Tips for the depressed | Hacker News Reader

Tips for the depressed

nplusonemag.com

418 pointsbookofjoe214 comments

One of the biggest force multipliers in overcoming depression is accepting that you can modulate your condition by taking small, deliberate actions.

It's also one of the most difficult and delicate ideas to communicate to a depressed person. Depression notoriously clouds peoples' judgment and makes simple tasks seem impossible. Depression also encourages a lot of binary thinking, where people tend to give up because they can't achieve the optimal solution and can't imagine anything in between optimal and complete failure. And most importantly, depressed people almost never want to hear someone else telling them that they should do something to change their own condition. If you've ever been through a depressive episode, you'll understand how unpalatable this idea is if it's not delivered carefully. Be careful to not make depressed people feel even worse about their condition.

For example, I've known several depressed people who spiraled deeper into depression when they could no longer perform their regular 60 minute gym sessions multiple times per week. It took a while for them to accept that a 5-minute walk around the block is better than no exercise at all. From there, they could push to 10 minute walks on good days, then 20 minutes, then 30 minutes, and eventually work their way back up to gym visits. Taking those tiny steps is a great way to re-learn that you can accomplish things, and it's a great to way to see gradual progress in yourself.

I used to workout 2 hours everyday in gym.

When I stopped supplements, I couldn't get myself to lift for even 15 minutes. I lost all my stenght and got depressed.

Supplements, or "supplements"? I've heard that this is one of the dangers of the use of any kind of substantially-effective PED: not necessarily that their use will disrupt physiological systems so greatly (though many do when abused), but that the difference in performance or physique while on vs off is so great that it discourages either working out while not using them, or else never getting off them.

Really? Which supplements?

I used testosterone + Primobolone

For me, doing those small things did seem impossible and even when I managed to achieve it, I didn't feel the reward. There didn't seem any point in making the bed if I felt the same whether the bed was made or not. Eventually I reached a mental place where I could turn that around: If it doesn't make a difference in how I feel, why not make the bed? I had to more or less take it on faith that eventually the rewards would come, and they did. Anyone out there dealing with this: Keep fighting, but don't kick yourself if you have a set back. You wouldn't kick someone else when they're down, so don't do that to yourself.

Edit: Just want to plug Allie Brosh here. This comic is maybe the best description I've ever read on how depression is experienced: http://hyperboleandahalf.blogspot.com/2013/05/depression-par...

Coincidentally, I really see no point in making the bed. I wonder if I'm depressed.

Is there anything else where you do see a purpose that needs doing? Maybe folding laundry, cleaning the kitchen, etc. That usually makes you feel more comfortable at home.

Whatever it is, you can start small. Fold one pair of socks. Clean one dish. Vacuum one room.

I think a lot of people don't see any purpose in making a bed.

For that matter, is there a link between depression and feeling overwhelmed with tasks all the time? Does one cause the other, is it a two way feedback loop, or is there sometimes a separate common cause?

> "For that matter, is there a link between depression and feeling overwhelmed with tasks all the time?"

If you're talking about work tasks, that seems more likely to be from occupational burnout. Here's a comparison chart that might be helpful: https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s...

I'm talking about both work tasks, and personal. Surprisingly I can get through assigned work tasks typically without issue. It is the tasks that I set out for myself that I have a problem with. Which fits in with why I'm primarily in a systems administration / engineering role -- I can pull on my decades of experience to solve tasks readily, however whenever I have to do a programming / design related task (which I can be fairly good at), I can't pull that off consistently. I can only do that if it is an area I'm not familiar enough with, where I can trick myself into thinking that it isn't that big of a project. But if I end up going down the wrong path and have to start over, then I fall apart and can't even think about working on it anymore. Or if I get a basic system developed (MVP), I find it difficult to work on improvements because the list of things I can do is never ending.

For my non-work related projects (open source software, home system builds, woodworking, 3D modeling) I wish I could hire a project manager to oversee my work on them. (would that be a variation of hiring a life coach?)

I remember this thread, so maybe you can.

Boss as a Service – Hire a boss, get stuff done

https://news.ycombinator.com/item?id=18512197

I fold laundry after ironing so that I can store it unwrinkled in the closet. I clean the kitchen after I cook, as otherwise it would quickly become messy (a biohazard).

I don't see a point in making the bed though - I can lie typing this just as well in a bed that's unmade. I feel similarly about cleaning up the dust in the apartment - it just doesn't bother me. I don't know if it's depression or nirvana...

It can be laziness but I tend to see all these details as a sign of a tad too low mood.

It's a relativistic conclusion that, whenever I'm a bit happy, I tend to naturally care more about making beds, picking nicer clothes, etc

So I can accept that thinking not doing these can be a sign.

The main benefit I've found to making the bed is that it shrinks your subconscious to-do list and helps you concentrate. If you make your bed, clean up the plates on your desk, and pick up your clothes from the floor, then your brain has nowhere to hide -- the only thing left to focus on is the task at hand.

But making my bed & cleaning were never on my todo list to begin with, so it isn't shrinking my subconscious todo list

Are there any menial tasks that are on your list?

Food

Well I guess if you never clean or tidy and it doesn't bother you and you're able to remain productive, then what I'm saying doesn't apply.

Making the bed is a waste of time. Better to let the mattress and sheets breathe and air out. (at least that's how I justify my laziness). Don't sweat it friend.

I'd say that's also a valid way of making the bed. Flip the bedding open, shake up the pillows a little, let it breathe.

Then again, sleeping in fresh sheets after a shower is supremely satisfying and might also count.

Do both - fold down the quilt/sheet so it looks neat but still breathes. Then make it later on. Takes me five seconds to make the bed and then I appreciate that neatness every time I walk past during the day - easily worth it to me.

Not making your bad could be healthy as it helps killing dust mite: https://link.springer.com/article/10.1007/s10493-006-9003-8

Speaking of treating yourself as well as you might treat a friend... I found this paper on self-compassion to be very helpful when dealing with self-criticism, guilt and shame:

Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself

https://pdfs.semanticscholar.org/b357/87b9b21486d00458e85f8b....

As soon as I read "Self-Compassion" I knew it has to be Dr. Kristin Neff; I read her book (https://self-compassion.org/self-compassion-kristin-neff/) a couple years ago and it was quite an eye-opener for me.

Just a note: your link is not working; here's a link to the paper, directly form Dr. Neff's homepage: https://self-compassion.org/wp-content/uploads/publications/...

As s as formerly depressed person I can attest that this is the only thing that worked. DO stuff. Even if you feel you can’t, even if it feels hopeless. Do it anyway.

Somehow through the act of forcing yourself you find you’re actually enjoying yourself, are making progress and feeling better.

Saying this is also the quickest way to get shunned out of the room by anyone with depression.

Fun fact: research has shown that cognitive behavioral therapy is more effective at changing brain chemistry than drugs. Tricking yourself into doing things is a lighter form of CBT so I heartily recommend it to everyone.

Or as my psychiatrist once said: Drugs don’t mean you’re broken or that this is outside your control. They just give you the space to fix it. CBT is the actual long-term solution.

https://www.nature.com/articles/4001816

> As s as formerly depressed person I can attest that this is the only thing that worked. DO stuff. Even if you feel you can’t, even if it feels hopeless. Do it anyway.

> Somehow through the act of forcing yourself you find you’re actually enjoying yourself, are making progress and feeling better.

I tried this approach. The "you find you're actually enjoying yourself" part never came. It left me profoundly exhausted, disappointed, and hopeless to the point of being suicidal.

I'm glad that you found an approach that worked for you, but depressive disorders are highly complex and poorly understood phenomena that aren't suited to neat little explanations of "the actual" solution.

I had a similar experience to yours. Divorce. Heartache. Depression amplified by..a lot. Tried to get out. Joined a couple of groups on Meetup.

Didn't work. Moderately enjoyed it. Would get home, then... crash. Back into the spiral.

Fast forward a couple of years. In a better place, somewhat. Try again, what the hell I'm bored and can only play so much HZD and BotW. It was surprisingly better this time. Started making friends. Texting.

Feels good. Better, at least.

So maybe you aren't in a place where that works for you right now. Maybe it will one day. Don't close yourself off to it completely, though. It's helped others, so who knows.

Well if it's any help, here's my two cents: to rewire your gratification circuits you need a lot of time and effort to alter your brains to accept some new ideas or behaviors. Took me a long time to get used to going to gym. Now it's like second nature. I know if you are really depressed it might be impossible to do it and other means, eg psychologist and medication, might be more helpful.

But the rewiring of your brain is the most important thing I feel in combating depression and getting somehow your lizard brain engaged in the "normal" things. For some reason I have felt that losing the connection to your primal desires (or the real you) is often the trigger, that will cause your body to tell you "hey, you are doing something wrong - please fix it". I know self-blame is the last thing any depressed person needs, but I think positive action and experiences are definitely key-part in overriding the negative thinking patterns. Things such as social connections, the feeling of belonging to a group and physical exercise.

Yet for certain, if you feel you are pushing yourself too much to me it says that there are deeper problems unsolved under the surface, that should be reworked with maybe a psychotherapist before going on a trip around the world. Or maybe it's a chronic chemical imbalance that just can't be fixed (eg Abraham Lincoln). Who knows.

To me physical exercise was like a magic cure that did feel like a natural depression medicine when you get the feeling of progress. Then other positive things started to build on top of it.

In the abstract, it's entirely plausible to me that I somehow need to work to "rewire my gratification circuits". However, nothing has demonstrated even a hint of actually doing that. I've tried multiple approaches to talk therapy, medication, diet/exercise, and self-directed behavioral activation (aka "do stuff"). None of them have noticeably helped; a few have backfired badly.

