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Comment by joescharf | Hacker News Reader

Everyone wants a pill as a quick effortless fix, but IMO it seems a lot of our modern afflictions come down to an gross imbalance of exercise, diet, sleep, and social connection. Most likely the way society (see disclaimer) currently functions - how we work, how we consume our limited leisure time is sort of an occupational hazard to peak health.

Not to mention, exercise is "too hard" for most, the food supply is weaponized with sugar and FUD, everyone is so tired at the end of their "BS job" workday, so hit the couch and stream the streams. And now you have a vicious flywheel that quickly turns people into candidates for the latest big-pharma "cure"

HN Disclaimer: I'm in the US and making generalizations based on my observations. Not saying that there aren't needs for pharma / pills / afflictions that aren't solvable by the above, etc...

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> Everyone wants a pill as a quick effortless fix, but IMO it seems a lot of our modern afflictions come down to an gross imbalance of exercise, diet, sleep, and social connection.

For what it's worth, exercise, diet, sleep, social engagement, and lifestyle changes are well-known inputs to addressing depression. Therapists will explore and encourage improvements in all of these areas. Good psychiatrists will as well, given enough time and a patient who is open to listening.

One of the difficult issues is that many depressed patients often don't want to hear any suggestions that depression might be due to anything other than external factors. This is why the pop-science version of the "chemical imbalance" theory became so popular in the mainstream: It gives a plausible explanation that depression is just something that happens to you due to no fault of your own, which is weirdly easier to accept for many people.

There are similar treatment problems with a host of health issues, such as obesity. The trend on social media and pop culture is to explain obesity away as a chemical or societal problem, minimizing the input of personal choice and actions. It's very popular to propose theories that "counting calories doesn't work" or hear anecdotes about people who claim to only eat less than 1000 calories per day but never lose weight (which isn't possible, even 100% sedentary coma patients need more calories than that).

But Obesity isn't very much about personal choice, as evidenced by most people being able to keep a reasonable weight without counting calories or putting in any effort whatsoever, while people like me have to obsess over everything because if we ate the way we "naturally" feel like we should then we'd be blimps.

Or rather, it is about choice, but the choice for some is "obsess over it and suffer a lot more than the people around you for the rest of your life", not to mention generally being treated like not being able to fight your body's compulsions is a personal failing by people who don't have to fucking do that.

P.S.: And before you go shoving your fad bullshit advice of the week at me, it should be noted that at one point I had lost half my body weight and am still over 100lbs down. I have been doing this for over a decade, I have tried every trick anyone has yet devised to make this easier and none of the work for this kind of weight.

Any diet will work for 10-15lbs. Like, literally any diet. This has been shown multiple times. Losing real, serious, obesity-level weight takes significant effort and suffering continuously and anyone who says differently is full of shit.

...unless there's a drug involved. Amphetamines and the new class of diabetes drugs seem to actually work wonders. The former is obviously problematic and ill-advised.

I’ve seen some published studies recently about altered gut bacteria in people whose mothers experienced trauma, altered insulin sensitivity. It’s definitely getting clearer scientifically why weight is so much harder for some

Yeah, there does seem to be a lot of data to support the idea that gut microbiome is a lot more significant to our brain function that we would have assumed, but until there's a reliable treatment I can get or self administer it is pretty much irrelevant to me.

I think the folks on HN are generally aware that weight loss is incredibly hard, I'd be surprised to see anyone here trying to shove fad advice down your gullet.

It happens almost every time. People show up when weight loss is discussed and talk all the pseudoscience behind intermittent fasting[0], Paleo, carnivore, anti-FODMAP, etc. and how that's the key and it changed their life because they are never hungry and blah blah blah.

[0] which I find hilarious because their definition is skipping one meal a day, not skipping entire days at a time the way I did when I was trying it. Skipping a single meal is not, nor will it ever be, "fasting" as far as I'm concerned.

I could flip this around and say that focusing on internal causes of depression is a way for those in power to avoid the social responsibility of having to change it. We can kick the responsibility ball back and forth all day.

