Stanford Accelerated Intelligent Neuromodulation Therapy for Depression

SSRIs and SNRIs can cause akathisia. It happened to me, and it was by far the worst thing that happened to me ever in my life. I went through 6 months of nonstop hell with akathisia, and it was the worst 6 months of my life. Trust me, if you have severe akathisia, it is worse than death.

This is somebody who has akathisia from taking Effexor (an SNRI): https://youtu.be/W_iiy8ISvdY

This is a public service announcement from an akathisia advocacy group (known as Akathisia Alliance) about akathisia: https://youtu.be/VgvhAilA070

Here is an article from a mother whose son developed akathisia from taking an SSRI for about a week. (My story has a lot of common denominators to this one): https://www.madinamerica.com/2021/06/boy-interrupted-a-story...

> TBH a little disappointed at hacker news, next time link to the study! I would love to see articles on NEW treatments for depression. Spoiler alert..there really haven't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.

No sorry, this is silly. For one thing, because speeding up a treatment from taking 6 weeks to 5 days is still pretty huge. And also because what inevitably happens is:

> New experimental treatment with potential discovered

HN: "yawn, most of these never pan out, let me know when they have completed studies"

> New treatment study shows amazing results

HN: "Okay, but nobody can get it yet, right? It's gonna be years"

> New treatment widely available

HN: *crickets*

or

HN: "So what? It's not a NEW treatment, we've known about this for YEARS now"

No matter what, you have people dismissing some new thing, because either it's too new to know for sure whether it works, or it's not new enough to be interesting. Your comment is a perfect example of that, as it's new enough to where most people probably have never heard of this treatment, but you're already dismissing it as too old and boring.

Highly recommend if you're anxious about SSRIs

I'm really glad Wellbutrin worked for you. When I tried it ~20 years ago (as a young teenager), it worked well for me for a few weeks and then absolutely did not work anymore. But that's the beauty/pain of SSRIs. There are a million of them and they impact each person differently.

I only connected the dots a few months back when looking into what Ketamine does. It's a miracle drug, I'm hoping my doctor will prescribe it to me but it looks like in my country you need to have been prescribed other anti-depressants and for them to have failed.

"Our results therefore support a direct role for NAC in tumor initiation."

I was going to try NAC until I read that

600mg, water-soluble, everyday before lunch.

Of course anecdotal and the effect might have been from the noise or vibration

https://en.wikipedia.org/wiki/Ketamine#Depression

> The approval of esketamine for TRD by the FDA was controversial due to limited and mixed evidence of efficacy and safety.

> In January 2020, esketamine was rejected by the National Health Service (NHS) of Great Britain.[41] The NHS questioned the benefits of the medication for depression and claimed that it was too expensive.

https://en.wikipedia.org/wiki/Esketamine#Depression

It's too early, and it's for treatment resistant depression.

So yeah, unless you're a doctor/neurologist and know the protocol for validating drugs, it's not really worth listening to the pseudo science advocated by drug users who also encourage taking psilocybin/LSD/MDMA as a silver bullet, and constantly talk about pharma conspiracies. "Listen to the professionals" is a better advice.

You don't want to exercise, see people nor wake up in the morning, and you feel terrible.

Quite often I get told that my experience and what I have witnessed from my friends and family going through similar change of life situations, is that it's all anecdote.

We must simply wait until enough scientific studies that test "primal methods" such as dopamine management, exercise, etc, come out to support this theory.

Until then, trust the science and buy whatever new pill or method that will solve it.

As for me and my friends however, we have our cure, and we try to motivate others around us with mediocre success. (Who are you to question the ways of science? Dr says to take pills and I can keep eating my junk food..)

However, in my experience, when you truly are clinically depressed, (1) you can't really force yourself to do anything good, and (2) even if you do something positive, you'll just get tired from trying to look like a functioning human being and may even feel worse.

In general, doing positive things do help, but only after you started medication and/or psychotherapy.

I know a personal trainer with depression. <shrug> No silver bullets. I'm inclined to see these things as symptoms, although (if I may borrow more PT lingo) maladaptive behaviour from unrecovered injuries is also a thing. Pretty much every physio will tell you that a pain in muscle X is caused by a deficiency in supporting muscle Y. It's just that we have zero insight into the mutual support structure (if any!) inside the brain.

Careful management of your social group and obligations can turn you from a depressed person who does nothing into a depressed person who does things. Sometimes that's good enough. But antidepressants can definitely do more.