> I think positive action and experiences are definitely key-part in overriding the negative thinking patterns. Things such as social connections, the feeling of belonging to a group and physical exercise.

Here's the thing: I'm not sure I've genuinely had a positive experience in a long time (maybe decades). I'm not sure I've ever experienced "the feeling of belonging to a group" in an emotional sense. I routinely do things and have interactions that I can intellectually analyze as having been positive accomplishments, but for me there's a disconnect such that this simply fails to add up to a positive experience. As far as I can tell, most approaches to therapy don't even acknowledge this as a possibility, let alone have a method to address it. Those that do acknowledge it tend to have a questionable-to-nonexistent body of scientific evidence and are often phrased with a weird mythical/quasi-religious/metaphorical quality such that I'm often confused as to what advocates or practitioners are even trying to say once they move on from discussion of symptoms.

I was just describing this to my therapist the other day. There are things that you recognize at the intellectual level that never make it down to the "lower levels", which ironically are the ones that matter.

She's an anxiety therapist, so I tell her my anxiety is holding me back from connecting with others, but part of me suspects that my inability to "feel" the connections is the real problem.

Depends. In the short term (12 months) CBT has been shown to be very effective. However, over two years it has been shown to be just as effective as doing nothing.

The problem of time turns up in multiple kinds of treatments, and I believe it has simply to do with how long the depressive episodes last. Usually by the time people seek treatment that will be at the peak of the episode. Regardless of the treatment, a couple bunch of month will pass and people find themselves getting better. I suspect most depression studies a deeply flawed because of this effect. At some point the treatment will stop working. But it's not that the treatment stopped working, it's that a new depressive episode has begun and the treatment never really did all that much in the first place.

I’ve found it effective to develop circuit breaker mechanisms. It took a while and it seems to help long term.

When I see myself slipping into a depressive episode, I circuit break it before it gets bad. Remind myself that overall life is pretty good, distract myself with work, take a break, or whatever else seems like it might help.

And most of all: dont follow the spiral. Jump out while I still can.

I've known several depressed people who spiraled deeper into depression when they could no longer perform their regular 60 minute gym sessions multiple times per week.

This part is hard. I've met people who have difficulties coming to terms with the fact that they're (even temporarily) unable to do something which used to be part of their routine.

> It took a while for them to accept that a 5-minute walk around the block is better than no exercise at all.

Because while it is good for your physical health, mentally it feels much worst then doing nothing. It reminds you of everything you cant do anymore. It makes you feel like shell of yourself. It also feels empty and you get none of the good felling you get from full workout.

I've struggled with this quite a bit in my own life. I find the "No Zero" mentality to work well for me. Treat every weekday as a "No Zero" day. What does that mean? It means if my goal is to go to the gym, even if I literally walk into the gym, do a pushup, and leave, that counts. It's more than Zero. Consistent non-zero days eventually help break me out of my depression. And when I miss a day... well forgive myself and keep going.

All easier said than done of course, and sometimes a no-zero goal is just to get out of bed... but it has helped me.

For anyone interested I got the idea from here: https://www.reddit.com/r/getdisciplined/comments/1q96b5/i_ju... The style and language of the post are not really my cup of tea, but the ideas behind it have really helped me.

The article on FiveThirtyEight "If You Stop Thinking Of Exercise As A Way To Lose Weight, You May Actually Enjoy It" [0] really helped me realize something similar.

I think virtually any doctor would agree that my half-ass, crappy exercise at the gym is still almost certainly better than me sitting at home and watching TV, even if it's not the most optimal way of doing it.

[0] https://fivethirtyeight.com/features/if-you-stop-thinking-of...

crazy how the first step is often the most important one

And every step is the first since the last one.

but there's a huge entry cost.

That sounds inspirational but it just comes across as daunting/insurmountable to those who haven't gotten used to the idea of taking that first step.

I meant it as factual rather than inspirational. It is daunting for sure, but every person in this journey will find out about it as soon as they take that first step. And most people around will not understand, and will not be able to help and support appropriately without that understanding.

I would have responded with exactly this -- the post that you linked. The four points that the author makes really make a difference if you can internalize them.

> Depression also encourages a lot of binary thinking, where people tend to give up because they can't achieve the optimal solution and can't imagine anything in between optimal and complete failure.

Definitely, it warps your perspective badly.. my conclusion is to never think over sadness. I'm sure we're mostly supposed to be hugging loved ones, walk or sleep.

> And most importantly, depressed people almost never want to hear someone else telling them that they should do something to change their own condition.

I'll add an exception. They/we do.. we just need someone we can relate to closely. To an absurd level even.. because whenever you can finally talk openly and feel someone gets you, the mental pain lessens rapidly.

Please be careful not to generalize when proposing solutions, because their is not the depression(1): Depressions can be caused by very different things, can cause somewhat different symptoms and certainly can be solved using very different approaches. I met a lot of of depressed people, most them got out of them with different approaches (meds, therapy, changes in their environment).

I myself tried the approach mentioned, during therapy, without any success: Achieving something just didn't produce any positive effect for me. Then I got treated (as last resort) with ECT, my condition improved temporarily, and suddenly, within the same therapy, I started to feel an effect and was able to stabilize.

In short: Propsing "Do <x>, it most likely will help you" is not a good idea, as it is quite depressing for the depressed (at least for me it was). Maybe it's better to say sth like "Try <x>, maybe it helps, if not, there is also <y> or <z>. There is a lot that can be tried, maybe something might help you. "

(1) A doctor explained it to me like that: "depression" is more like a term to group together conditions that partially share symptoms, and that is it basically used for handling the insurance stuff etc. For treatment (at least for severe depressions), the term is too rough to be useful. E.g. a lot of severely depressed people also show symptoms of psychosis as side effect.

EDIT: Formatting and reformulated a bit (I think I was too harsh)

What you’re saying also applies to a meaningful extent to procrastinators, myself included.

>>One of the biggest force multipliers in overcoming depression

One of the biggest force multipliers for me was accepting myself the way I am, and living with my depression. I was diagnosed with Major Depressive Disorder, PTSD, and Bipolar. I've been on several SSRIs for a year, but I've quit it all. I found out that drugs are good to calm me down, but they make me so normal to the point of boredom. I could no longer hyper-focus to build/design products.

When I researched it I found out that creativity is strongly linked to depression. It made sense...I couldn't imagine Picasso, Kakfka, Shakespeare, and all the creative great thinkers/artists living a life like not-depressed-people.

When my doctor, and the head of the Psychiatrist dept tried to influence my decision I said that I love myself when I hyper-focus.

I love it when I'm randomly strolling the streets thinking about all the silly things other people think I'm wasting my time thinking about.

I love it when I read the depressing thoughts/ideas of great philosophers like Russell, Wittgenstein, and Kant.

I love it when I look at depressing paintings by Munch, Picasso, and Van Gogh.

It remains one of life mysteries to me why we are trained to reject depression and loneliness..why we, hackers and artists, are trained to live by unwritten rules of how we should live our lives..

“Be alone, that is the secret of invention; be alone, that is when ideas are born.” ― Nikola Tesla.

You were prescribed SSRIs with a Bipolar diagnosis!?

No, that was for depression and ptsd. I stopped seeing my doctor when he told me he thinks I have bipolar.

Ah. As someone who went through the same thing (minus the ptsd), next time you get in a bad mental spot go see a psychiatrist and tell them about the bipolar diagnosis. There are some very mild mood stabilizers out there nowadays that don't zombify you. (SSRI's can trigger manic episodes and cycling in people with bipolar, fyi).

Also just making sure you don't trying and deliberately alter your moods with caffeine, weed, or amphetamines will keep you relatively stable (even without drugs). Although if you start having a full blown episode it's worth keeping what I said above in mind.

Sorry if the advice is unwelcome. This is just what I found helpful.

People with bipolar often use caffeine, weed, or even amphetamines to deliberately trigger hypomania. Feels good, but unfortunately it also increases the frequency of depressed episodes. It's like Karma.

I largely agree with all the advice here. I dropped out of college due to depression, then I torched my tech career with a manic episode that led me straight from a FAANG SWE job to an involuntary psych ward patient for a month, which was followed by a half year brutal depression.

I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

I’m really on the mindfulness bandwagon but don’t believe it’s “positive thinking.” The opposite, it’s less thinking, more acknowledgment of how you feel. If you feel depressed, maybe that’s ok, maybe that’s part of the human experience. If it endangers your life that’s perhaps not ideal, but if it endangers your goals, perhaps that is ok. I think modern society pathologizes feelings and acts like anything that detracts from your ability to be “successful “ must be cured. It’s ok to feel bad feelings it’s how we react to them that’s more often a source of frustration. Meditation gets mislabeled as some way to reduce stress and clear your mind when I believe it’s training for how to learn to react to difficult thoughts and feelings.

I have many more thoughts on this topic for when the time is right but as much as self-care advice gets responded with “thanks I’m cured” self-care is the foundation to recovery. I have many more strategies to do this even when thoughts/feelings are giving resistance.

Thank you for sharing your experience. I have had a similar experience where the endless stress and burnout culture in the tech field led to total mental collapse about 5 years ago and I can't say I have fully recovered. How have you dealt with employment post meltdown? I have found better jobs since then, however, they all seem to introduce some level of anxiety to my life and I am contemplating leaving tech after 20 years but find that I am not "qualified" to do much else. Just curious if this is a just me issue or if you or others have found a way out of this mess.

