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Comment by WalterSear | Hacker News Reader

Meditation excerbated the anhedonic symptoms of my treatment resistant depression quite severely.

Fortunately for me, it sent me back into treatment with a psychiatrist that put me on the only class of antidepressants that actually works. (Recent studies in which they throw out everyone who does not respond to treatment, handily gaming the statistics in the process, notwithstanding.) I'm unlikely to ever see remission, but I'm definitely doing better now.

Before anyone suggests it, I'm experienced enough to know I wasn't 'doing it wrong'. Being 'stuck' in the present is how depressive anhedonia feels.

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Having dealt with years of clinical depression and not getting much done beyond basic 'just in time' survival I want to say the following:

Meditation may unlock or bring you closer to the bad stuff you've been avoiding dealing with that has been making you depressed or feel bad. You need to put in a lot of work and plow through it with persistence, even if in that moment you don't feel like it. It may be difficult if you feel like you're covered in mud and darkness but there is light at the end of the tunnel even if you can't see it at the moment.

Yup, not that.

I didn't need psychotherapy, and there was nothing it brought me closer too. I need help with organic depression.

I don't want to preach and I don't know your situation but I offer my perspective regardless. I may be talking completely past you because I'm not familiar with the term organic depression, and that's ok, maybe someone else will find this helpful.

I grant there may be some mechanism that can be fixed alleviated by chemicals acting on the body but everything is connected, body-mind-soul. As far as I can tell, depression is in essence a negative feedback loop of bad thoughts that flood your brain and body incessantly creating negativity and sluggishness that further shape your thoughts and behaviour.

A depressed person may not even realize their mind may be constantly telling them they suck or they're not worthy or whatever, but that is, as all thoughts and emotions are, illusionary in the sense that you don't have to take that as your own. You don't have to associate your being or identify as that chatter or the phenomenon passing through that body. You're purer and more beautiful and more deserving of love than that.

Thoughts can have tremendous energy especially if you get provoked by or stuck to them. What prolonged persistent meditation practice (say at least 2x30 min per day) may help one achieve is a sort of mental clarity or non separateness from/non attachment to thoughts, seeing how the mind really works.

> As far as I can tell, depression is in essence a negative feedback loop of bad thoughts that flood your brain and body incessantly creating negativity and sluggishness that further shape your thoughts and behaviour.

Science have a thoroughly incomplete and yet much more detailed and nuanced understanding of depression. I suggest you look into it, if you are interested enough to have an opinion on the matter.

I meditated for over an hour a day for several years - I had long term injuries that needed me to sit motionless several times a day while I treated them, so I would get myself set up, and the meditate through the session. (It wasn't a painful or otherwise sensate process.) I'd had started meditation earlier than that, with some classes and literature in college.

I'm actually up in arms now against people who insist that mediation/yoga/SSRIs/most therapists can make a damn bit of difference in the case of actual depression. I wasted 20 years of my life listening to them, when the people those things are going to help aren't actually depressed to begin with.

> I'm actually up in arms now against people who insist that mediation/yoga/SSRIs/most therapists can make a damn bit of difference in the case of actual depression. I wasted 20 years of my life listening to them, when the people those things are going to help aren't actually depressed to begin with.

Woah, "actual depression"... hardcore!

The problem isn't other people. You are the problem. Your ego is so big that it bleeds through your posts, as if it's crying out for someone to stop it.

Talk of depression and other mental health issues always seem to bring out the crackpots on HN - "meditation and lifting weights will cure <disease>".

I'm glad you found a medication which works for you. And I hope people who are suffering ignore the crackpots and go see their doctor.

CBT has been shown to be as effective as Prozak. We can't outright discount the impact therapy may have. All depression is "organic" depression, such that it manifests itself physically. This doesn't persist as if in a bubble independent of all other life factors; things are interconnected, they can all fall into a downward spiral, and spring back up together.

Did you read what I posted? You're making my case for me. Did you even read the title of the article you are commenting on?

Neither CBT nor Prozac are effective treatments for actual depression. And CBT can be very counterproductive if the underlying depression hasn't been successfully treated. If this is the case, the depressed person is being set up for failure. Prozac, on the other hand, is snake oil.

People who respond to CBT alone aren't depressed. They are suffering situational stressors and a lack of cognitive behavioural skills. People helped by SSRIs are by and large simply regressing to the mean.

