If you are based in the US and live nearby a university they usually have good counseling services and the infrastructure to refer people even if you're not attending the school. Search "{school} counseling services" on google.
It's important to understand the economic pressures in psychiatry. I went to see a psychiatrist, who prescribed me antidepressants. They helped give be a baseline level of energy to get me out of my acute depression, but they addressed none of my underlying issues that caused me to get depressed in the first place, and a couple years later I was right back in the depths again. And I'm fine if my dr's economic model meant he couldn't do psychotherapy with me, but he never recommended I get therapy, and that's what I'm so bitter about regarding him.
I've heard it said that giving antidepressants to a depressed person, without any therapy, is like giving amphetamines to a tired person: yes, they may temporarily cure your "tiredness", but what you really need is to go to sleep.
So while I don't think OP should take detailed advice from random strangers, he should be aware of his options. Talk to a therapist first to see if they can uncover what some of the root cause issues are. Be open to medication - some mental issues really are largely organic in nature, but a good doctor and therapist will know they are just one tool to improve your mental health.
> I've heard it said that giving antidepressants to a depressed person, without any therapy, is like giving amphetamines to a tired person: yes, they may temporarily cure your "tiredness", but what you really need is to go to sleep.
I don't even know where to start with this comment. This whole thread should be booted waaaaay off HN.
A few people have problems with medical professionals. It's true, assuming you're in america, we're definitely not the best. But you find a few 1,000 people online with bad experiences (obviously, because people with good experiences have moved on and don't spend their time researching that issue) and assume you have a complete picture but you're only looking through a pinhole of information returned with biased search results. You probably aren't googling, "how many people have gotten their lives back after using anti-depressants?"
> he should be aware of his options.
Yeah fine, be aware. Talk to professionals, get second and third opinions if necessary. Take a holistic approach to your well-being. But please lets not glorify google medicine here.
Heck, I stated off the bat that antidepressants did help me. I'm not "anti-antidepressant" at all. But I do understand the economic forces at play means that plenty of "medical professionals" are more than happy to charge $200+ for a 20 minute meds management consultation, simply because it's faster/easier than dealing with underlying issues.
As for your "This whole thread should be booted waaaaay off HN" comment, the anger people are responding to is lots of us have had horrible experiences, but we're just told to "shut up and listen to your doctor". How do you think the whole opioid epidemic came about? Huge parts of the medical establishment were more than happy to get their commission, people's well-being be damned.
Then a great experience with another psychiatrist who managed to get me to function just enough for me to go see a psychologist who not only "cured" me but gave me a superpower of being resilient against life's wraths.
So your mileage may vary.
To whom might be reading this: don't give up. It sucks but sometimes we get unlucky and need to change doctors.
how?
I live less in the future and more in the present.
I judge myself less and feel emotions more.
Intellectually I am already well aware that my frame of mind is often the main issue and that I could simply choose not to be bothered by something - but that realization is a "system 2" thought which doesn't arrive until "system 1" has already derailed my whole day.
This is the silver bullet in my opinion.
How do you define fairness, rethink it and tone down your expectations.
How do you define love / relationships? Rethink it and tone down your expectations.
How do you define work / career / success? Rethink it and tone down your expectations.
I honestly believe this is a huge help.
A therapist who is a good fit for you is very hard to find. Learning about the skills you need to reorganize the way you view yourself and the world, simpler and the solution which a good therapist will help you with.
As someone who has suffered from depression and been negatively impacted by bad medical interactions for this and other conditions, the only choice is to do the work myself.
This sounds absolutely terrible. Something not to far from victim blaming.
Don't have a home? Learn how to be happy homeless! Husband gave you a black eye? Tone down your expectations!
The correct quote is ”COMPARISON IS THE THIEF OF JOY.” – THEODORE ROOSEVELT
"Comparison is the thief of joy" - As quoted in Becoming a Great School (2013) by Cooper, Gustafson and Salah, p. ix"
Nothing wrong with expectations, ambitions, drive.
>"Death by medical error or accident is the nation's leading cause of accidental death"
Trust the "leading cause of accidental death".
Medical training is extremely limited. Physicians literally don't understand how any of the drugs they prescribe work, and the standard operating procedure is to memorize 2-3 drugs out of one class and never prescribe anything else in that class.
Physicians are constrained by: their hospital policy, HMO incentives, civil liability, criminal liability, boards, legislation, insurance rates, personal biases, past unique experiences, influence of their mentors, weather, bad knees, bad marriage, whatever. Sometimes they are just having a shit day. Some keep practising to the point they are so senile they attempt to sign a prescription with the syringe needle (witnessed that myself).