If you are really burnt out and want to leave tech, I urge you to do it sooner than later. If you lack qualifications in whatever you want to do, you can still get them. Don't wait, follow your dream. Even if you fail, you'll have less regrets trying than going back to doing work you can't stand anymore.

I've burnt out multiple times and gone back in to tech only to get burnt out again and again, and have dragged my feet in switching careers, and have missed valuable years and decades that I could have been moving towards work I would have found more fulfilling, and now I'm finally trying that career change, but I wish I hadn't wasted all that time working in tech jobs I've lost absolutely all interest in and started to hate decades and decades ago.

From my experience most industries use and abuse people even worse. Sure my tech job is stressful but I've seen most other peoples jobs treat them worse AND compensate them for that less.

I think that self-care has become shorthand for treating yourself, when sometimes it means being responsible as well.

>I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

Care to link any of them? I have a hard time believing they are placebo, as they fundamentally alter neurochemistry.

Parent probably doesn't mean that they don't do anything, only that they do not actually treat depression.

Wrong either way.

If one doesn't work, try another. Depression is a lot of different illnesses with one name. What helps one might make another worse. The only way to know which you have is which med helps. If any. Some of them (nobody knows how many) don't have a working treattment yet. Others absolutely do, and if it's the one you have, lucky you.

The book Lost Connections goes in-depth into this.

https://www.amazon.com/Lost-Connections-Uncovering-Depressio...

> I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

For you. There are many causes of depression, and many reactions to the depression and to the various treatments.

For me, the very day I started taking an SSRI I felt physically different. My brain felt slightly too large for my skull, and it felt "fizzy." That, and the loose stools, went away after a time. (We have serotonin receptors in our digestive system, to guard against swallowing poisonous seeds.)

And I immediately felt like cleaning the apartment.

While I still have depression, it's manageable, and the SSRI knocks it back enough that I can see and deal with bouts.

In other words, for me, I seem to have a chemical condition that SSRI is exactly designed to deal with.

For me.

>We have serotonin receptors in our digestive system, to guard against swallowing poisonous seeds.

Nobody knows the purpose of serotonin in the gut [0]. The fact that you've accepted this theory as fact suggests to me that you've also drank the kool-aid with respect to the role of Serotonin in depression, which is very controversial.

Also the fact that you experienced results with SSRIs in such a short timespan (placebo-controlled trials have found depressive symptoms don't get better for months) suggests to me you are experiencing a placebo effect and not some adjustment of a 'chemical condition'.

And this is fine, and I'm happy for you, but I don't think it's unreasonable to demand a better treatment than placebo. The placebo effect has also been shown to be very strong with cancer patient, but placebo wouldn't be an acceptable treatment for them.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272651/

> I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

Please don't spread anti-psychiatry misinformation online. I'm sorry that it didn't work for you, but please don't dissuade others from seeking proper treatment.

Playing devil's advocate: Even if SSRIs are just placebo (they're definitely not, and we have decades of science to explain why that's a false statement), what would be wrong with that? Placebo is remarkably effective, and even placebo is even getting stronger with time: https://www.psychologytoday.com/us/blog/straight-talk/201803...

This is where people are mistaken when they conclude SSRIs are placebo. SSRIs still diverge from placebo, but placebo is so incredibly powerful in short depression studies that it's hard for SSRIs' superiority to reach a numerically large statistical significance.

> I’m really on the mindfulness bandwagon

Mindfulness is a common therapy technique within professional treatment. I think you'd find that a lot of the mainstream self-care practices are mirrored in professionally-guided therapy. However, some people just can't/won't trust professional institutions, so at least we have mainstream pushes for mindfulness and self-care to slip these techniques in the back door.

Many people are upset I called antidepressant placebo. It’s obviously a huge discussion out of the scope of this thread. But keep in mind that companies make a ton of money selling SSRIs and _still_ have trouble differentiating results from placebo, despite arguable massive publication bias influenced by big pharm.

Furthermore the metrics for these things are the most subjective thing in the world, surveys of humans. Most statisticians consider that data very low value but it’s the foundation of modern psychiatry.

Placebo is great if it works, sure, but psych meds have a long list of side effects. It’s be better to get placebo healed by your local witch doctor than a medical doctor, if you’re just relying on placebo.

Again it’s a big discussion and of course I’m open minded to learning more but on the flip side a lot of people take modern psychiatry as infallible medicine despite a lot of flaws.

I agree. The book Lost Connections goes in depth into how all antidepressants are either same as placebo or better by a statistically negligible amount. (Oversimplified but the book does a good job).

https://www.amazon.com/Lost-Connections-Uncovering-Depressio...

It's also misinformation to assume SSRI's work the same way for everyone. For my mother, antidepressants made her suicidal.

so did my psoriasis pills .. great now i have fucked skin and wanna kill myself. at least without the pills i just had one of those. neither helps my depression tho.

> It's also misinformation to assume SSRI's work the same way for everyone.

the person you replied to didn't say that. the point is to defer to professionals and not your own hunches.

Professionals prescribe these long-term to people, even though something like 5/7 cases never get good results.

> I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

Then your research methodology leaves a lot to be desired.

Are you familiar with dialectical behavior therapy [1]? A lot of what you describe as important in your journey (dealing with feelings, mindfulness) are a focal point in DBT.

[1] https://en.wikipedia.org/wiki/Dialectical_behavior_therapy

> I’ve done a lot of research and I think psychiatry is pseudoscience and antidepressants are largely placebo.

Even if they didn't work for you, making claims like this on a public forum is very irresponsible for you, and can be very dangerous for those who really need the help.

Please refrain from making such statements unless you're a medical professional.

I think people should be allowed to share their opinions, even if they're controversial. Just because you disagree doesn't mean he's wrong (nor am I saying he's right).

I have no dog in this fight, but you don't have to Google much to find studies that cast doubt on the efficacy of anti-depressants.

https://www.medicalnewstoday.com/articles/325767

Ehhhhhhh...

And google swings... and it misses...

There are two somewhat competing studies involved in what you linked.

The original meta-analysis is stating that "[a]ll antidepressants were more efficacious than placebo in adults with major depressive disorder." And if you dig into that study, the level of effectiveness varies, but is consistently above a placebo.

The other, states that the original meta-analysis missed some points within their study; specifically that under the standardized criterion, there is an unknown level of bias in the results (73% showing unknown bias, and 26% showing high risk of bias - essentially confirming that most studies couldn't be done in a full blind or double-blind manner); and that while the sample size was high, the effect size was less known due to drop-out rates of the studies.

This isn't necessarily contrary to the initial meta-analysis, but brings to light that they may need to be taken with a level of caution; it doesn't make the claim that anti-depressants are no better than placebos, but that when doing the meta-analysis Cipriani et. al. needed to make more apparent exigencies with their results.

All this being said, the puff piece draws a more black and white tone with the meta-analysis and the meta-meta-analysis results; which tends to be the problem with these types of pieces. Sure, do your own research, but you'll need to dig into what's actually behind the journalistic fluff to get at the real meat and potatoes of the subject, if you don't you may come away with the idea that anti-depressants have 0 efficacy instead of "some efficacy, with the caveat that studies are somewhat mixed on individual results due to the nature of how the studies are conducted."

I agree with everything you said, and was merely pointing out the evidence is far from overwhelming (or even conclusive, in my opinion).

If we're going to talk about making dangerous statements, mentioning that antidepressants are effective while ignoring the fact they increase suicide for some people seems a lot more reckless to me. Of course, you don't know if they will do that until after you are already taking them.

https://www.bmj.com/content/358/bmj.j3697/rr-4

Since at this point it seems unlikely I really "have no dog in this fight," for what it's worth I think antidepressants likely help more people than they harm, but I do think their positive effects are exaggerated by health professionals.

I really like the article you linked; I also found it interesting at the end of it:

  "It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt and when psychotherapy does not increase the risk of murder."

And I think it really speaks to the need to have professionals that aren't just throwing folks on drugs and sending them off. A whole form approach to mental health is needed, where a combination of various forms of therapy may be the best way to help an individual; since pretty much every study can agree that the efficacy essentially comes down to the individual level.

For my ADHD, anxiety, and depression I don't take anything (currently), but I do regularly see a therapist with whom I work through issues I'm having and how to combat them, as well as how to reinforce my successes. This isn't to say that at specific times I haven't tried different pharmacology to combat one or all of these issues; but at this time, the most effective thing __for_me__ has been basic therapy.

This isn't to say that what has worked for me will work for others, but at its most basic, finding a professional that is willing to really dig into what's going on is extremely important, as they will be able to work with the individual to figure out not only what's going on, but even what the goals are and whether they are even achievable goals (elimination of symptoms, management, setting new normal habits, etc. etc. etc).

And that's why I get frustrated with fluff journalism around much deeper studies, they can convince people that an entire system and industry is a bunch of quacks that shouldn't be taken seriously; is the person that's doing self-study going to dig into what it means for a study to show bias or the effect size or the sample size; or whether it's a direct study or a meta-analysis; or what the type of statistical analysis was used (were they using teeming or densification methods for gaps in data, was it a regression analysis, if so was it linear, bilinear, quadratic, etc); I could keep going on... or are they going to just read a couple of journalism pieces and call it a day.

This isn't to say I don't love medium-science (not hard, not soft) journalism; I love Quanta and the pieces they put out about science and math concepts, but if I want to dig deeper I will look up the pub or pre-pub information from the details they're covering; I would hope that someone that's doing self-study would do the same with medium-science medical journalism, but I can't ever guarantee that.

Code blocks for quotes do not display well on mobile. I had to scroll horizontally a dozen times to read that quote.

