Ask HN: Should I take antidepressants? | Hacker News Reader

Ask HN: Should I take antidepressants?

5 pointslifevalue9 comments

Hello HN,

I'm 39 years old. During the past ~10 years I find very hard to find joy in the everyday life, when I'm not into a relationship with long-term potential. I'm pretty healthy, ok-looking (far from great), financially independent through my own work.

Even though logically I see a lot of reasons to be happy with my situation, emotionally I find it hard to. I've practiced CBT, I've been in psychological therapy for the past year, I like to exercise, I've even taken a 6 weeks solo trip to Asia. But, without a life partner, life hardly makes sense. And when I (seldom) find somebody I like and we start something together, I tend to cling to her as my source of happiness.

I know I should find more hobbies and get more friends (all my 3 good friends have families/children), but I find it hard to discover stuff that I like, or sustain small talk, or be energetic in interactions. I'm sometimes asking myself what's the purpose to continue living.

My therapist suggested antidepressants for the 2nd time now. I'm tempted to take the plunge. Would you recommend anything else I could try before that? I'm open to anything.

Do you personally know people that have been helped long-term by antidepressants?

Thanks so much...

> Do you personally know people that have been helped long-term by antidepressants?

Yes, several, including myself.

As for the actual question:

> My therapist [...]. Would you recommend anything else I could try before that?

Nothing against your therapist, but maybe get a second opinion from a medical professional specialized in this sort of thing, i.e., a psychiatrist. As opposed (or at least in addition) to, you know, random people on the Internet.

I have suffered from chronic depression since I was a teenager. I have been on anti-depressants for the past decade, although I am about ready to start weaning myself off of them (under a doctor's supervision of course).

It sounds like loneliness is one of your core problems. My guess is that you have difficulty forming and maintaining personal relationships. I would give group therapy a try. It can be awkward and unnerving but it teaches to you how to be part of a community and how to interact with others in a meaningful way.

With respect to the symptoms of depression that you are experiencing, your first move should be to see your primary care physician. There are a variety of physical ailments for which depression can be a symptom. For example, hypothyroid, diabetes, vitamin D deficiency, low testosterone, sleep disorders, etc. Get some lab work done.

If you do end up deciding to take anti-depressants, make sure to continue therapy. Medicine alone won't fix your life. The goal of anti-depressants should be to make you feel well enough that you can start to fix your life. Also, if you decide to take anti-depressants quit drinking, smoking pot, or any other recreational drugs you may dabble in. They do not mix well!

Stay active. Sitting around the house is like suicide in slow motion. Go out a do things. Even if it's just running errands or taking a walk in the park you will feel much better than if you are sitting at home wondering if life is pointless. Get in shape, too. Find some activities you enjoy. Ideally, they should involve some form of "play." Whether it's basketball, surfing, snowboarding, or whatever, you need to have a way to experience being in the moment.

I also suggest reading Joseph Campbell. Start with The Power of Myth. The original PBS documentary series of the same name is available on Netflix as well.

Do you exercise? I don't mean go on walks, which people consider exercise for some reason, but things like running long distances/sprinting or go to the gym and lift heavy things on a regular basis. I notice you mention climbing and a trip to Asia but specifics are not mentioned. If you do not, I would try this before trying a pharmaceutical intervention which should be left as a last ditch effort. Exercise helps massively with brain function and mood be releasing endogenous compounds that aren't released in large amounts from other activities.

I guess I should also ask, why do you feel the need to have a partner? Do you want to reproduce? I know as living organisms most of us do. Maybe you could dive in deep and examine that desire and what purpose it serves.

Also, poor people should get more money.

I'm not sure what your comment has to do with the subject at hand, it seems to be sarcastic but poorly placed.

Sympathies--much of that sounds familiar. Someone else mentioned SSC here. I tried some of the stuff he mentions, and one that probably helped some was tianeptine sulfate, which you can buy legally as a supplement, without a prescription. No withdrawal zaps, etc. Definitely do your homework if you're going to try this. And I'd stay away from tianeptine sodium, which sounds like it has far greater addictive potential.

As far as clinging to women, some combination of age and several really awful breakups/betrayals seemed to rid me of that.

Good luck.

"But, without a life partner, life hardly makes sense."

I'm sorry you feel this way. Looks like you already know the answer and a potential fix to the root cause. As with many drugs anti depressants are temporary relief and long term can have side effects. Better to address the root issue.

One question to ask is which antidepressant specifically? Not enough people ask this question on top of deciding to take antidepressants to begin with and the risk/reward profile isn't the same for all of them. I would personally steer away from the ones that have more severe side-effects or are more difficult to withdraw from until you've exhausted other options. I've personally used SSRIs (citalopram/celexa) to treat depression - I think it was slightly but not especially helpful for me. The side effects weren't too problematic, nor was coming off it. Some people actually do respond very well to antidepressants but any single antidepressant doesn't perform very well as a treatment on average.

Scott Alexander has a pretty good write up on things to try before and including antidepressants: https://slatestarcodex.com/2014/06/16/things-that-sometimes-.... And also some background on antidepressants here: https://slatestarcodex.com/2015/04/05/chemical-imbalance/.

One very promising development in recent years which is missing from the above is using psychedelics for treating depression. This carries its own risks, including legal, but the risk/reward ratio based on early trials actually looks much better than for mainstream antidepressants. I intend to start microdosing soon for my own case. I'd recommend looking up Robin Carhart-Harris and/or Roland Griffiths research here if you're interested, or Michael Pollan's new book on this which I hear is good but I haven't read myself.

I have my own potentially relevant write up of a few different factors, solutions attempted and solutions to try here: http://black-dog-running.herokuapp.com/depression-things although that's more of a stream of consciousness and not very well written (and some of it is just personal and likely not interesting to others).

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