They are just humans. Rather greedy humans, most of the time. They will never be fully frank with you.
3rd opinion? People often seen 5+ physicians, and spend 10+ years to get a proper diagnosis.
Severe pain in testicles: ER doctor asks about blunt trauma, sees nothing, prescribes antibiotics. Family doctor later agrees. Year later, same pain! See a nurse-in-training, second question: "When was the last time you ejaculated?" ....oh... Sure enough, no antibiotics necessary.
Tapeworm-looking thing found wiping my bum: doctor ask about look and itchiness, consults a parasite specialist. They come back with pinworms, because tapeworms don't just come out. Prescribed a medicine that deals with both, and I look it up. I read the drug is perfectly safe, and also "do not use traditional remedies like pumpkin seeds, which contain trace amount of a substance that puts tapeworms to sleep" ...oh... I had just spent two days snacking through a 4 lbs. of pumpkin seeds on a nut-free whitewater trip, so it was a tapeworm.
Ball of foot hurts: Doctor stumped, sends to get orthotics. Orthotics get made custom. Years later, I try on a pair of EE wide shoes ...oh... right, wide shoes that makes sense.
Burning left side of face: wasted so much time with a few specialists, telling everybody that it doesn't really bother me I just want to be sure it's like a brain tumor. No answers from no body. Then one day, a bunch of wax falls out of left ear and ...oh... it clicks; my face burns when my ears get too full of all that wax I make.
So doctors don't always get the full picture either, because how could they surface every relevant detail in 5 minutes!
Like "I worry about your executive function" weird.
Oh I know a good story.
I know a woman who unfortunately isn't the most educated person in the world and happens to have a nasty health issue where both her feet are all swollen up and makes her hard to walk around.
She's been seeing doctors left and right to solve or mitigate her condition.
One time, when she went to an appointment at the local hospital, her doctor handed her a form for her to sign and told her just to sign on the dotted line and don't worry about it.
The form was a consent form to amputate both her legs.
I happened to come across her when she was going to get a second opinion with the very form in her hands, completely furious.
She still has both her legs, even though she still suffers from the same issue.
Oddly enough, the hospital which handed out the leg amputation form also had a malpractice suite where they amputated the wrong leg of a patient.
Moral of the story: even though medical professionals are expected to be more knowledgeable about health topics, they are still human and far from infallible. More importantly, ultimately you're the person responsible for your personal health, and you need to have a say on what's done with your life based on the info that medical professionals make available to you. If you do not take an active role on these decisions on your health, others will eventually make these decisions for you, and they may not be good or have your best interests in mind.
I basically got diagnosed online by 2 different people about 2 different issues, one is biological, and the other is mental. And they were right. This is nerds out there who read about topics constantly, way more than the average doctor, not even close. So a stranger can help.
Also depends on where you are located, doctors can be dogmatic, there is countries that give antibiotics before extracting teeth, and there is those who don't. Countries who believe ADHD can stay into adulthood and go undiagnosed, and others who believe it is impossible to have ADHD as an adult.
In the ADHD case, depends on who what countries are right, some group might be living a lie taking meds for an illness that doesn't exist, or the other group is suffering being undiagnosed with ADHD despite seeking help, the doctor just tell them its not possible to have ADHD.
I would rather research and try to solve my issues over hand my situation to the medical zeitgeist of my country. Also I am sure if I give myself days of research, thinking, talking to people, comparing situations over some doctor talking to me for 15 minutes then giving me the two meds given to everyone who enter that door (SSRIs and benzos), I might probably be up into something.
I will never stop researching my medical issues, I will never trust my doctors fully, I will always google, research, ask, ask second opinions. Some doctors care more than others, some doctors are capable more than others, you have no idea which ones the RNG gave you.
I agree that someone should go to the doctor. But almost everyone agrees on that, and yet very few actually go. I didn’t, for a decade, and mostly out of laziness (not going is after all the default option). Going around commanding people not to do X is only going to make them X.
The only thing dangerous here is you, acting like people shouldn't advocate for themselves to every extent their intelligence allows.
..is somehow always better...than everyone else? Always?
Professional opinion is just that, an opinion. Opinion of potentially the worst medical student, from the worst medical school. but because they got a prescription pad, they are now smarter than anyone else in America. Got it.
Health is ultimately our own decision, and ours alone.