Psychiatry is a lot of flailing around and trying different things, probably because we don't have a very good understanding of the exact nature of everyone's condition. Everything seems to help 10-20%. That group does not overlap, and effect sizes vary substantially between individuals.

I have had the experience of deep depression and starting a new medication that pulled me out of it, making me active and functional again. It may have been coincidence, but I doubt it. I then was able to get off that medication and enjoy my life again.

I think in many ways antidepressants can actually make things worse because of the emotional blunting side effect that can make it hard to connect with others.

Please don't generalize about things you know little about.

There are many depression treatments that have no "blunting side effect" at all.

My mother committed suicide because of anti-depressants so you can kindly go fuck off with your arrogance and ignorance to boot. The Brain is far more complex than pseudo-intellectuals like yourself like to think. Serotonin does a whole heck of a lot more than control mood so any imbalance caused by the medications can be equally as fatal.

Not buying.

More to the point, there are many, many different drugs with many unrelated modes of action and very different side effects, all labeled "anti-depressants". You can complain about side effects of one of them, or even a related family of them, but pretending all are alike identifies a crank.

This is dangerous. Sure criticize for-profit pharma but it will cause harm to tell others who are struggling to ignore the huge of amount of research on different pharmacological treatments that are over and over again proven to be more effective than placebo.

The meds I'm on have no profit built in. It's like $8 for 90 day supply. The research shows it's so effective that it even lifts mood/energy/sociability for non-diagnosed mood disorder patients (without giving away too much personal detail it was originally an effective treatment for something unrelated to mental health).

If anything these 'change your attitude' or 'tips' kind of articles get under my skin a bit. For many changing habits can be helpful, especially CBT with professional guidance, but for many actual major depressive disorder patients no amount of habit or behavior changes will have meaningful effect without actual medicine.

When I was in university I took psychology modules out of interest and crashed lectures out of curiosity. Im inclined to agree with you. Coming from a pure mathematics background, I felt that their methodology of studying sonething as complex as the human mind and the underlying assumptions rather unqualified, lacks attention to details and a sense of rigour. This opinion and (the OP's remarks) aren't going to be popular here, but this was my observation as I was sitting down in lecture theatres listening to psychologists and their models and how they arrived at them and how they applied them.

Fields like neuroscience and behavioural economics are far better in their approach to understanding how we think. I'm glad you found some measure of comfort in meditation and that you recovered. It takes immense strength to fight an enemy within.

Regarding just "bad feelings is ok" part. I have a similar belief currently with one difference - bad feeling resulting from something bad happened is normal in my opinion - just like physical pain it helps the body to identify problem and adjust. Chronic bad feelings are not normal - just like chronic pain or inflammation.

I have struggled with "depression" for decades. Now I'm healed. I went to countless psychiatrists, took drugs and everything. I didn't really help much. I told them I feel bad, they labeled me "depressive" without trying to find out what is really going on. In the the end I had to find it out by myself. The depression was just a symptom. The main cause of it was a social phobia. None of the therapists ever addressed this. Other factors: unforgiveness and my own frustration that I wasn't aware of in many situations. So I started peeling off all these layers. I just didn't really know myself, was so full of inhibitions.

Often depression isn't something you should be afraid of. Neither is it something that you just "have" like a sickness. There may be reasons for the depression and maybe you can dig them out.

I just skimmed the article but what I've read seems to be how to cope with depression, not how to address the underlying issues. Better try to find out where it comes from, if possible.

how did you improve your social phobia?

it's not so hard when you know how. so when a person looks at you and you feel insecure the normal reaction would be to look away. now just don't look away being conscious of this feeling that makes you want to look away. the key to overcome social phobia is body language. change your body language and the feeling will follow and slowly the phobia will get less and less. then after enough practice you become more and more open and inviting. people will start to like you because you seem to be an easy going guy always ready to talk, share and laugh. then being in company will not be a burden anymore but something to enjoy. it is so different now. I was so miserable because of this and couldn't enjoy fellowship for more than 20 years.

How did you discover these facts about yourself?

good question. of course I got older which helped in bringing the inhibitions down which made me more aware of myself and of my own feelings. then going after those feelings and trying to figure out what they mean I slowly discovered what was behind them.

for example, one day I was in a course and I felt miserable even before I was there. then suddenly it dawned on me that this is my aversion to the whole thing. it's not rational but irrational. once I knew what was going on the bad feeling went away quite quickly when as before I'd just suffer without end.

before I was helpless, now when a negative feeling comes I try to guess what it could mean and often I find the answer quite quickly. once the source is identified, the bad feeling dissolves and I'm back to normal.

and another important factor was that I started trying to live by the golden rule: "do unto others as you would have them do to you". the problem was that not to do this often caused a lot of the confusion in my life and my feelings. I don't think it would have been possible to figure it out while I was in this chaos caused by not following the golden rule.

oh yeah, and the last thing that helped a lot is that I stopped going to therapists and took on responsibility, not relying on what others say about how I feel.

Things that help me when I feel depressed:

- Listening to upbeat, energetic music and avoiding depressing music, which tends to make me feel worse

- Walking outside on a clear, sunny day

- Eating my favorite food

- Playing a good game to get my mind off whatever it is that I'm obsessing about

- If I am able to concentrate, reading something by a favorite author, listening to a good podcast, or watching a non-depressing movie (most of my favorite movies are, sadly, pretty depressing, so those tend not to help)

- Doing exercise

- Getting enough sleep, but not too much

- Improving my diet and supplementing to overcome nutritional deficits (this and regular exercise are long-term fixes, and have helped my mood and energy level tremendously)

- Talking to a good friend, or maybe calling a crisis hotline (though the results vary greatly depending on who you wind up talking to)

- Journaling (I've been using a voice recorder for years, and this makes journaling much easier, more natural and faster for me than writing... just talking things through, even effectively just to myself, often helps a lot)

- Talking to a good therapist. They can sometimes provide insights and offer good advice that I otherwise would not have thought of.

- Looking at the stars on a deeply dark night sky, and thinking about how small and insignificant my self, my problems, and everything else on this earth really are

- Reading stories of people who've survived ordeals and overcome tremendous adversity. This again helps me put my own relatively trivial problems in perspective.

- Then, as Nietzsche said, "The thought of suicide is a great consolation: by means of it one gets through many a dark night."

- Finally, I try to remind myself that I've been through this many times before and I always eventually feel better. Time heals all wounds.

When you are actually depressed and not just feel a bit down, those things seem unreachable.

my uninformed opinion on this is that there are countless way to suggest the same thing and maybe one will resonate with you. this would become a motivation to offer earnest advice and be prepared that likely you will not be that magic person.

in this sense advices like "just do X" are useless, while advices like the one above are not.

for sure serious depression is very unlikely to be treated that way, but for every case of clinical depression there are many less critical ones.

Doing all of them is.

Doing one of them isn't.

What did Nietzsche mean by that?

He never said. Nietzsche wrote very aphoristically, and it's often up to the reader to make sense of it.

For me, this saying resonates because I've found that when I think of suicide I feel better because it makes me think that after my death I won't have any more of the troubles that plague me in life. It'll be a relief. In a way, it's hope.

It also, I think, for a time gives me the feeling of control over my life.

The trick, though, is not to actually act on one's intention. I guess I'm pretty good at procrastinating, which has hurt me a lot in many other aspects of life, but it's good in this one sense.

But can a reader who's truly depressed think as rationally as Nietzsche and make sense of it?

Because of the views around suicide and how it can be seen as an "out" for issues that are actually only temporary, associating suicide with hope in any sense could be counterproductive. You have to make these people understand. Sometimes they never intend to understand, and only take the parts that validate their preexisting notions. Suicide and hope in the same statement.

One could also view seriously depressed people as extremely lucid. (If it's not brain damage induced of course)

Reflecting on the states of mind I have when I am or am not depressed, I would say I'm far more lucid and have a more accurate (if less broad) worldview when I'm depressed.

I never really understood the point of view that depressed people somehow are more realistic, seeing things as they “really are”, while non-depressed people are overly optimistic. Maybe it’s true in the limited setting of a study, but depressed people tend to behave in ways that are basically irrational and counterproductive: staying in bed, passively ruminating about the future, procrastinating and avoiding useful/enjoyable activities, etc. These are not the actions of a rational person, and many (perhaps not all) depressed people would feel somewhat better if they didn’t engage in these types of activities. It’s definitely hard to change this type of behavior, and change is not a magic cure, but it is a useful component.

The reason why I believe the “depressed people are just seeing the world as it really is” line of thinking is harmful is that it encourages people to believe that their depression is simply the result of their accurate world view, and that trying to change things in order to feel better would mean they have to fool themselves.

I would think it meant either that when you think about suicide - it is the lowest you can go and things would improve from there. The other way to interpret is that thinking about suicide makes you come face to face with the enormity of death and which consequently helps you get through.

I have interpreted it, and some similar comments, as a way to lessen the pain of expectations and feeling like you're falling short of your own life.

The emotional distance between "perfectly healthy and wonderful" is much much further than "I really could end it and it wouldn't be much difference".

At the worst points, looking at it from the bottom of the hole to just that little bit up, makes it bearable enough to eventually start something, and slowly work back up toward okay.

Probably a sentiment he borrowed from Schopenhauer.

“They tell us that suicide is the greatest piece of cowardice; that only a madman could be guilty of it; and other insipidities of the same kind; or else they make the nonsensical remark that suicide is wrong; when it is quite obvious that there is nothing in the world to which every man has a more unassailable title than to his own life and person.“

"Worst case scenario, you can step off the train!"

