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Comment by dogruck | Hacker News Reader

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.

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.

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.

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?

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.

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