRIs can have negative side effects that you might not be aware of.

When people I'm close with start taking them, they are less interested in being intimate and stop "loving"/being affectionate.

In my experience, having a schedule, exercising and making sure you are around other people help a lot more while preserving your personality.

yeah well the same thing happens when someone is really depressed and not on ssris as well

There's a difference between a lack of affection/physicality because you're depressed and because you're using an SSRI.

I still wanted to be close to people while I was depressed - I just felt useless and unable to do much else. On the SSRI I lost the desire to be affectionate, both around others and when I was by myself. It took around 6-9 months after I came off the SSRI for me to feel like I returned back to a normal state.

In my experience, people who start taking SSRIs have improved dramatically. Stop using anecdotal evidence to discourage people from seeking valuable help.

He's not discouraging people from seeking help; he's encouraging people to be educated about the help they're seeking. For people who are in affectionate relationships, this is an important factor and is worth mentioning.

This, like a lot else in this thread, is good advice for people who are not depressed.

Have the blues? Cut the fast-digesting carbs and experience less blood sugar fluctuation.

Have bipolar depression that flips into florid mania after a day-long hike? Hoo boy.

SSRIs never did a thing for me, but THOSE kinds of side effects were a drop in the ocean compared to the REAL problems going on in my head. If they had made a difference I'd have happily traded the side effects. Hell, the side effects were even worth it just to try something, ANYTHING.

I remember when I was on SSRIs I felt pretty "numb" and sluggish, but that's a small trade off for remaining alive.

- "What is with it with people expecting that a quick run will sort out your life? Like cool, activity releases endorphins and shit, but are endorphins going to pay this credit card bill? They going to patch things over with my friend? They going to find me a job? They going to fix my life?"

- "How the hell am I supposed to get out of the house to go running a few miles when I practically can’t get out off my couch?"

No, running and exercise won't immediately solve your problems, but neither is sitting on on your couch.

What exercise will do is make you feel good and make you a productive human being so that your brain is functioning optimally and so that you can solve those problems.

Why is depression thought to be an illness with the individual? I guess otherwise would mean facing our slavers.

Nice thread and here my top 10 list of antidepressants (in that order):

1. Most of the times, there's a clear reason for a depression, something which is not that easy to change and worse not that easy to identify as the real cause (e.g. wrong boss, wrong cofounder, wrong investor, wrong friends, toxic workplace, big nose, etc.); before looking at the other antidepressants, try to get rid of the main issue; often it is even too late, even if you get rid of the main depression cause, the depression just stays (PTSD). Either because the cause was too strong or too long. Some think that there is no direct cause-effect-relationship but this could be also another sign of a severe depression and that they just resigned (‘I can’t do anything about my depression, it’s genetic, this is me...’). It ‘s easier to resign and to give up, especially if you are depressed

2. Have social encounters every day, best: have a SO or friends (ok) or some good coworkers (better than nothing); this can be quite hard, having social interactions is not that easy when lacking a SO or friends

3. No addictive/depressing online stuff (FB leading the way, then your smartphone)

4. Sleep

5. Cut gluten, should be on #1, gluten and too many wrong carbs boost anxiety

6. Keep carbs under control, no need for keto but low carb might not be the worst idea

7. Exercise

8. Working/be productive, consume less

9. Create urgency, set yourself goals with deadlines, get busy and you won't have time to get depressed; just imagine you catch a plane the last minute (do you think you are depressed when catching the plane? No of course not)

10. Meditation

Again: Advice 2-9 won’t help if 1 is not solved.

Edit: Why the downvotes?

Edit2: After I got downvoted, my final advice...

11: Stay away from depressed people on HN because "negativity is infectious" (Robert Greene)

> Most of the times, there's a clear reason for a depression

I'm gonna have to disagree pretty strongly with that assertion without any supporting evidence. In fact, I would argue that rarely is depression caused by a clear reason which has a direct path to resolution. This is the exact perspective that makes those going through depression feel like others are trivializing what they're going through.

That's probably why you're getting downvoted, since it's #1 on your list.

> In fact, I would argue that rarely is depression caused by a clear reason which has a direct path to resolution.

I'm gonna have to disagree pretty strongly with that assertion without any supporting evidence.

Sure, let me quote Harvard[1]:

"It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression."

Enjoy your continued confusion as to why your 'advice' is being downvoted.

[1] - https://www.health.harvard.edu/mind-and-mood/what-causes-dep...

‘It's believed’ != evidence

Someone's throwing stones in a glass house.

Still waiting on ~any~ article to back up your assertion from a respected institution.

I never claimed to have any evidence—you did but didn’t deliver.

If you read my initial post again you can read that this is my personal top 10 list. So I won’t provide any evidence. And my one reply was just imitating your discussion style.

See my posts above for references to books and articles by Fuhrman, Hyman, Weil, Korb, Hickey, Moore, Bluezones, Howey, and others that support your suggestions as things that can help people in various ways -- quite a few providing evidence linked to scientific studies and thus moving beyond personal anecdotes.