> Listening to upbeat, energetic music and avoiding depressing music, which tends to make me feel worse

Anecdotally, this would have completely the opposite effect on me. If I was frustrated or down in high school I would listen to Whitehouse or something and get over it by virtue of the fact that there exists someone orders of magnitude more manic than I was. It made my feelings seem trivial in comparison.

Even when I'm not feeling down, listening to stereotypically upbeat music is sure to make me feel down. I would wonder how people could produce such an upbeat thing and speculate how such upbeatness could be acquired. Then I would conclude they're just in a separate plane of existence from me, unreachable by any means, and by then I'm feeling more down than I was.

This is when I'm not depressed.

> Time heals all wounds.

I can never bring myself to believe this, depressed or not. Some people are born a certain way, and there's no real cure for whatever condition they have. If it is meant that we only live a single lifetime then I'd be inclined to believe it, but in that case I don't think such a statement will help people questioning the value of staying alive.

Coincidentally I was reading Johnny Got His Gun the other night, which is probably an antithesis to this statement. Imagine you're a veteran, no arms, no legs, no mouth or eyes or ears or anything really except one's own mind. All of it blown off by shrapnel. Nothing but your own thoughts to pore over the details for the rest of your existence. Can time literally heal such wounds?

Depressed people, or people who aren't even depressed currently but have been through it enough times, will take any adage thrown at them and like a martial artist find some way to redirect the intended meaning behind the words into one which fulfills their personal outlook on life. You can mean perfectly well by saying such while it will end up having the opposite effect. And you might not even know this is the case when the other person says "thanks" or something. They know if they give the generic universally acknowledged upbeat, energetic response people expect, the other party will be satisfied and go away. Anything to make them so they won't have to listen to words that will never mean the same things again.

It's difficult to get through to people who do not think rationally. For all you know they might not even be seeking advice but merely validation that nobody really, truly cares enough to get to the bottom of their psyche, their desires, them, and instead regurgitate Inspirational Quote of the Week as if it were something resolvable over the course of a day. When they receive that validation it only solidifies their position.

I'm not saying you shouldn't try. I will not give mental health advice for these reasons.

But that's how it can go.

"listening to stereotypically upbeat music is sure to make me feel down"

It doesn't have to be stereotypically upbeat music. It should be music you actually enjoy and make you feel more energetic and lifts your mood up. If listening to depressing music does that for you, great.

"I can never bring myself to believe this, depressed or not. Some people are born a certain way, and there's no real cure for whatever condition they have."

I can't speak for everyone. I can only speak for my own experience, and in my experience with time I've always eventually felt better. Maybe I wasn't "cured" of my depression, and I'd always feel depressed again eventually too, but at least for some time I'd find relief and my feelings of gloom and doom would be behind me. I could even smile and laugh for a time, and enjoy myself. For me depression comes in cycles and waves.. I've learned to ride them out.

"I was reading Johnny Got His Gun the other night, which is probably an antithesis to this statement. Imagine you're a veteran, no arms, no legs, no mouth or eyes or ears or anything really except one's own mind. All of it blown off by shrapnel. Nothing but your own thoughts to pore over the details for the rest of your existence. Can time literally heal such wounds?"

Oh, come on. That's a super extreme example. Do you have your limbs, sight, speech, and hearing? If so, you're much better off than Johnny. He'd have probably have given anything to have a fraction of what you have for a single day. You should try to appreciate that and be grateful for it.

There's a way of looking at life that helps you and a way that hurts you. Focusing on how miserable and unlucky you are will inevitably lead you in a downward spiral. Count on it. Instead, do everything in your power to focus on the positive aspects of your life and how you can improve your life. That way leads to healing. Your choice.

Also, I'd strongly recommend you watch some videos on Brooke Ellison and Kyle Maynard. Ellison was paralyzed from the neck down when she was hit by a car when she was 11 years old. Maynard was born a congenital amputee, missing half of each arm and leg. Ellison wound up going to Harvard and becoming a professor. Maynard became a champion wrestler and climbed Mount Kilamanjaro.

These are people who've overcome adversity the like of which most of us can not fathom. They're far from alone, either. I like to seek out stories like this, because they put my life and my problems in perspective, and really inspire me to appreciate what I have and make the most of my life.

Someone here recommended David Burns' "The Feeling Good Handbook" and it was a very, very good read. I'm not going to say it turned my life around, but it taught me how to spot and disarm all kinds of cognitive distortions, defeat laziness, better align my expectations of others, assess my self worth positively...

It's also well written, fast paced, and sometimes even funny. It includes lots of exercises that are practical and easy to do.

As far as I'm concerned, this (and its predecessor, "Feeling Good") is the best self help book ever written. It's helped me tremendously with moderate depression and anxiety. For anyone suffering, I'd highly recommend just giving the book and its exercises a try.

thework.com is along the same lines and also very good.

I found Feeling Good to be stimulating while reading it but impossible to put into practice. Filling out worksheets of your emotions everyday is exhausting. The anecdotes of nearly instantaneous recoveries were unrealistic, and I've since read that therapists generally notice changes in their patients over years. The SSC take on therapy books strongly applies: https://slatestarcodex.com/2019/11/20/book-review-all-therap...

> In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.

I also really enjoyed this book, and he comes off as a really decent human being. Not sure how much of it has stuck, but one thing that did is the idea that my enjoyment/satisfaction of doing something is often far greater in retrospect than in prospect.

There is some thought, though, that the "cognitive" part of CBT isn't actually what matters. The line of thought is that the initial studies did both the cognitive and the behavioral, but that it was the behavioral part that produced more or less the entire result. It'll probably never be seriously studied further, since CBT is so popular, but it does suggest one core piece of advice: Doing something, almost anything, will probably make you feel better.

https://en.wikipedia.org/wiki/Behavioral_activation

Beyond that, someone suggested that simply accepting that depression will always be with you can help. It seems to have for me.

Crazy thing about this book is I was so depressed I could only read the first chapter or so. And it still changed my life in the end and I live by that first chapter.

I like the tip about paying someone else to clean your house.

When you are truely inside of a depressive episode, all those tips probably won't help you. By definition, you cannot think straight.

Think of it more like a computer game: As long as everything is okay, you should make sure to save your progress. While you are feeling good, try to minimize the effect of an episode. This way the episode itself also becomes less bad.

This could be: Getting a cleaning lady (edit: or cleaning gentleman), setting up your bills to be paid automatically, saving money. Stuff you should do anyway, whether you have had depressive episodes or have not. Just setting up your life, so it can be slowed down a bit once in a while without catastrophic outcomes.

For me the logical consequence is to adopt minimalism, so there is less stuff potentially dragging you down with it, once things turn bad.

it could also be getting a cleaning person, regardless of thier gender. :P

yeah, written like someone on the outside looking in but never been in.

Getting a cleaning person to clean your house is often out of the question because you're ashamed of the state your house is in and dont want anyone else to see it until you've done something about it but you never do anything about it because you're in a depression.

Depressions most insidious part is the fact that it re-enforces itself. You get stuck in self defeating loops.

I think I can empathize. That's why I wanted to stress the fact, that you do those things when you have a time window of feeling good. Always be on the lookout of how to save a little bit of progress for after things will have inevitably turned bad again.

If you have a little bit of money, you cannot use that to feel happy, but at least you can use it to make yourself not feel bad about a particular problem. Alternatively, if you do not have money to solve it, consider just throwing away the whole thing and be done with the root cause of that problem.

There's some good stuff here, but it completely skips gratitude.

Focusing on what you're grateful for is one of the more powerful and best proven methods to combat depression. I've been through clinical depression and consider it the key to my recovery.

There's evidence to suggest that this isn't the case.

https://news.osu.edu/gratitude-interventions-dont-help-with-...

There's an overwhelming amount of evidence that gratitude is inversely correlated with depression, and a good amount that shows it to be useful as an intervention as well. Even the article that you provided as evidence to the contrary found positive effects, just not dramatically higher than placebo.

For example, here are the first couple pages of results I got for gratitude studies. Every single one found a positive affect.

https://journals.sagepub.com/doi/abs/10.1177/135910531557245...

https://www.tandfonline.com/doi/abs/10.1080/0144341090349393...

https://link.springer.com/article/10.1007/s10902-014-9542-3

https://www.cambridge.org/core/journals/spanish-journal-of-p...

https://www.sciencedirect.com/science/article/abs/pii/S00926...

https://synapse.koreamed.org/search.php?where=aview&id=10.12...

https://www.sciencedirect.com/science/article/abs/pii/S01918...

https://www.tandfonline.com/doi/abs/10.1080/15298868.2015.10...

https://psycnet.apa.org/record/2016-51687-001

https://onlinelibrary.wiley.com/doi/abs/10.1111/sjop.12252

what if you find it difficult to have gratitude? you want to be grateful for what you have, but you're not, and can't explain why.

if you don't care about anything, meaning you have no gratitude, how do you jumpstart this process?

Great question. I wouldn't worry about feeling grateful. Just reminding yourself of "what you have," as you phrased it, is enough.

When we're depressed we have a tendency to fall into the mindset that everything is bad. Reminding yourself that there is something good in your life helps break that cycle. If you can make it a habit your brain actually gets better at finding the positives and it starts to create a positive feedback loop.

P.S. If you want to learn how to make habits easier I highly recommend Atomic Habits https://www.goodreads.com/book/show/40121378-atomic-habits?f...

i actually just finished that. you're right it's A great read

There are two options I'm familiar with:

1. Without wondering if you sincerely mean it, make a point to say "thank you." Typically if you are depressed you will be alone, and so it is possible to recognize situations where you took an action now to make something easier for yourself later: for example, doing the dishes now instead of waiting for them to pile up. When that happens, verbally thank yourself on behalf of your future self. If you're capable of doing this, it jump-starts gratitude after a while.