A lot of the time the change in behavior is a coping mechanism rather than a cause for the depressive symptoms. They don't work out because they are so physically drained they can barely even muster up the energy to fulfill their responsibilities, or they become recluses because they believe their social connections aren't capable of supporting that level of vulnerability.

I suspect that it is more like the other way around, in that lifestyles incentivized in the developed world are rather poor at mitigating causes of depression, and by that I mean on a more fundamental, macro level instead of individual, which is why it has become so pervasive. For example, we have a fairly individualistic society, where many people have very shallow roots in their communities because of various causes of upheaval like immigration, education, employment. This makes it very difficult to get compassionate community support, which leaves mental healthcare workers to fulfill that position in a clinical manner.

First, that's borderline impossible to the point that it's an impractical and irrelevant suggestion. Second, for many, including myself, not much results but more stress and misery. Depression isn't one disease and is just a syndrome (a set of symptoms) caused by many different unrelated conditions and for many people those causes are entirely biological- not behavioral- and need to be treated like any other physical ailment. For some people (but not all), medication, therapy or other treatment can cause an improvement great enough for them to do be able to do those things and for some of those people (but not all) doing those things does help.

Forcing yourself to do these things while depressed is really hard.

There are good 'catalyst' like Buproprine and SSRs

This person has been managing depression without drugs or counseling for decades. There are ups and there are downs. From the outside, it's not always possible to tell the difference until they drop the bombshell "I'm extremely depressed lately" (as in, not just today or yesterday, but continually for a week or more).

I think of it like this: inside my head is a brain, and that brain experiences the world a particular way. Let's call it a colour filter. Well, everyone has a different filter, based on genetics and formative years. For some people, their normal state is 'content', unless something pushes their mood above or below. For other people the normal state is "shitty: slightly worried about nothing in particular, a bit sick of everything, I just want to go to sleep", and they have to constantly struggle to push above that state into one that is more bearable.

Behavior is the result of the chemistry in your brain. You go out and socialize because it makes you feel good. Now what if you go out, socialize, and it makes you feel pain? Note, the pain itself does not have a physical cause, but that does not mean it is not real.

That's what difficult depression cases are like. Depression, like everything else, is a spectrum. The fact that one person can say "ah fuck it, I'll go out" and actually feels good does not mean that forcing a depressed person to go out is the cure for depression.

“Doing” things is literally impossible (well, torture is possible but unsustainable).

What you have seen is probably depressed people not managing well. Do not call it dopamine-bingeing because there is absolutely no intent there.

Depression is very very debilitating and it really messes up with your mind in unfatomable ways.

I’ve been in both sides of this question and, at least in my experience, its like wondering what happens when a tank of gas ignites itself. The activation energy just isn’t there. The thoughts are, but the spark isn’t.

I used to think this was just an analogy in my mind, but we’re an electrochemical beast and what does our brain actually *do* beyond selective catalysis.

Cause / effect. Are they depressed because they don't work or hang out, or do they not work / hang out because they're depressed? And there's bound to be other options as well.

I mean nothing personal, but your comment has energy of "thanks I'm cured"

- Situational: you force yourself to do things, you feel better and break out of the cycle

- Physical: you force yourself to do things, you don't feel anything but suffering. You don't get endorphins from exercise, you don't get serotonin from going to events and hanging out and achieving things. Depression is usually anhedonia which is a loss of feeling - whatever happens you're completely emotionless

Depression creates a feedback loop: not doing things makes you depressed, depression makes you not do things. So sometimes you are just lazy and need to start doing stuff. But sometimes it's a physical depression which caused you to stop doing things, and just doing things again won't make you not depressed. That's why I generally suggest starting and trying things, to see if they have any effect, but don't push it otherwise.

For me depressive periods manifest as borderline obsessive computer gaming. It's not the binging that triggers the depression. I continue functioning as an employee and family member but need something to lift the feeling of anxiety and sadness. It's very much like a pain killer. I don't suggest compulsive gaming for anyone as a remedy but for me it makes things tolerable. I've been also so depressed that I got therapy and antidepressants, and warmly recommend the approach - but you need to find a therapist you feel suitable.

Well, the problem is that depression causes a lack of motivation, and the lack of action or inability to do even normal chores continues to fuel the depression. (Depending on its severity it sometimes even impairs people from doing basic tasks like taking care of personal hygiene - there are cases where indiviuals don't brush their teeth or even bathe for weeks; e.g. https://web.archive.org/web/20120305002714/http://damnihateb... ). So to us "normal" individuals these people may look lazy or those that lack discipline, but it's actualy the disease impairing them.