I wouldn't discount design advice of a qualified engineer because of the musings of a random person, so why would I do the same for a doctor.
Too many people in this thread are just going "software developers don't know what they're talking about. I had a bad experience with software once, so no developers have a clue, they're just after money"
Dumbest doctor is stupider than avg math/eng. They just tend to be less autistic on avg.
"The American Society for Engineering Education (ASEE) found that between 40% to 50% of engineering students drop out or change their majors."
"So, what is the dropout rate for medical school? In a standard, single four-year program, that would put the medical school dropout rate at between 15.7 percent and 18.4 percent, confirms the AAMC."
"In mathematics, the dropout rate is even higher with 47% (U.S. college dropouts show comparable numbers; Chen, 2013)."
It's ok to question and discount doctors. Plenty of incompetent practitioners out there, well protected by powerful lobby, trade union, massive liability umbrellas.
They even passed laws to reduce their own liability.
I'm sure they needed that because they are so excellent at their job, they are only the leading cause of accidental deaths.
However, with supply management of physicians, comes responsibility to ensure reliabile supply to replenish ranks to avoid surprises, and thus all efforts are made to ensure that students can pass. You simply can't have 70% fewer graduates one year, and 170% next.
"With an admit rate of 7%, it is easy to understand why the Johns Hopkins School of Medicine is sometimes viewed from the outside as highly competitive."
"Massachusetts Institute of Technology/Acceptance rate - 7.3%"
If you have good memory, and not a total dolt, you can be a physician. Analytic ability is a tertiary concern.
Asking for advice on the internet is a very valid strategy, given the terrible state of mental health care in the US.
Having had a critical infection repeatedly misdiagnosed until I finally went out of my way to pick a better professional, I don't buy the "just have faith in your doctor" argument.
Doctors are more like plumbers than we like to admit. There are good ones and bad ones, and it's hard to tell the difference. They do best when you can give them direction (cooperatively) and when you are willing to get a second opinion.
Parent comment is not giving explicit medical instructions. All they're saying is "talk to a medical professional" isn't some miracle advice that always works, particularly for mental health. It's fine to give anecdotes as long as one holds them with a grain of salt.
People keep saying we should _normalize_ talking about mental health, and what you're suggesting goes against that. If we were discussing heart health and someone were to talk about their exercise, diet and medication online, would you say, "Hey, wait a minute! You're not a doctor. You can't say that." Of course not. What you're advocating for is an overly paternalistic approach to mental health issues, as if people are too dumb to listen to different viewpoints and come to their own conclusions.
My psychiatrist was fairly clear on what was what and which things needed to be treated with therapy and which medication could help with. (Medication helps symptoms, it does not cure.) Finding the right medication would take months or years and will not solve everything. There will be side effects that I needed to monitor and report. And so on.
When seeing any doctor, you are your own best advocate. It helps to come prepared, knowing your family history, and things you are struggling with.
Researching medications can help, but most people are not qualified to use them without supervision, myself included.
Note: This is assuming you need medication. It was fairly clear in my case medication was absolutely required to at least treat psychosis.
I prefer to refer friends to a therapist or psychologist, who do not prescribe medication.
FWIW, my understanding is this has little to do with the drugs and mostly to do with the recovery process.
In a deep depression, you might have suicidal thoughts, but lack the will to take action on those thoughts (because depression takes away your motivation). As you a person comes out of depression, they tend to recover their motivation before their suicidal thoughts dissipate. This creates a situation where a person with suicidal thoughts now has motivation - which means they have the potential motivation to take action on their suicidal thoughts.
The important nuance of this is anti-depressants don't necessarily make your suicidal thoughts _more_ suicidal. In fact, it's likely, anti-depressants are making your suicidal thoughts _less_ severe. However, they do increase your motivation before they can fully eliminate suicidal thoughts.
I'm not saying you should take an anti-dpressant willy-nilly. It's just BS to be fear mongering like this without considering why this situation happens.
In a way, yes, there can be feelings induced that can provide the motivation and energy to go through with suicidal thoughts, but those unpleasant emotions aren't exactly triggered by an inherent will to die. Those who experience akathisia sometimes feel like the only way to rid themselves of the feeling is to end their lives.
I point this out because it might seem, or feel to those experiencing it themselves, that those suicidal thoughts are organic and what the person really wants, but they tend to be exacerbated directly by medication and can get better with time. I also point it out because there are ways to sidestep 5HT2C activation with different medications or combinations, it doesn't necessarily have to be inevitable.