2. Instead of feeling gratitude for things you perceive as positive, look for things that you perceive as neutral. The majority of your sensory experience is neutral. If your emotions are very negative, instead of looking for a dichotomy between negative and positive, look for a dichotomy between negative and neutral. You will perceive that neutral is not-negative. Because neutral is not-negative, increased perception of neutral sensations is a positive. If you perceive neutral sensations as positive for long enough, it jump-starts gratitude after a while.

The problem with that though is I perceive nuetral as negative. Neutral is registered same as negative because it's not positive. This is why gratitude is hard because people like me can't find the positives nearly enough to start recognizing and changing how I think.

In fact, I find it difficult to think that people are okay with neutral because how is that any better? You arguably still failed at whatever you were trying to do, just the results weren't as harsh. I dont know. I think I might just be really far gone at this point.

I'm talking about neutral perceptions, not thoughts. An example would be something like the visual perception of a sidewalk. Presumably you don't get an emotional reaction about the sidewalk one way or the other, it's just a sidewalk.

The majority of your sensory experience is neutral perceptions like that. Once you notice them, negativity seems small in terms of proportion of sensory experience. What actually happens is that negativity occupies the majority of attention, meaning that your mind is latching onto things you perceive as negative. Broadening the scope of awareness to include neutrality means that definitionally the mind is not as latched-onto the negative, therefore negative things seem smaller, therefore they are slightly more tractable to deal with.

Often I have had a similar struggle to the one you described because I have not found my own personal reason for being grateful. I know now that it's because I was often living inside the narrative of people who were close to me, that was not my own. Being captive in this 'not-self' narrative has been quite deceiving. Taking back my own narrative has been super powerful for me.

In other words, I no longer think I am weird for not feeling joyful or being grateful for things for which I have not yet been given the chance to ask myself if I actually am grateful for them, or if I actually personally value them at all. Being stuck in someone else's narrative, or a cultural narrative, is to me like being in a jail, because the narrative will not correspond to my feelings, because it's not mine.

I now use the Nonviolent Communication set of strategies to listen to my own feelings, and use them to learn which of my human needs are unmet.

I also had Compassion Focused Therapy, which brought me back from the dead.

The writing of Francis Weller has inspired me beyond belief. If you're interested, this is a taster: https://www.thesunmagazine.org/issues/478/the-geography-of-s...

Or if you prefer listening, I love this podcast with him: http://charleseisenstein.org/podcasts/new-and-ancient-story-...

I suffered from treatment-resistant depression for over ten years. In my case, time definitely did not heal, and psych meds that were tried did not help significantly. Felt like everyone had gotten used to my depression and did not take it seriously. Was convinced that I had "terminal" depression. Until at a low point, when visiting a new doctor (non-psych) for a routine check-up, the doctor who I'd never met before told me that I seemed so low that she wasn't comfortable sending me home alone and sent me to the emergency room. At that point I started intensive therapy, learned DBT (Dialectical Behavioral Therapy) skills, and was started on meds that actually did help. I'm now proud and happy to say that I've been largely free of depression for the 5 years since then. Sure there are low times, but coping skills and closely managing meds have helped greatly.

Mostly here to say: If you're depressed to the point where you're seriously thinking about killing yourself, you have a life-threatening illness. IMO, it should be treated as such.

Some of the contents of this article basically amount to DBT skills (i.e. "Get out of bed even if you don't want to") so I recommend looking into those if these types of suggestions sound helpful to you. But suggesting that somebody who is suffering should binge watch TV to wait it out seems unhelpful and counterproductive to me. Take it seriously, and seek help if you need. Things can get better.

I have observed when i am alone for 3 or more days without talking to anyone i get depressed. Even if i have conversation with anonymous people on the internet over text chat, depression gets reduced a lot. Are there any scientific research on human contact over text and depression ?

I'm curious as well

2 cents: Get off / moderate your social media, news media, TV show service intake - stop giving in to the comparison game that you can never win. When you play this game, you are living vicariously through the lives of others instead of realizing the incredible opportunity you have in each moment to maximize your own potential and be the best version of yourself.

For a long time a source of my discontent in life came from comparing my small steps towards big goals to the empires and platforms of the top performers in the same field. It made me feel irrelevant and like my efforts were pointless. I got out of that trap by taking extreme ownership of my actions and what I create, and I started viewing my progress solely relative to who I was yesterday, rather than to external benchmarks. I forget the exact quote, but it's similar to something like: "the best way to improve something is to start measuring it." and this really crystallized for me when I read a blog post by James Clear: "The Domino Effect." Momentum is important in our behavior - harnessing it to your own benefit becomes like a super power once you can appreciate how useful it is.

Not mentioned in the article or in the comments thus far, is that massage therapy has an alleviative effect on clinical depression in some people.[1][2]

It's not fully understood why massage (in particular, deep massage) might relieve depression, but it does reduce cortisol and increase general relaxation, countering the stress caused by depression.

Another study suggested that massage therapy can be approximately as effective as pharmaceuticals, but I'm unable to find the reference at the moment.

There's no particular harm to muscular therapy a.k.a. massage, and if you have a good and well trained practitioner, it is very pleasant and relaxing regardless of mental state.

1. Meta study: https://www.ncbi.nlm.nih.gov/pubmed/20361919

2. Women's health (Mass General Hospital): https://womensmentalhealth.org/posts/massage-therapy-for-dep...

I've had severe depression my whole adult life and this is what has worked for me:

1. Zero alcohol. 2. ICE cold showers. 3. Extreme cardio. 4. Meditation. 5. Breakfast with a friend. 6. Play with a big young dog. 7. Cognitive Behavioral Therapy. 7. Meds. 8. Get up at 5am. 9. Journal.

Feeling Good is one of the best books on depression from a scientific perspective.

I've dealt with depression and anxiety on and off, and one thing that's missing on the list that helped me a lot is purpose and service.

It may be your job, caring for another person, volunteering for something that has impact, taking responsibility in a community or anything else really as long as it's meaningful. It's a pain if you feel crappy to take on more responsibility but in my opinion, it helps because at least if you feel like crap you're still doing good for others and you can get through a lot of suffering with that in mind.

For me personally mindfulness and talk therapy and exploring your feelings and whatnot is fine but it's also very self-centred and you can do it all day and still be miserable so at some point, I just thought getting out of my head and getting on with life as best as possible is what matters.

AFTER FIFTY YEARS, billions of dollars of intensive marketing campaigns, and tens of billions of dollars of profits for pharmaceutical companies, it is still far from clear that antidepressant drugs are any more effective than placebo. The only group of people who have demonstrably benefited from the widespread use of antidepressants are pharmaceutical executives and investors.

I don't think this is accurate or helpful, and I hope people who benefit from medication don't stop taking them after reading things like this.

> I don't think this is accurate

Yes it is accurate. It is very accurate. The garbage studies routinely dumped on us by Big Pharma have been continually debunked, reversed, and retracted after the raw data comes out (often in lawsuits).

Nevermind the complete absence of long-term studies or any studies that reflect the actually usage of these drugs in the real world.

Here we go, actual data about SSRIs vs the placebo effect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

It would be super cool if we all took the time to cite data that back up our assertions instead of just insisting that our ideas are correct.

I'll quote the lede from the abstract so people know what they are clicking on:

Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

Nobody currently taking antidepressants should stop them without very careful planning and consideration of whether they should and how, but the same very strong consideration should be given before starting them for long term use, too (with a professional ideally, which I am not).

On the other hand, from the end of the article, "My colleagues and I have conducted a meta-analysis of various treatments for depression, including antidepressants, psychotherapy, the combination of psychotherapy and antidepressants, and “alternative” treatments, which included acupuncture and physical exercise (Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012). We found no significant differences between these treatments or within different types of psychotherapy."

So the first thing you should know about the treatment of depression: Nothing works very well.

I'm not agreeing or disagreeing with anyone here. I'm merely asserting that we should use facts to back up our arguments.

> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I dunno, studies seem to suggest otherwise. I think it's terribly irresponsible to be telling people not to take medications that can help them.

You don't know. My brother is a doctor who writes papers on meta-analysis. The Cipriani paper is trash. The actual effect size is LESS than in the paper posted in this thread (Kirch et al) which was featured on 60 minutes about the placebo effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597641/

it is accurate. i don't know if it's helpful to the antidepressant drug user, though. placebos work better than nothing, but not if you know they're placebos

Actually, the crazy thing about placebos is that they work (albeit not as well), even if you know they're placebos.

https://www.health.harvard.edu/blog/placebo-can-work-even-kn...

It's partially accurate, but it's mostly misinterpreted.

"No better than placebo" sounds like the drugs don't work at all, but that's not true. Placebo is unreasonably effective at treating depression, and strangely enough placebo is getting more effective over time: https://www.psychologytoday.com/us/blog/straight-talk/201803...

Take a look at the response chart for placebo vs. SSRI some time and it will become very clear. Placebo treatment is literally so effective that it's difficult for actual antidepressants to significantly separate from placebo. That doesn't mean they work, though.

So why don't we just give everyone placebo? Ignoring the moral issues, active treatments are still superior to placebo and the results tend to last much longer than placebo. And for the most severely depressed patients, active treatments perform much better than placebo.

The placebo effect cuts both ways. If someone goes into an SSRI trial convinced that SSRIs are a garbage conspiracy pushed by Big Pharma after reading anti-psychiatry posts on the internet, they are much less likely to see depression remission.