Why is it so hard for people to get adequate sleep, exercise, a good diet and social interaction? Even most non-depressed people I know don't do these things well (except maybe the last one), so this isn't something unique to depression.

Exactly this. We throw people into a sick society and then blame them for their lack of personal responsibility when they get sick themselves.

As an individual, yes, do what you can (which might mean changing to a less “sick” culture or subculture so you’re not fighting a sisyphean battle). And also, we should do better as a society.

Society is simply a collection of individuals and their behavior. It is not synonymous with politics.

For example, If people lack meaningful social and don't want to socialize with their neighbors, call friends, or have dialogue with their partners, you can't legislate solution to that problem.

Who said anything about politics or legislation?

It seemed to me that you were proposing that (1) we as individuals do more and also (2) we as a society should do more.

Maybe we fundamentally agree, but I was pointing out that society IS the individuals. doing (1) is how you do (2).

Maybe this is pedantic or my own bias, but I think it is important to keep in mind. Some people use "society" as a substitute for "other people but not me".

When some people talk about changing social norms, they mean forcing other people to act opposed to leading by example.

At the end of the day, I think I agree with you that we do live in a sick society. The best remedy is to cure the sickness in ourselves.

I agree, and it’s an excellent point. I guess I also wonder if we can be more aware as individuals of the forces shaping society and culture, and actively try to engage in changing them. But it still starts with ourselves.

Same with drugs. There's a bit of cocaine-epidemic where I live. With lots of gung-ho politicians clamoring for a "war on drugs" and "zero tolerance" and "hold the addicts accountable", etc. But I don't hear any politicians talking about why so many people want to snort cocaine...

That's because they love their cocaine.

Nice points. You don’t even have to argue about internal vs external causes. The real question is about capability. To me when a person is not receptive to advice about lifestyle changes it’s less about stubbornness or ignorance and more the patient communicating apathy, lack of energy, motivation.

Worrying about fault and taking an adversarial perspective where you see patients as being stubborn or lazy and concluding that resistance to lifestyle changes is due to that is absolutely insane.

People are resistant to those things because they are being told - do all these things and make all these hard changes and you will feel better and have motivation and energy. While they are thinking, “but to do all those things will require a lot of motivation and energy”. So patients are being told to get the things they want, they need to already have them.

It doesn’t matter if depression is a chemical imbalance or whatever. The reality is people get stuck and medication is a very easy initial step that can get them moving. It’s well established that executive control varies among people. It’s not a moral deficit to be on the lower end of that spectrum and be unable to spontaneously will yourself out of a depressive apathy.

> One of the difficult issues is that many depressed patients often don't want to hear any suggestions that depression might be due to anything other than external factors.

I knew someone like this. She'd get new therapists until one of them tells her what she wants to hear.

You're nailing it IMO. If you get to blame society, genetics, or external factors then you don't have to take responsibility. You get a pass. (people think)

To counterpoint your anecdote: I know a girl who is fit, eats great, gets good sleep, regularly goes on long trips with friends, still clinically depressed and struggles to experience any sort of joy which is why she puts in so much effort into trying to improve her life. Still got depression, baybee.

Funny thing. I actually got depression/burnout when I was preparing to run a half-marathon (I do it yearly).

It pissed me to no end that the couple people who got to know about it basically told me to "just exercise more and do volunteer work and it will go away", even when I told them that it was caused by work-related stress.

Telling a depressed person to just start exercising, eating well, and sleeping sufficiently is really not significantly more helpful than telling them to just be happier.

Telling them they can fix their problems without doing any of those is not working either.

And who’s saying that. I think that’s a ridiculous assumption that goes along with anti med opinions

> This is why the pop-science version of the "chemical imbalance" theory became so popular in the mainstream: It gives a plausible explanation that depression is just something that happens to you due to no fault of your own, which is weirdly easier to accept for many people.