> Research indicates that some suicide victims have an abnormally high number of 5-HT2C receptors in the prefrontal cortex.[13] Agomelatine, which is a 5-HT2C and 5-HT2B antagonist as well as a MT1 and MT2 agonist, is an effective antidepressant.[14][15] It has been called a norepinephrine-dopamine disinhibitor because antagonism of 5-HT2C receptors by agomelatine results in an increase of dopamine and norepinephrine activity in the frontal cortex. Conversely, many SSRIs (but not fluoxetine, which is a 5-HT2C antagonist[16]) indirectly stimulate 5-HT2C activity by increasing levels of serotonin in the synapse although the delayed mood elevation that is usually typical of SSRIs is usually paralleled by the downregulation of the 5-HT2C receptors.[17] Many atypical antipsychotics block 5-HT2C receptors, but their clinical use is limited by multiple undesirable actions on various neurotransmitters and receptors. Fluoxetine acts as a direct 5-HT2C antagonist in addition to inhibiting serotonin reuptake, however, the clinical significance of this action is variable.[16] Several tetracyclic antidepressants, including mirtazapine, are potent 5-HT2C antagonists; this action may contribute to their efficacy.
> An overactivity of 5-HT2C receptors may contribute to depressive and anxiety symptoms in a certain population of patients. Activation of 5-HT2C by serotonin is responsible for many of the negative side effects of SSRI and SNRI medications, such as sertraline, paroxetine, venlafaxine, and others. Some of the initial anxiety caused by SSRIs is due to excessive signalling at 5-HT2C. Over a period of 1–2 weeks, the receptor begins to downregulate, along with the downregulation of 5-HT2A, 5-HT1A, and other serotonin receptors. This downregulation parallels the onset of the clinical benefits of SSRIs. 5-HT2C receptors exhibit constitutive activity in vivo, and may retain the ability to influence neurotransmission in the absence of ligand occupancy. Thus, 5-HT2C receptors do not require binding by a ligand (serotonin) in order to exhibit influence on neurotransmission. Inverse agonists may be required to fully extinguish 5-HT2C constitutive activity, and may prove useful in the treatment of 5-HT2C-mediated conditions in the absence of typical serotonin activity.
And you think a random stranger knows any better? I know firsthand that the medical profession has serious limitations in its understanding of and ability to treat depression, but no way in hell am I taking some rando's advice over that of any of the many doctor's I've seen.
Anecdotally I've been to therapists and doctors that were no help and I've read an article online [1] which was a tremendous help.
[1]: https://kajsotala.fi/2017/07/how-i-found-fixed-the-root-prob...
Anyway in discussions like this I feel like what it lost is that you will actually respond to how compelling the thing someone else is saying is. Like, it's not "oh a bunch of opinions, I'll get influenced by one randomly and it's probably wrong". It's "oh, a bunch of opinions, which explain why they think they're right and how well it worked for them, I'll incorporate that into my own understanding".
I've found they're more often than not ignorant of the latest studies, as well. Doctors are put on a pedestal in our society that very few of them deserve. A solid 2/3s of the ones I've seen are over-confident, dismissive, and often peddling out of date information. The rare ones that truly focus on their field and put their patients above their egos are difficult to find and even harder to get to with average US insurance.
This type of side-effect is thought to be mediated by 5HT2C activation when initially starting SSRIs, however, over the period of about two weeks, 5HT2C receptors downregulate and reach an equilibrium that can cause the effect to diminish or go away entirely. As an aside, there's research that suggests that abnormal amounts of upregulated 5HT2C receptors are present in suicide victims.
One of the reasons Prozac is recommended as a first line of treatment, besides the fact that it has a long half-life, is because of its 5HT2C antagonism that can block 5HT2C from extracellular serotonin activation from SSRI effects.
There are also plenty of antidepressants that don't typically cause that particular problem, especially if they aren't typical SSRIs or serotonin agonists.
My current OPINION is: Until you have read studies and got some plausible experiences from people with the same medication, one doctor alone isn't a good source for taking medication.
I will only take medication in the future if life wouldn't managable without, but not for issues that just take time.
Tapering doses for all sorts of medications are routinely done, and any pharmacy can handle such an rx. If they can't - you don't want to go to such a pharmacy anyway.
Some people move permanently, in order to obtain medical care. Sometimes, to another country.
Most compounding pharmacies will ship, and most physicians will only require one visit in person in 12 months.
