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Comment by podgaj | Hacker News Reader

Do you realize these two sentences say the same exact thing? You have a pain, which is a signal of a disorder, and you need to change something to fix it.

"At first I viewed the depression I started fighting in my teens as a scourge, a defect, something broken to be fixed."

"I have since come to see it as an important signal. When I am managing my life and mental states well, it often fades into the background. When it starts to flare up, like with some kind of physical pain, that's telling me I need to pay attention and change things up a bit."

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No. One sees the depression as something to be fixed, the other sees the underlying problem causing the depression as something to be fixed.

Yeah, I agree. But the signal is still the disorder that needs to be fixed.

Any psychiatrist will tell you that psychiatric medications only treat the symptoms of mood disorders and that they do not know the cause of most of them. It is hogwash that they think mood disorders are "only chemical imbalances in the brain". They know these disorders are polygenic and environmental. But for some people, a short dose of SSRI's or antipsychotics can keep them alive long enough to find out what it is that is giving them so much pain, i mean singnals.

Are you familiar with what it’s like to have depression? It’s not something you can really ever get rid of, even if you can mitigate it with medication and lifestyle changes. It’s there, though not dominant, even when things are going well and even when you’re in a positive mood.

I struggle with similar feelings, and the idea that depression becomes something that is there but can be put to positive use absolutely tracks with my own experience.

I think depression can spiral into a positive feedback loop that forms a depressive disorder. Mood affects life which affects mood which affects life...

Many people who haven't been stuck in that positive feedback loop have still been blue. Their capacity to feel happiness is muted just like ours, but they are successfully able to get out of that with a behavioral change. That's not always the case with a depressive disorder, and it can take a multi-faceted approach of medications, lifestyle change, sleep hygiene improvement, sometimes electroshock therapy for those people to get out of it.

> Are you familiar with what it’s like to have depression?

Pretty sure there are many distinct conditions that we now call "depression".

Your description is very true for some of them, and not at all for others.

Please read my other posts. I have a 35 year history of hospitalizations for both manic and depressive episodes and I have attempted suicide twice. I have lived with 9 month long depressions where all I could do was watch cartoons and not enough energy to even brush my teeth.

If one cannot get rid of depression then one cannot get rid of heart disease or cancer.

Have you been tested for lyme's disease regarding the lack of energy?

I had it a large chunk of my life. It went, eventually. It can go but that's because it's not in my nature/mind/brain/chemistry/whatever. In this I'm very fortunate, but please don't completely rule out defeating it, though the odds are poor.

This probably varies by the person.

Some people might get a single episode, then get through it one way or another, and never have another one.

Others might have a lifelong tendency or vulnerability to it, and in that sense it might always be there in the background. I'm fairly certain I was more or less depressed (although not diagnosed) in my teenage years and early 20's. In my later 20's things were brighter, although I probably had a tendency for some amount of depression, especially during the darker winter months of the year (I live in the north). However, there were definitely times when I wouldn't have considered myself depressed. I'm not sure I'd even say it was "there" at those times, in the sense of being actively present in any way, even in a non-dominant way.

Later on, I got another deeper episode of depression that I'm still battling.

Yet other people might have it always there in some way, as you say.

>It is hogwash that they think mood disorders are "only chemical imbalances in the brain".

Who are you quoting here? What psychiatrists think this? AFAIK, this hasn't been the meta for a long time.

No, I agree with you. I do not find psychiatrists believe that mood disorders are only chemical imbalances in the brain.

I have come across people have been led to believe it’s a chemical imbalance by psychiatrists, even in the last few years.

It may not be the modern psychiatric view, but it’s also true that psychiatrists are just doctors, and many of them are very slow to change from what they were taught in medical school.

it's a default API for brains, but ideas will trigger neurochemistry too .. well I'm sure you got that already

I can't speak to exactly who uses this terminology, and I have not heard it from a medical professional, but I feel like it lingers on, like in medication pamphlets.

Because fundamentally, I think, it is necessary to try to get people to comply with medication that seems to help sometimes, while avoiding the reality that the way it works is not known.

Amphetamines have shown some promising results in actually curing depression. There is a vicious cycle of depression where the anhedonia and lack of motivation cause the sufferer to allow the underlying causes to get even worse leading to deeper depression. Amphetamines can help break that cycle and ideally even start a virtuous cycle where their use can be tapered and eventually discontinued. It's vitally important though that the drug treatment is combined with behavioral modification so that the artificial stimulation of reward circuits can be operant conditioned on behavior patterns that mitigate the underlying cause of depression. Anyhow I might be off on the jargon since college psychology was a long time ago, but the basic concept strikes me as highly plausible and consistent with what we know about the human mind. And anecdotally I have friends who benefited from amphetamines for depression.

However used improperly it can end in amphetamine addiction or even psychosis. It's not surprising most mainstream psychiatrists don't like to use them for depression, but it is a powerful tool in the box.

That seems perfectly reasonable to me as a line of reasoning, and I'm not casting doubt on whether it could work.

With that said, I also wonder how many of those people had undiagnosed ADHD/if such studies involved screening for ADHD.

Unmanaged ADHD leading to consistent failures in life and other difficulties -> depression/depressive symptoms from the consequences, lack of achievement, etc over the long term, is a pretty common story.

And obviously, the responsiveness of those with ADHD to stimulants is pretty well-known.

> However used improperly it can end in amphetamine addiction or even psychosis.

Someone I know managed to do that, despite being on intramuscular antipsychotics. Unfortunately no middle ground, the meds keep him anhedonic and abulic, but without them it's mania. I would be careful with stimulants.

I think these two sentences are different: it's analogous to treating a symptom vs treating an underlying condition.

Yeah, I agree with that distinction. This is am important semantic discussion.

But he just changed the name of the thing he wants to get rid of from "pain" to "signal". The signal is still a disorder. The signal is the thing that bothers us.

I think they is saying that if you put your hand on a hot thing, you get a signal. You can also call it pain. But the problem is not an internal problem with your body, but a consequence of your environment. So change your environment or what you are doing and the pain will disappear. Don't try to keep your environment the same and try to change within.

(I don't entirely agree with them, but that's my best summary of their argument).

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