Yes, and "chemical imbalance" is totally legit but not like its predominantly being marketed. The chemicals (dopamine, seratonin, whatever) are already present in our bodies - they just aren't consistently expressed across the population. For many people, these chemicals aren't released as regularly or in sufficient quantities for a given time period. Often due to lifestyle, but also just differs from person to person. But hey, put in 45 minutes of Z2-Z3 cardio and it can be amazing how the cobwebs get cleared.

> The trend on social media and pop culture is to explain obesity away as a chemical or societal problem

The somewhat recent corporate opportunism targeting obesity and marketing it as completely normal and healthy, almost something to strive for, is incredibly concerning.

> it seems a lot of our modern afflictions come down to an gross imbalance of exercise, diet, sleep, and social connection

If you think about it in an evolutionary timescale, the way most of us live in the West these days is horrendously incompatible with the sort of life we evolved to live. Thousands and thousands of years were spent out in nature, in small communities, eating certain types of foods, engaging in physical activities, etc.

The sit-on-a-chair-all-day, look-at-screens-all-day lifestyle is a comparatively new development, and neither our minds nor our bodies are suited for such an existence. That's enough to cause us a fair amount of trouble. Add all the socioeconomic issues you mention into the mix, and it all starts to make perfect sense to me.

I’ll add situational-depression to your list: an ongoing sadness due to being stuck in a bad circumstance (bad relationship, terrible job, etcetera). The defining factor is that once the bad circumstance is “fixed”, the long-term sadness is quickly gone (replaced with ongoing contentment) and symptoms don’t reappear. This is not an academic definition, just a personal observation, although perhaps you have seen the effect happen to others in your life.

I’ve had situational-depression badly enough that I would easily have been diagnosed as clinically depressed (more than one person said so, and if I had gone to a doctor I am sure I would have been given a label and some pills). When the cause was resolved, I immediately switched out of the funk and all symptoms of “depression” were gone. I don’t believe it was correlation, that is I don’t believe depression lifting caused me to fix my bad circumstance: I don’t think I had any influence over the actual date the underlying cause was “fixed”. Chronic clinical depression is not usually fixed in a day.

> gross imbalance of exercise, diet, sleep, and social connection

Indeed. What's worse is that we, as individuals, know this. But we, as in the western society at large, seem to be utterly unwilling or incapable of addressing this.

Long working hours to make ends meet. The shittiest food is the most convenient option. There's a metric fuckton of light- and sound pollution which messes with our sleep. 10% of folks suffer from sleep apnea for a variety of reasons. So many things are messing with us. At some point, we're going to have to start dealing with these things.

I know the serotonin theory of depression is pretty much dead, but it is a fact that being around people raises serotonin levels. For introverts it is tiring, but it is better than not being around people.

Being around people reduces cognitive decline in old age.

Being around people reduces depression levels.

Being in a supportive community reduces the severity of symptoms from schizophrenia.

The 2+2 nuclear family concept is an abomination, we are supposed to live in a multigenerational community, surrounded by friends and family.

The modern American lifestyle destroys psychological health. Without large social circles, finding romantic partners is hard, which leads to all sorts of negative life outcomes.

Raising kids is hard, friends of mine who have nearby extended family have a much easier time raising kids (and are more likely to have more kids!) Heck my sister had kids 20 years before I did (bit of an age difference), 2 sets of grand parents, lots of free baby sitting, and aunts and uncles to help out with homework. It was also useful for me, I got to learn a lot about babies early on.

> gross imbalance of exercise, diet, sleep, and social connection

Yeah lots of these are solved with a large social group. I have some good friends (who sadly now live a bit aways from me) who host dinner parties 3 or 4 nights a week. People come over and help cook and clean up, so everyone eats healthy meals all the time.

Friends who have lots of family nearby, just rotate whose house they go to on different nights, all the kids and adults after school/work get together to do child care and cooking. Healthy food for everyone, less work.

Lots of modern life scales up really well. 2 parents will get exhausted taking care of 1 baby, between cooking, cleaning, and watching the child.

4 parents, 3 kids? Much easier. Seriously, piece of cake.