Why I don’t believe it’s accurate:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I have very rarely had any issues with depression, my whole life, and when I was depressed there was always a clear reason (e.g. a breakup). Until about a year ago, when I got my first fully remote job, and after 6-8 months I realized I was starting to be depressed a lot, listless, feelings of despair and anxiety, etc.

Just doing more of my work in a coffeeshop or elsewhere with people around, seems to make a big difference. Which implies that perhaps just visiting a depressed friend a lot, might make a difference? Just a thought.

Related, but not exactly on topic: what do people make of the word “depressed”? I am unsure whether people use the word to mean “a deep lack of any enjoyment that persists for a long period of time (weeks?)” or something stronger, which adds on “and whose source is not easily explained”.

In my head, depression means the latter, but I’m unsure what the popular conception is.

Clinical depression has defined symptoms: https://www.mayoclinic.org/diseases-conditions/depression/ex...

Here is a good book that largely discusses this: https://www.amazon.ca/Weariness-Self-Diagnosing-Depression-C...

I was depressed for sometime till I found I've low T, once I supplemented it depression disappeared. I wonder why doctors don't ask you to get your T level checked when they find you depressed instead of prescribing antidepressants.

Testosterone has a lot of side effects people don't like: "male pattern baldness", hair growth pretty much everywhere else, acne, breast growth, changes in libido (either direction). Testosterone has been implicated in reduced longevity in men, too. As you note, it can have significant impact on emotional wellbeing, and that can also go either way.

If anything those are good reasons to pursue increasing T levels without those side effects. This may be possible if the cause is environmental. The speed with which testosterone levels have been dropping in men seems to indicate it is not natural selection.

There are plenty of people who would trade feeling better for a longer shitty life.

How are you taking it?

IM injection

I can't answer for him, but typically it is 100mg/wk for testosterone replacement. This can be taken once a week. For body building administration is usually done twice weekly. There is a newer cream that is applied to the scrotum, otherwise it is usually injection.

If you are doing TRT testicular atrophy usually isn't a concern although it could be a cosmetic concern. Taking human chorionic gonadotropin will preserve testicular function but may not return the look of your saggy nads.

This came at a good time, thank you OP. I just lost my job -- excuse me, 'parted ways from my employer' or 'joined the gig economy', whatever euphemism is in fashion -- and without a clear place to go in the morning, it's been hard to do simple ADL (Activities of Daily Living) https://www.care.com/c/stories/15077/activities-of-daily-liv.... -- I think I will try the alarm clock thing, firts of all.

Do not use the snooze function.

First, once you're out of bed at an appropriate time, you want to stay out of bed. Second, the minimum interval of sleep you need to actually rest is 15 minutes. Snooze alarms, even on mobile devices, are currently 9 minutes. Third, tangentially related, do not use an obnoxious-sounding alarm, because you will make a negative association with your necessary tool. Use pleasant or inspiring music.

Source: I am a person with chronic depression who managed to solve this issue for myself.

For me, even not depressed, "[d]o not use the snooze function" means "turn the alarm off and sleep in another three hours."

Obviously if it works for you it works for you, but if you don't have the willpower to stay out of bed, as I generally don't, at least the snooze button gives you another chance to wake up at a reasonable time, which puts the day on the right track.

I'm not sure why you wouldn't adjust your standard waking time, if you feel the urge to snooze.

Sleeping for me means the same time to bed and to rise as I can make it to avoid disruption.

A close friend of mine suffered from clinical depression for approximately 8 years and after all conventional medical approaches it was 1 dose of approximately 125 micrograms of LSD that solved that depression within minutes for several months completely. Obviously, he had to continue to work on the underlying issues as well so as not to fall into a negative cycle again.

Just don't ever give LSD to somebody borderline schizo, if you don't want them to spiral down the drain. Little life lesson there.

I liked this bit personally:

> Depressed people want to open their hearts, to confess their fears and forbidden urges, to be comforted, reassured, persuaded that life is worth living despite this intolerable, indescribable pain. They want the other person to open his or her heart, not recite from a script. The communion of hearts is healing.

One thing on which I have never gotten clarification, only evasion, is ... what if you are faced with something permanent that is a bummer, major, and that affects your mood. A progressive disease, an unfixable disability, and so forth. Are you "depressed" then, or just legitimately sad?

How do you report things on HN? This may be the wildest inaccurate information I have ever seen pass here.

I have suffered depression, and nearly all of the points mentioned in the article except for some trivialities are completely of the mark.

> How do you report things on HN?

Users with enough karma can click "flag," or you can email hn@ycombinator.com

The #1 tip for the depressed learnt the hard way: talk to the doctor.

Please. Don't delay. Your brain is playing tricks to you. But it has bad sense of humor. One of the tricks may become the last trick in your life.

Please.

This will make a neat self-checkup downward spiral detection checklist. I have one, but it's three items, and I'm not happy with it, I'm still struggling to be aware of how I am on any given day or any given moment.

My current three points are "Feeling sexy?", "Endlessly arguing invisible opponent?", and "Light is fucking annoying?"

As Tianeptine wasn't mentioned: it did help me, took it for 7 months (Coaxil, 3x12mg/day), no side effects.

https://en.wikipedia.org/wiki/Tianeptine

There's a dead comment mentioning it's addictive potential. This is no joke, there's /r/QuittingTianeptine. There used to be a subreddit for sourcing tianeptine (closed down I think) and the desperation in some of the posts was scary.

Do you, or does anyone reading this, have experience with taking it, improving, and quitting it? How does the risk compare to its effects?

Yes, I took it for a while. It really helped me get out of bed, like a light stimulant. It wasn't habit forming for me, but I could definitely tell how others might get hooked. It was more effective than the 6 or so other conventional antidepressants I took.

I have a hard time understanding depression, I’m curious about the topic, but I’m afraid to ask the questions I want to ask because I don’t want to offend anybody. Is there a safe place somewhere. Does anyone know a depression ama out there?

Had minor depression that lasted 2 years, visited a few psychiatrists who wanted to prescribe meds, which I refused. Despite nothing bad happening in my life, I felt depressed, therefore logically I assumed it must be my health. I tested for everything in my blood tests, and I went to every specific parameter and researched very well about it. Turns out, labs have very bad standardized measures about testosterone, which puts 20year olds and 70 year olds in the same bracket. I had the testosterone of a 60 year old. I got on testosterone replacement therapy and literally it helped in a week!

Conclusion: Sometimes its not your environment, or bad stuff happening in your life. Sometimes its just bad doctors and terrible public healthcare that doesnt have a stake in your wellness. Check your testosterone people!

The article says acupuncture has no side effects. That is not true.

http://whatstheharm.net/acupuncture.html

This is the first article on depression that didn't make me angry. Thank you. For some reason telling people time heals offends them. I only do it because I know from experience.

This will be exceedingly unpopular here but a good tip for the depressed is to go to a rural or downtrodden part of Mexico, or a country in Africa, or India, etc.

Any recommendations for someone trying to help a depressed friend get their work and health on track? I make a lot of attempts to help but many seem futile.

has anyone found that doing math, geometric puzzles or problems helps a lot? i found this out by accident, and it works most of the time. as soon as i realize i'm spiraling down i start doing problems. usually i try to do one or two a day so that i don't have to ramp up during the next "episode".

Acupuncture? Closed the tab right away.

Biggest game changers for my depression:

* Magnesium glycinate 1200mg/day

* More sunlight

* Expressing Really difficult feelings

* cutting out all caffeine

I had some health issues starting from age 40: untreated sleep apnea that I didn't know about for at least 10 years -> led to (combined with?) low thyroid -> led to IBS and something like a food allergy to legumes and nightshades (leaky gut). Which resulted in the worst burnout I've ever had in my life and a falling out with my favorite job I've ever had.

I finally started climbing out of the hole I was in around October or November of last year, and got "back to normal" around February of this year after taking an online survey and realizing that I had most of the symptoms of ADHD. My steps:

* Started eating bacon again and more meat in general, because tryptophan is converted to serotonin in the gut. There are also vegetarian options for this which I've listed below (this was the single biggest factor that led to my recovery).

* Started taking iodine, I immediately had energy again and my eyebrows grew back (for thyroid).

* Started taking syllium husk powder (Metamucil) 1-3 times per day and drinking kefir to feed good bacteria (for gut health).

* Starting keeping todo lists so I could separate the planning and doing of tasks (for ADHD primarily, to overcome task anxiety and executive dysfunction).

* Started saying no and slowing down in general, to provide time for meditation, daydreaming and seeing myself from the outside/being grateful like the visualization exercises of astral projection (for ADHD, depression and anxiety).

I could write at length about this because the journey has been difficult, frustrating, but enjoyable and rewarding as well. I think that western culture discounts mental health to such a degree that we sacrifice our lives for inanimate things like money and responsibility. I also think that a substantial part of mental health issues are physiological and environmental. Carrying a chronically high load of cortisol our entire lives is just not natural.

Here are some products that should help with depression if you don't want to be on medication. I'm not a doctor obviously, nor affiliated with NOW (they just make affordable supplements):

https://www.amazon.com/NOW-L-Tryptophan-500-Veg-Capsules/dp/...

https://www.amazon.com/Now-Foods-L-tryptophan-Veg-Capsules-2...

https://www.amazon.com/NOW-L-Tryptophan-1000-60-Tablets/dp/B...

Iodine and supporting minerals, take 1-2 weeks to start, then as needed:

https://www.amazon.com/NOW-Supplements-Tyrosine-Selenium-Cap...