This isn't to say that CBT therapy doesn't have benefit to someone recovering from depression - but that it's not a cure, it's not a resolution, it's a hand helping you back up once you are well - but not until the depression is treated first.

> Before anyone suggests it, I'm experienced enough to know I wasn't 'doing it wrong'.

Hello, Walter's ego!

You were meditating incorrectly because everyone does in the west. It's not a mindfulness life hack, and there are millennia of spiritual and philosophical background that are ignored when people claim it's simple. And as I'm sure you know, the Buddha taught that ignorance causes suffering.

Which class of anti-depressants are you talking about? I assume it's not SSRIs?

MAOIs

May I ask which are you taking and for how long?

I had the best few weeks of my life when I started Parnate. Unfortunately the effect petered out, and upping the dosage wasn't an option.

The US is one of the few countries in the world where you can get adequate MAOI therapy, I think, which is unfortunate for the rest of the world. The only thing I can get where I am now is Selegiline, and even that made the doctor uncomfortable.

Ouch. The first few days on MAOIs was eye-opening: I realized what it was like for 'other people', and realized why I had felt so misunderstood for so long - I was being misunderstood :) Other people had had no reference to my distress, and I had had no reference of life without it.

I tried all the MAOIs, and ended up on EMSAM - it's Selegilene in a patch form. The other (oral) MAOIs caused such profound drop in blood pressure and pulse pressure that I would frequently get the mid-low 'roaring' tinnitus that is evidence of an event causing permanent hearing damage. I also collapsed several times. I'm getting the roaring now from time to time with the EMSAM, but I really don't have any option but to suffer the hearing loss at this point.

(Fyi: doctors - even ENT specialists aren't aware that low blood pressure - even extremly short term, acute episodes - causes hearing damage, despite a significant body of academic literature on the matter.)

I have been taking it in combination with a modest amount of Provigil and caffeine, under my psychiatrists guidance. Caffeine is a much more powerful stimulant when combined with an MAOI. IMHO, it's the combination of the three that is helping me. If I stop taking either of the stimulants, I start feeling worse after a few days. I'm not cured by any means - yet, however I'm better than I have in memory. My SO concurs, too.

(I've been on EMSAM since ~September. I spent the rest of last year going on and off all the others)

IMHO, you may want to try it in combination with other drugs. Stimulants worked for me, but I'm on the ADHD spectrum, which may have something to do with it.

I had the same experience when I started Parnate - I really thought I was cured. It was a night and day difference. I still remember just walking down the street and feeling like things are overall pretty ok and I'm gonna figure everything out over time. I remember thinking how impossible my previous state was and how it was no wonder I hadn't made any progress all that time.

I also seem to respond to stimulants only. I have tried to get provigil but that's also impossible without a sleep study and a diagnosis for narcolepsy. I have access to Ritalin but it's a bit too intense when I use it occasionally, and I'm scared of long term side effects for dopamine receptors.

I'm currently taking Wellbutrin, which works (I know because I tried to stop a few months ago and I went from depressed to suicidal), but it's clearly not enough. I could take Selegiline intermittently on top of that, but it's a dangerous game to combine these. I also take a ton of supplements which seem to do something, but the problem is a lack of consistency. I think the consistency is probably the big theme overall - I also have positive effects from caffeine if I go over my standard daily dose, but I don't see anything that requires dosage escalation as a long term solution.

Are you taking Selegiline at standard doses? I've thought about trying it again with a higher dosage into a range where it stops being selective.

12 mg patch - it's non-selective at this point. ( Fwiw, due to it being the patch, I haven't been watching my diet at all. In a post market study of ~40,000 people over and extended period, there were two hypertensive crises reported, which IMHO, are more likely to be misdiagnoses than anything else.)

Fwiw, you may want to try it with 1-3 cups of coffee next time - it may make the difference for you. Ritalin is, well, crunchy. I don't like it either. It's less unpleasant than adderral, I suppose.

The downside of the patch? The US is the only country where a drug invented in the 60s, and a delivery system invented in the 90s, that would have cost $250/month out-of-pocket in 2014, costs $250/month after insurance. The out-of-pocket would be $2300/month. Obscene.

Yeah,I just checked again and I can't even get the patch here. They only have the 5mg tablets.

Anyway, thanks for the info.

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