3 grand parents, 4 parents, a young auntie, 5 kids? No problem at all.

Society has seriously screwed the pooch.

If I had some insane amount of capitol I'd try to start some sort of shared housing for families, do intense interviews to match people up (see: My last failed startup) people cook together, raise kids together, support each other. Put 3-5 new/young families in a mid size housing complex with a shared yard. Put a support network in place, house chaperone (cough RA cough) to help out now and then.

Extended Family as a Service. Dystopian, maybe, but possibly it'd do a lot of good in the world.

(If any investors want to get in touch, please do, :-D )

To me, this is undoubatedly a huge part of the problem.

I noticed that my depression spiked when I started to become more isolated. I was getting older, long time friends are now scattered about the country/world, difficult to make new ones. Family members are isolated and scattered doing their own thing in their nuclear units. Parents are divoced and fending for themselves too. Finding a romantic partner under these circumstances is difficult ... having no friends can be seen as a "red flag". It snowballs.

I have also thought of the concept of shared housing for adults. I LOVE this idea.

They share the responsibilities much like a multi-generational family would, they just happen to be strangers.

> Society has seriously screwed the pooch.

Pretty much all available data says as much, but we refuse to do anything about it. Hell, most refuse to recognize there's even a problem.

I've subscribed to this line of thinking my whole life, and mostly still do, but I've had to reassess after watching/listening to the case of Andres Iniesta, a professional footballer who sought professional help in the Summer of 2009. A starter for FC Barcelona and the Spanish national team, having just won the 2009 European Champions league with FC Barcelona and the 2008 European Championship with Spain. Multimillionaire and in peak physical condition, yet fell into a deep depression during the peak of his life. Definitely caused me to reassess my assumptions on clinical depression.

Serotonin syndrome is also a real risk.

SSRIs are extremely dangerous if tryptophan intake is also increased (with supplements, for example), even moreso if niacin is also consumed to encourage the tryptophan -> serotonin pathway.

https://selfhacked.com/blog/serotonin-syndrome/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184959/

> Everyone wants a pill as a quick effortless fix

Isn't a quick, effortless fix the ideal goal? Wouldn't that be better than a slow, difficult one?

Lifestyle changes are a lot harder and more time-consuming than taking a pill; if the latter were equally effective and low-risk for all people, it would obviously be the better choice.

I think so too. 9 times out of 10 a person has horrible eating, sleeping, or drug habits and a sedentary lifestyle.

There is a book that I’ve had recommended to me that posits a similar idea to what you’re saying - it’s called “The Myth of Mental Illness” - I have not read it yet, but will pass along the recommendation to you.

> The Myth of Mental Illness

Having been close to a few people with psychotic disorders (I'm not misusing that term, I mean paranoid delusions, hallucinations, ...), this rubs me the wrong way. A mild case of depression may be safe to approach this way but with serious psychiatric problems that is dangerous.

The author wrote a book saying schizophrenia doesn't exist, and was made up by psychiatrists. While it's probably true that it's a blanket term for what are probably multiple causes or possibly more of a spectrum disorder, I have seen schizophrenia up close. It would be foolish to say it doesn't exist, in that there are millions of suffering people in existence who fit the symptom criteria and benefit from treatment.

You also need to be careful about people who advocate this position because some of them are affiliated with cults.

I'd lump those pill into that list of the cause of modern afflictions. I got off them, because they made things worse, just in different ways than the depression itself. I cured myself with diet and exercise.

Seems rather heavy handed conclusion. And are you just referring to ssri drugs or all depression drugs.

Do you think you would have been able to make the lifestyle changes without medication first? If so then why?

It may be easy after the fact when the depression is lower and you have side effects to look back and judge the value that way. But it may be hard to imagine what did not happen or how life may have trended if not for it.

Obviously I have my own bias. I don’t think I would have been able to start and stick to exercise if not for the kickstart from medication

> Not to mention, exercise is "too hard" for most,

> Disclaimer: I'm in the US

These are related. This is largely from car dependence. In a lot of places you can get daily exercise through walking.

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