As you guessed though, taking actions is indeed one of the behavioural techniques of Behaviour Therapy or Cognitive Therapy to tackle depression. It does work, and depressed individuals do cite an improvement in their mood when they do some task (especially stuff they have been procrastinating).

But if you consider the cognitive model of depression (i.e. the common thinking patterns of depressed individual), one other aspect of depression is that they don't feel satisfaction or a feeling of accomplishment in doing such tasks. And thus, any mood improvment is only temporary. Which again makes them feel helpless and they regress. Thus, cognitive therapy focuses on not only encouraging behavioural actions, but also working on correcting thought patterns that devalue such actions.

("Perfectionism" is one example of such thought pattern - if something is not "perfect", the individual often devalues the whole work done. Using the same examples you cited, even if you get this kind of individual to do a workout, as soon as s/he misses a workout, they will immediately start to blame themslelves for not being able to "maintain" discipline to the point of becoming dysfunctional..

It can, sure. But as many other commenters have pointed out, depression isn't just one thing. And for many individuals who suffer from major depression, it isn't situational at all, so doing all those things (assuming you can do them), doesn't really change anything at all. Because of what has happened in the world over the last 21 months, it's harder and harder to separate a chronic, deep depression from the situational depression that many people have found themselves in. I've suffered from depression my entire life (I self-diagnosed at age nine but had symptoms going back to at least age six), and even I'm unsure if the depression I'm experiencing now is more situational or more biochemical, just because everything in the world has been such a mess.

I can tell you that for people with deep depression, there is only so much fronting and working-out and socializing a person can do before the energy required to do those things and put on a front, of "acting" OK becomes too much. And that can often explode in a fit of rage/sadness/sorrow, because believe it or not, most depressed people don't want to be depressed and don't want anyone else to know they are depressed.

I can also tell you that there are people who are so depressed they literally cannot get out of bed to take a shower, let along go for a run. They cannot move, not out of laziness, but because the act of physically moving is too mentally and physically taxing and painful. They literally cannot do any of the things that give them any sort of dopamine binge. They don't eat. I was an incredibly active high school athlete (cheerleading and gymnastics) before I fell into my first "can't-get-out-of-bed"/"can't function" period of depression as a 16 year old. I was lucky I had my parents (especially my mom), because she was tireless at finding me the right psychiatrist (six in an 18 month period) and keeping notes of the side-effects of the different medications I kept trying (over 15 before we found a combo that worked at the time and probably that many have been tried since as I've gotten older and my body and biochemistry and hormones have changed), not to mention handling the insurance, taking me to doctor appointments, making sure I could eat. I had to handle more of it myself when I had another major depressive episode in college -- my mom still helped but I didn't live with her anymore and was no longer a minor, whose health she could take an active role in without signing forms that we didn't want to sign. And I had to handle it completely on my own when it happened in my early 30s, and I still had to work and had to expel every ounce of energy I had into getting a job done until I could get the right medication to help me out of it just enough to continue existing.

Trust me, if it was as easy as just forcing yourself into doing things that don't make you depressed, you'd have a whole lot less suicidal people. And you wouldn't have as much excitement around rTMS and Ketamine and other therapies that are starting to show real promise.

Which was discussed on here a fair bit a couple days f weeks back…

At one point I was working out 4 days a week, was absolutely ripped, and salsa dancing multiple nights a week; but I was still depressed.

It really depends on what kind of depression you have, often it’s a consequence of something else (in my case, probably an anxiety disorder and a genuine difficulty forming lasting social bonds).

Yes. Clearly I disagree with others here.

The problem is that it's a vicious circle so it's difficult to change your behavior/lifestyle. But if you can, maybe with external help, it surely helps except maybe in very hard cases.

By the way, I'm not sure the term clinical is being used correctly in other comments. Could someone with relevant knowledge confirm?

The worst obstacle to break the circle are negative thoughts, that hide where the exits from the labyrinth are.

All of this takes a supreme level of effort, it never felt natural to me. Never got a "jogger's high". I was just depressed while my feet are moving. After spending time with friends I am emotionally drained and need to recharge. When I have a serious bout of depression, it's difficult to leave the bedroom / house for days or weeks at a time (at its worst). My entire body feels like I've been tumbled down a hill in a barrel.

In this time I've had a half dozen suicide attempts, two of them requiring medical attention. I still think of myself as a worthless waste of space. Every day when I wake up part of my routine is to shake off the suicidal ideation just to get started for the day.

