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Comment by Silverback_VII | Hacker News Reader

What about very cheap and nonetheless effective "treatments" like exercise,sleep hygiene, magnesium, zinc, fish oil, onion, galic, saffron and even simply eating edible non psychoactive mushrooms? all these have been associated with a reduction in depressive symptoms.

but obviously nobody can make a fortune with these simple advices.

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I'll take it in good faith you're not just being a nasty troll, but that's a LOT of work for someone who is depressed, enough to be a non-starter. In reality drugs should probably be seen as a way to start better life habits. The benefits of hose habits are real, but getting there is a lot.

This is true but it’s modeled after behaviors in the big picture - you just described a lot of effort and commitment versus taking a pill, maybe doing therapy / counseling once a week or two, and just living life. I’m getting back into fitness routine and it takes time, effort, and money that typically aren’t subsidized by the corporate gigs I’ve worked.

> you just described a lot of effort and commitment versus taking a pill

Funny but I have come to regard the "effort and commitment" as part of the recovery mechanism. Causal or concomitant, I have no idea, let's just say 'linked'.

By the same token I have come to regard "convenience" as, if not a great evil, some kind of joker/trickster that lures us down a dark path.

This strikes me so much. Exercise is a proven health booster and yet health insurance doesn't cover gym memberships or exercise equipment. Why is that?

I’m not in the insurance industry and have no idea what the actual reason is.

And I don’t know what the statistics are, but a significant percentage of people with gym memberships rarely go to the gym. I suspect the percentage of people with free (i.e. payed for by insurance) insurance who rarely go would be much higher.

Further thought: Maybe insurance companies could pay, reimburse, or reduce rates for those who can reliably prove they are exercising.

My insurance offers reduction if you pass a basic health check each year. It's kinda nice but also sets up a slightly adversarial relationship with my doctor, which I don't like.

Ideally the health checks would be done with someone else, to reduce that adversarial conflict of interest problem.

Maybe your doctor should even get a small reward each time you pass the basic health check, so that in aggregate they are better aligned with keeping people in shape for those checks.

I've seen plans that subsidize gym memberships.

Treatments like exercise also have high variance - depending on the circumstance and how diligently you implement it, it may have no effect, a big effect, or even cause injury in the worst case.

Insurance likes low variance outcomes because they’re easier to model accurately

>health insurance doesn't cover gym memberships or exercise equipment

Because neither of those things are necessary to exercise.

I bet if you asked your GP for some body weight exercises you could do at home he'd happily provide some for you and insurance would cover the visit.

As I've argued before, if someone can diet and exercise then they aren't very depressed, so most of that advice is useless and why people work on drugs since taking a pill daily is much easier to accomplish for someone who can't get out of bed or find a reason to do anything at all.

Magnesium, zinc and fish oil supplements don't seem very hard to take. And what about a cold shower of 2 min each day? also easy to implement without much effort if one is willing to suffer a little bit.

> Magnesium, zinc and fish oil supplements don't seem very hard to take.

Obviously people do that and it works for a handful, but rather ineffective in general.

> willing to suffer a little bit.

Yeah, no. That's definitely not something a seriously depressed person can do, I say as someone doing that now. People who suggest these things are completely out of touch with what depression means. You'd be lucky if they were taking shows at all.

>but rather ineffective in general.

Study with 22 people with major depression: "Treatment with both omega-3s was associated with a significant improvement in depression, with an average 64% drop in symptoms for the EPA group and 71% in the DHA group."

https://www.webmd.com/depression/news/20210618/fish-oil-supp....

> Study with 22 people

i.e. worthless. DHA is being studied and has massive effects on inflammation but the science is definitely not there for depression. You need to adjust your epistemology if you are making decisions based on tiny studies like that.

Seems like 22 subjects is better than zero. One is better than zero so if it worked for one person that's probably worth trying for a second. I hate how people act like you can't try anything until it has had a study with thousands of people over years. Sure, that increases confidence but in most cases the study doesn't invent a treatment, it just adds trust in the effectiveness.

No, that's not how it works at all or else we should also recommend fairy crystals at the same time. Anyway, people do try it. That's the point. It's common practice and it's known to not work for most people with severe depression. It's only a matter of time that we have strong meta-meta studies showing that definitively. For now, here's a Cochrane meta-study that reviews 35 studies [1].

1. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

>i.e. worthless

Certainly not and considering the almost non-existent side effects, it is at least worth a try since it looks very promising. You are right that it is a tiny study but it doesn't mean that it has no value.

I have to say that I know people like you very well, I almost can hear the "go see a therapist and take your meds" or better "don't try and certainly don't think you can solve this on your own". A positive force first and foremost acknowledge people's potential and doesn't put roadblocks everywhere.

The first two are hard to take. Almost all magnesium formulations don’t do anything, and they’ll mostly sell you those because they’re cheaper.

If you take the wrong zinc brand it gives you the worst nausea of your life. Although I haven’t heard of even good ones helping with depression - it is a pretty strong aphrodisiac and testosterone booster, but that’d just be an additional distraction on top of being sad.

Meta studies show those supplements in fact have little to no quantifiable impact on most people's depression out side of placebo

>no quantifiable impact on most people's depression

"According to existing literature there is an inverse relation between magnesium and depression. " https://johs.com.sa/admin/public/uploads/187/46_pdf.pdf

While you N=1000-reddit-teletubbises try to hold back humanity the N=1 change the world.

But that's the thing, a lot, if not the majority, of people getting prescribed these awful drugs aren't depressed, they just have a shitty life, a shitty job, no hygiene, no nutritional education, are going through a hard place, etc.

Giving pills to these people is a crime

Why do you think you know this? What do you base it on?

It's not your place to decide if the quality of life improvements others experience with medication are worth it or not. Sometimes life gives people circumstances that are hard to cope with, and sometimes medication helps them cope.

> It's not your place to decide if the quality of life improvements others experience with medication are worth it or not

It's our place as a society to ask questions and be very concerned about the fact that more and more people need medication to operate as normal human beings, especially when these medications are dangerous and/or addictive

all of those things cause depression, leading to a nuerobiological effect needing the treatment

You forget the part where the treatments can cause addiction, sexual disorders, suicides, emotional issues, cardiovascular diseases, &c.

These things are prescribed way too easily to people who have tons of others ways to get out of their issues without relying on these potentially dangerous drugs.

Medication definitely has a place, but the current trend of over prescription is very alarming.

It's so much more complex than "take that pill and you'll be happy", in lots of countries these things are prescribed by general practitioners without any kind of mental or lifestyle evaluation. You just show up there: "hey I feel down and anxious" and boom you go home with 6 months of xanax. In my country (France), 25% of people consume antidepressant in any given year, 12% are regular users, several studies concluded that out of these 25%, only 1/3rd have signs of depression [0], I know it's the same thing in other EU countries, and apparently also in the US [1]

[0] https://www.slate.fr/monde/76468/depression-medecins-prescri...

[1] https://archive.nytimes.com/well.blogs.nytimes.com/2013/08/1...

Those things can often work, but the depressed mind is often 100% convinced that there is no way out. Nothing you do can make a difference.

Intellectually you can agree that all those things are worth doing.

But some deep calculating part of your mind will see that between hard work that will not help, and doing nothing which will also not help, the latter is the rational choice.

1. Most of those are not actual treatment, and the association is spurious.

2. Tons of depressed people are still depressed even though they exercise, eat well and sleep.

3. Tons of people are making fortunes peddling these and similar 'cures' to everything :)

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