I've tried tons of other things like zinc for weightlifting and omega 3, B vitamins, iron, etc to boost mood and the immune system. Everyone should try seeing a few nutritionists and holistic medicine healers to find what works for them. Hope this helps someone.

I would love to finally see an article that has tips for a society on how to prevent depression, instead of the constant stream of self-help BS that is constantly directed at people who may have real reasons to be depressed.

That's a good point. Everything, even the coronavirus has this narrative attached that prevention should be the utmost priority. At the same time the same narrative is completely missing in case of depression.

I guess the difference is that depression has been learned to capitalize on for a long time now.

Let's pick something else that isn't as broad as "depression."

How about:

  - "I would love to finally see an article that has tips for a society on how to prevent ADHD..."
  - "I would love to finally see an article that has tips for a society on how to prevent Schizophrenia..."
  - "I would love to finally see an article that has tips for a society on how to prevent Bipolar Disorder..."
  - "I would love to finally see an article that has tips for a society on how to prevent Mania..."

Each and every one of these are somewhat related mental health disorders and can cross over with depression as well. They can exacerbate it or even change how you may respond to various types of therapy (talk, drug, STM, etc).

And "real reasons to be depressed", what would those be; or are you mixing up sad or anxious or morose or frustrated or ... with "clinically depressed." Clinical depression, much like the other mental health issues that I used above, doesn't have to have a reason as proscribed socially.

Unfortunately, most "self help BS" is written from two perspectives, those that have never had a bout of clinical depression; and those that have and found a specific way to get __themselves__ through it. If those that used specific things to get through it presented that information in that manner instead of "this is what everyone should do" it may be understood better overall, but that's a failing of being human; not of the writers.

My question is why are people so depressed nowadays?

>It has been said that we are as far advanced in the understanding of depression at this moment as was the European conquest of the Americas when Columbus first set foot in the Bahamas in 1492.

Comparing the fight against mental illness to the genocide of native Americans is unfortunate.

I hope they work for some, but for me, SSRI's are frankly, trash. All the downsides with none of the upsides.

The only thing that worked was Imipramine, and I can't get it anymore because it's "old" and "not recommended".

The newer focus on psychedelics and drugs usually used for recreational purposes seems more encouraging.

If you're anti-depressant resistant, I'd recommend you try Gabapentin, a seemingly overlooked drug that works wonders for anxiety and depression. Quick tolerance buildup, do not give in and try to go over ~2g/day.

The somewhat similar Phenibut also works, but it's a direct GABA agonist with terrible withdrawal symptoms and an extremely fast tolerance buildup.

If you can’t get “the only thing that worked,” then you need a new doctor. It’s irresponsible and borderline malpractice to take someone off a medication that works simply because it’s “old” or “not recommended,” unless the reason it’s no longer recommended is because of previously unknown side effects.

It sounds like you found what you need in gabapentin, so I’m glad for that, but I would have gotten a new doctor in your situation instead.

> I hope they work for some, but for me, SSRI's are frankly, trash. All the downsides with none of the upsides.

They absolutely work for many people. Unfortunately, many people deprive themselves of SSRI trials because they read too many negative anecdotes online. If you're seriously depressed for an extended period of time, it's worth a trial of an SSRI medication. If it doesn't work, just taper off and be done with it. At least you'll know.

> The only thing that worked was Imipramine, and I can't get it anymore because it's "old" and "not recommended".

That's bizarre. Imipramine is still widely prescribed with over a million prescriptions per year in the United States alone. If it works for you and your doctor is withholding it for some reason, please see a different doctor ASAP.

Given your strange and definitely not-normal experience with the medical system, can I suggest that you refrain from giving advice to others? I'm sorry you've had a negative experience with SSRIs and doctors, but it's extremely important that you not dissuade others from seeking proper medical treatment.

> If you're anti-depressant resistant, I'd recommend you try Gabapentin, a seemingly overlooked drug that works wonders for anxiety and depression. Quick tolerance buildup, do not give in and try to go over ~2g/day.

I recommend against Gabapentin as a first-line or even a second-line treatment. "Quick tolerance buildup" is not compatible with long term treatment stability. Gabapentin can be prescribed in limited circumstances for anxiety, but it's not a good first choice solution.

> The somewhat similar Phenibut also works, but it's a direct GABA agonist with terrible withdrawal symptoms and an extremely fast tolerance buildup.

Please don't recommend Phenibut. It's not an antidepressant. It's highly addictive and has severe rebound and withdrawal symptoms. Drugs that make you temporarily feel good should not be confused with antidepressant drugs.

SSRI's work barely better than placebo because the serotonin theory of depression is dead. They would never be invented today.

>Please don't recommend Phenibut. It's not an antidepressant. It's highly addictive and has severe rebound and withdrawal symptoms. Drugs that make you temporarily feel good should not be confused with antidepressant drugs.

This kinda sounds like drugs like clonazepam or lorazepam. They're also very addictive, and are not antidepressants at all, however they are anti-anxiety drugs and they work very quickly. And anxiety and depression seem to go hand-in-hand for many sufferers, so they do seem to really help some people, at least initially.

I think a big problem is the medical establishment really doesn't have a good handle on what depression really is (biologically) or how to treat it.

> This kinda sounds like drugs like clonazepam or lorazepam. They're also very addictive, and are not antidepressants at all, however they are anti-anxiety drugs and they work very quickly. And anxiety and depression seem to go hand-in-hand for many sufferers, so they do seem to really help some people, at least initially.

Phenibut works through similar pathways as those drugs. A lot of people overestimate their understanding of Phenibut by reducing it to a simple GABA-B agonist, but at the high doses that people take for euphoric effects it's actually doing a lot more.

> I think a big problem is the medical establishment really doesn't have a good handle on what depression really is (biologically) or how to treat it.

We can always improve, yes, but the standard treatment protocols (therapy, lifestyle changes, therapy + medication) are actually quite decent if you find a provider who cares enough to work with you. Many people find a lot of relief through standard practices. Unfortunately, many people don't have the resources or patience for therapy, and they won't tolerate any side effects from medication (which tend to diminish over time). A lot of those cases are the most vocally negative about depression treatment and "big pharma", skewing the overall perception. Many of the SSRI and therapy success stories don't go broadcasting their depression stories to the world. They just quietly go back to their lives.

Of course, it's worth trying anything.

I did say they didn't work for me. Sertraline and fluoxetine specifically.

Anyone suffering should go to a doctor and try some medication. It's better than giving up thinking nothing will work (which is a symptom of depression!).

> They absolutely work for many people. Unfortunately, many people deprive themselves of SSRI trials because they read too many negative anecdotes online. If you're seriously depressed for an extended period of time, it's worth a trial of an SSRI medication. If it doesn't work, just taper off and be done with it. At least you'll know.

SSRI's do not work. Linked elsewhere in this thread: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

> The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

Serotonin being the key driver of depression is as wrong as complex carbs being the healthiest macronutrient.

A newer meta analysis from 2018 says they do work: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889788/

> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo

Anecdotally, SSRIs do work for some people, and it can be life changing.

> The somewhat similar Phenibut also works, but it's a direct GABA agonist with terrible withdrawal symptoms and an extremely fast tolerance buildup

Some antidepressants can have terrible withdrawal symptoms too - I went through the worst couple of weeks of my life after tapering off dosulpine, and I know someone else who had it rough after tapering off a tricyclic.

> Some antidepressants can have terrible withdrawal symptoms too - I went through the worst couple of weeks of my life after tapering off dosulpine, and I know someone else who had it rough after tapering off a tricyclic.

Apples and oranges. Not all withdrawals are equally bad.

Savvy healthcare providers will switch you to Fluoxetine, which has an extremely long half-life, and then taper the Fluoxetine.

Phenibut's withdrawal symptoms are on another level entirely, especially when people take abuse-level dosages to feel temporary euphoria: https://www.reddit.com/r/quittingphenibut/

Dosulpine, and tricyclics, have SNRI effects, rather than SSRI effects, so I don't think fluoxetine would work here.

In my case, I had only been taking it for a few weeks, and tapered off slowly until I was only taking a quarter of a pill - I was not prepared for what ensued.

You are right though, not everyone experiences the same things with these kinds of medicines - presumably it all comes done to genetics.

But I think it's worth mentioning that SNRIs and SSRIs can have awful side effects, especially since this often seems to be downplayed or even downright ignored by doctors (mine didn't even mention it as a possibility, and had even told me it was OK to stop without tapering).

I've got you beat; neither SSRIs nor gabapentin nor any other of a variety of on- and off-label meds worked for me.

Despite that I don't think it's a good idea to recommend or disrecommend any specific drug; it is very much a biochemical roll of the dice as to whether a med will work on a given individual and the odds aren't even particularly good. My suggestion to the depressed is to try as many as you can withstand to increase your odds of finding something that works, with the understanding you might be among the unlucky ones that nothing works on.

>Despite that I don't think it's a good idea to recommend or disrecommend any specific drug; it is very much a biochemical roll of the dice as to whether a med will work on a given individual and the odds aren't even particularly good.

Since many drugs seem to affect different people differently, it seems we really need to work on understanding how drugs affect people differently based on their genetics. This is similar to, for instance, how some people think cilantro tastes like soap, because of a gene mutation. I think there isn't nearly enough attention being paid to this, and it's making the field of psychiatry look like various drugs are no better than placebo, when it's much more likely that some drugs work great for some people, but terribly or not at all for others, so right now it's a crap-shoot when instead we should be figuring out what will actually work for certain people based on their genetics instead of shooting in the dark.

Reply on news.ycombinator.com