CBT has helped to deal with the logical / behavioural impacts of this. I don't get as mad or frustrated at myself and am better equipped to recognise triggers and pull myself back from the edge.

I think if I had been able to get help when I was a child (I first started self-harming at age 7), perhaps being happy and motivated would feel more natural.

But no, even forcing a lifestyle change and doing all the things you said have no lasting effect. I doubt it will ever feel natural for me to wake up, go for a run, meet a friend before work for coffee, enjoy meetings with clients, etc.

Definitely still do those activities, otherwise things snowball. But the problem is a literal chemical / hormone imbalance in my brain that affects everything from when, how often and how long I sleep, and how much lethargy I have throughout the day.

A lot of people struggling with depression have had a lifetime of advice similar to what you suggested. Well-meaning family think it's as simple as just getting moving, and they think the symptoms are the problem, and we have a lifetime of being told to stop being lazy, stop feeling sorry for ourselves, etc, which is the main "stigma" of depression and the reason why these types of well-meaning posts usually result in less than positive responses from long-term chronic depression sufferers.

Edit to add - everyone's root causes are not the same, so while I have decent stretches where I can push myself to exercise and face the day, other people can't and there are times where I can't summon the energy and it's difficult to move. Also inb4 try changing your diet, have you tried meditation, read this <insert famous author>, etc. Living like this sucks and I've read and tried many things to ease the pain. Improvements are slow, incremental, hard-won, and often temporary / good until the next downer hits.

[Note: I am not a doctor, but I lived with people with depression]

Apparently, in the case of true clinical depression (i.e. not just "feeling down"), not much. The typical reaction is "yeah, whatever", and they do it for as long as you want them to do it because they don't feel like resisting.

A change of behavior/lifestyle can certainly help, in the same way that lifestyle changes can help with many other diseases, but forcing depressive people to do what non-depressive people do looks just as effective as forcing people with broken legs to walk.

It also looks like there is more than one form of depressions. But the way I see it, depressive people are not sad, they are emotionless. Nothing brings them joy, but nothing saddens them either. I didn't even notice any "binge" behavior, they are just as likely to gain or lose weight, because who cares about eating. Depression is not grieving.

Statistically, sure. Individually it might not work and uncertainty makes something hard even harder.

I've actually maintained a pretty healthy schedule, with regular swimming, intense hatha-yoga (more like gymnastics), spend a fair amount of time with people. At some point I've also became a workaholic.

How I felt — pretty horrible, all those nice things (unhealthy attitude to work is not nice, of course) barely helped to maintain a thin veneer of my social persona. Basically, most of the people who interacted with me would not know that I'm depressed. I think there are a lot of people like that, just outer shells.

I did not get medical help either in the form of therapy or drugs.

In the hindsight, I think that depression could have been helped at least a bit by going to the good therapist. I had some issues with rage a couple years later, and going to psychoanalyst really helped me a lot. Oh, you know what also helped a lot? It may sound stupid, but at some point I've started going to piano lessons and it really was beneficial somehow.

It is unfortunate that the term "depression" is used frequently for things that are not really depression.

I highly recommend this lecture by Stanford's Sapolsky On Depression to understand the difference. He will do so far more articulatly than I ever could.

As a person intimately familiar with depression as it has been with me for decades and it is still deeply inside of me the answer to your question is “No”.

Depression is hell. It sits inside you. You cannot run from it, you cannot hide from it. Whatever you do it is still inside you and it does not let up and it tortures you continuously.

It does -not- improve by going for a walk. It does not go away with social interaction. It does not go away by not eating.

It turns the entire world bleak.

I have to time my interaction with other people carefully, so I won’t start screaming before I am alone again.

Asking a depressed person to “go for a walk”, “exercise” and things will be better is absurd. It Is like asking person in a wheel chair to get up and go for a run,

It is also the standard reaction from people once they hear “you are depressed”. They have no idea whatsoever what they are talking about, and I wish people would just stop it. Don’t you think if it was that f…ing simple I would have done it a long time ago.

I feel a deep need to scream at a person who suggests it, but you can’t do that in this society.

If I could put a finger on them and let them experience what is inside me for a moment they would be the one running away screaming.

I recently talked with my partner about this, and annecdotaly, one friend had bad enough depressive episodes, they got an antidepressants prescription. Later they complained that it really helped with the downs of the depression, but in general it felt stifling and kind of muffled the highs in life previously accessible.

But, fortunately, the medication helped enough that they started and stuck to an exercise regime and then managed to phase out the medication.

I think with mental health in general, everything comes with a great deal of your-mileage-may-vary.