Your point #11 is insightful too, judging by the moderation of several comments in this thread. :-)

That said, often the ongoing "cause" of depression is an interwoven set of issues which may feed on each other in a downward spiral, and getting out of those overlapping feedback loops can be difficult -- even if in hindsight specific causes might be identifiable. So, I can see why someone might object to the phrasing that "there's a clear reason for a depression" even as I tend to agree with the premise overall that causes (e.g. lack of sunlight, lack of sleep, relationship issues, poor nutrition, etc.) can usually be identified and (hopefully) addressed. But when the causes interact, granted, it can be very difficult to try to untangle that knot -- like when money issues prevent eating healthier or when (as an extreme interwoven example) relationship issues undermine sleeping well, which leads to financial issues, which stresses relationships further, leading to binge eating of junk food and sugar spikes and inflammation and headaches, leading to avoiding exercise, causing lowered self-esteem from worse appearance contributing back to relationship issues, and so on for strange knotty loops... The good news is, like Alex Korb (in "The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time") and others point out elsewhere, a positive upward spiral is possible too, as one issue after another gets addressed which frees more energy for dealing with the next issue...

I agree that these are all good parts of a holistic treatment plan, but therapy and medicine also deserve to be on here. A more accurate title would be "ways to get out of a rut."

As a bipolar for whom antidepressants can be destabilizing, yeah to 3,7,8,9,10.

I've had a hypomanic break from learning some Buddhist meditation.

If we're supposed to be happy all the time, why are there so many sad songs?

Seriously though it irritates me how people have been brainwashed to think depression is somehow abnormal.

Here's something I've learned in life: Depression exists for a reason.

There have been times in my life that I've been very depressed. Sometimes it was due to some event that happened but more often it was pretty random.

During these periods, I've often been very creative or it has done something else that I didn't immediately recognize as a benefit at the time. Yes, it was painful. But life isn't supposed to be all roses.

What I do think is wrong is taking (and getting hooked on) anti-depressants. A lot of my friends take them -- usually in response to a depression and now they've been taking them ever since. Unless you suffer from a very severe form of depression, I think anti-depressants do more harm over the long term than good, and many doctors of course want to keep their patients on them so it gives them an excuse to have an office visit. There's a lot of abuse, because there's a lot of money to be made trying to make people happy.

In my experience, anti-depressants do not make you happy. They make you numb, and (at least for me) they destroy your sex life. What kind of life is that?

I've come to the realization of acceptance. There's only so much I can control in my life, and that includes all the complicated chemicals swirling around in my head that are controlling my emotions. You start to realize that control and free-will is mostly illusionary, how you feel and what that does to you is more like a partnership with you and your body. There are of course things you can do but if your brain wants to make you depressed, you're going to be depressed and go through that experience. I don't think it wouldn't be as prevelant if it didn't serve some higher purpose, and I try to keep that in mind whenever I find myself depressed.

It's pretty sad when my friend tells me his doctor diagnosed him with a lack of something in his brain where only way to go is anti depressants for the rest of his life. He didn't even suggest aerobic exercise or diet, nope straight to prescription drugs. I'm not a doctor but based on my experience with depression and health, lifeStyle is so much more important than drugs no matter which disease you have or don't have

What your friend deserves is evidence based treatment. For depression that's a talking therapy (CBT), maybe combined with meds.

The evidence for exercise as a treatment for depression is poor.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

> Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies.

> Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies.

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

> Attendance rates for exercise treatments ranged from 50% to 100%.

> The evidence about whether exercise for depression improves quality of life is inconclusive.

this line, and the last line, are important:

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

> The evidence about whether exercise for depression improves quality of life is inconclusive.

Did it work? Is that part of the story not interesting?

Please, don't equate being sad with being depressed, sadness is a normal part of the life, feeling miserable every waking moment is not.

How do you define what is "normal" in life? Is it not normal for people to have periods of their lives (weeks, months, years) where they feel constantly miserable/sad due to a variety of reasons?

It's a fair question. The mathematician Ted Kaczynski proposed depression to be largely a modern construct (emphasis mine):

> Imagine a society that subjects people to conditions that make them terribly unhappy, then gives them the drugs to take away their unhappiness. Science fiction? It is already happening to some extent in our own society. It is well known that the rate of clinical depression had been greatly increasing in recent decades. We believe that this is due to disruption of the power process, as explained in paragraphs 59-76. But even if we are wrong, the increasing rate of depression is certainly the result of SOME conditions that exist in today's society. Instead of removing the conditions that make people depressed, modern society gives them antidepressant drugs. In effect, antidepressants are a means of modifying an individual's internal state in such a way as to enable him to tolerate social conditions that he would otherwise find intolerable. (Yes, we know that depression is often of purely genetic origin. We are referring here to those cases in which environment plays the predominant role.)

Aldous Huxley made the same point in the 1960's:

>there is evidently a whole class of drugs effecting the CNS which can produce enormous changes in sedation in euphoria in energizing the whole mental process without doing any perceptible harm to the human body...a great deal of control could be used by not through terror, but by making life seem much more enjoyable than it normally does. Enjoyable to the point, where as I said before, Human beings come to love a state of things by which any reasonable and decent human standard they ought not to love and this I think is perfectly possible.

http://www.informationclearinghouse.info/article24712.htm

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