Tapering SSRIs is the normal unless a provider has alternative indication it shouldn't be done.
No one with depression is going to read this and go “Oh, you’re right.” It’s self gratification disguised as help.
Everyone knows they really ought to see a doctor. There are plenty of reasons to be scared to. An untimely hospital visit bankrupted me thanks to no health insurance. My sleep doctor had to cut me a deal of only $50 per visit instead of the usual $150, and she really cared about me. I was part of a lucky few.
I think what rubs me wrong about your advice is that it’s positioned at the expense of all other advice. No one’s allowed to have an opinion except yours. Smart people like OP see right through such things, and it tends to push them away. Which is particularly troublesome when the advice is good, like yours is here.
Yea it's mainstream and to be expected under legaleeze circumstances.
But it's not the kind of advice I would give to a friend whom I'm genuinely concerned about.
Have you known anyone who was depressed and managed to get better by following the advice of a generic "profressional"?
I haven't.
Quite the opposite. I've seen people get worse in one dimension or another by taking medication or following other professional advice.
It’s worked.
My advice to friends and family experiencing such issues is to take those issues seriously, and to see a doctor about them.
I think the increasingly common practice of forbidding medical advice in online forums is deleterious. For a lot of people professional medical care provides no solutions, hearing other people's personal experiences is helpful and comforting.
My opinion, doing both is good. Consult a professional and read about other people's experiences.
At the very least maybe somebody mentions a form of therapy that you've never heard of that you can ask your doctor about, or find a therapist that specializes in. If you ignored everyone's advice online you'd never even hear about that.
Personally, I'm starting Internal Family Systems therapy, which has seemed more promising for my psyche than many other modalities. But there are countless others. CBT is a good place to start, but doesn't work for everyone.
In reality, roughly 3-10% are good, the rest just go by standard guidelines only and/or punt you off to someone else.
What's the difference between mean and median in a Gaussian distribution?
Looking forward to your contributions to mathematics.
Are we talking about grades? Honestly when I see "50% of doctors are below average" I intuitively think of some other metric, such as the correct/incorrect diagnosis ratio, or the number of people that died because of their errors. Maybe it's just me but their uni (?) grades never comes to my mind.
I have learned way more useful info on online forums from people who were going through the same experience. Yes you have to be discerning but the advice “go to a professional” is thoughtless. There are a lot of incompetent people working in mental health. I am sure it’s easier if you have tons of money or just lucky to run into a good therapist. But already being down and then being disappointed by the professionals is devastating. At least it was for me.
For everyone who had their life turned around by medication I have met two or three who either did not see improvement or had negative side effects on all options tried so they gave up.
Some drugs, like the typical or atypical antipsychotics that treat bipolar or rapidly oscillating bipolar, have the side effect of reducing your energy and making you more passive. It's hard to pick out the effects of some drugs from actually solving the issue or just making you more likely to not cause a fuss.
I find this comment so overused, ignorant and dismissive. In my city it can take months to get a 20 minute appointment with a specialized doctor, while the internet is full of useful and scientific information and helpful people. That isn't even saying if the doctor really understands your problem or just dismisses it (had that often enough), like you dismiss other people's anecdotes. What are people supposed to do while they are waiting for an appointment for months with acute issues? I'd rather spend days myself and read the same information that a doctor (hopefully) would read in order to work on the problem before it gets worse or kills me.
So yes, try to talk to a medical professional at least once if you have the chance. If not or if it does not help, keep doing what you need to do and try to get the best information that you can find.
why ? they don't really have a solution for it other than prescribing anti depressants. I don't see why they need to see a doctor.
Depression can be caused by hormonal imbalances. It's tricky to get things right-- see a doctor!
By the way, is the Hunt library still open 24x7? I remember it being a fun time when it was. Spent many a night there.
If you were comp sci, Dr. Sturgill and Dr. Heckman are still making life hell for undergrads (for a good cause, of course)
Anyway, I see your point and don’t really have a better reply, so shrug I tend to agree that anything that can be attributed to ignorance rather than malice is correct, but the phrasing just seemed mildly aggressive to me. Not a big deal though!
An option if you prefer an entirely-online experience.
But yes, your mental help is not worth asking strangers on the Internet for help. You deserve better than what we here can offer.
asking for advice and personal stories regarding navigating an issue as complex as depression and the way it's treated is not only prudent, it's smart.
a good healthcare provider is one that is fully willing to discuss unorthodox strategies found via independent research. take advice from the internet and find a provider who is willing to discuss it with you.