Comment by hobin | Hacker News Reader

Comment by hobin | Hacker News Reader

I was going to respond to a few of the comments here, but then I realized I was going to say pretty much the same to all of them, so here goes:

I've got clinical depression. What this means is that there is something fundamentally wrong in my brain that causes me to be depressed. There is no direct environmental cause that makes me depressed. Now, here's what many people get wrong about severe depression:

Severe depression does NOT mean that exercise, a healthy diet and getting a social life won't help at all.

Rather, depression completely drains your motivation to do any of those things. Which in turn make you more depressed. Which makes you even less likely to do any of them. And so on and so forth. It's 'positive' feedback, but it starts with a neurological problem. This is why all the 'cheer up'-sort of advice doesn't help people who're depressed, and why it tends to only make them more miserable.

Of course, this is only my experience. I'm quite sure there are plenty of people who are depressed for reasons found in their environment, and then get stuck in the same loop. But it would be ridiculous to presume that I'm unique in this regard.

I also have clinical depression, and this has also been my experience.

Something which also adds to the problems is that people so often condescend - 'you won't feel better unless you do X, Y or Z' and actually essentially accuse you of bringing it on yourself. And a lot of the problem is the guilt you feel about everything, so it's the worst possible thing you can do for a depressed person.

I find having some project that gives you an output is important, to contradict the standard 'oh don't spend so much time on a computer project' points. The alternative a lot of the time for me is spending all day in bed because I feel so low, so having an outlet matters. But of course you then find it hard to balance that.

Having said that, all the standard healthy advice is important too. It's just really important to differentiate between mild and severe depression - it's like the difference between having the flu and people recommending painkillers and having a serious chronic disease. The advice is good for mild depression but really not going to touch anything for the severe variety.

For people who are lucky enough not to suffer from severe depression - don't presume to know what it's like because you've felt a little bit low before.

/rant

"clinical" depression is meaningless. Literally, it has no meaning. Perhaps you mean "Diagnosed by a real doctor", as opposed to "self diagnosed from a check list"?

But when we look at depression diagnosed by experts we see a variety of forms, and a variety of strengths.

I agree that well meaning people sometimes offer really bad advice.

But advice about developing a healthy lifestyle (being careful with caffeine, alcohol, recreational drugs; eating better; sorting out sleep; getting exercise) and developing a social life are important, because these thing help people with very serious, life threatening, illness. In combination with therapy they can be part of an effective cure for many people. (At least leaving others with several years of recovery). If needed, this advice can be combined with medication. And, if needed, all of this stuff can be started if the patient is in hospital. (At least in England all MH hospitals should have programmes of OT to start social life outside hospital and they should have some kind of exercise stuff, and contacts with local gyms.)

I've known people who are ill enough to require electro convulsive therapy and they said that this other stuff was important to them, but that they needed help to apply it.

And that's the important thing. Saying "I am to ill to do this stuff" is not the same as saying "this stuff would not be helpful to me if I did it". What people need is help to apply this stuff.

Well, to me 'clinical' depression implies diagnosed by a doctor, yes.

Sure, and it does vary a lot. So perhaps I meant to say severe vs. mild.

People overstate these things to a degree. Like I said, sure they help, but it's scratching the surface IMHO. What's more important is to attack the depression itself, directly.

And, though anecdotal, I've been through periods being severely depressed despite going to the gym a lot, and eating relatively well, and had it make very little difference. I've also socialised a lot and had that make no difference. So this isn't just conjecture.

I guess part of it is that it varies from person to person. Also the degree of the depression at any given time waxes and wanes.

And agreed, a key thing is to admit you can't do it all by yourself, and go and get help.

The key thing, however, is for people to lose that attitude of 'go get a life doing things I think are healthy/fun and you'll be happy' because, basically, that's b.s. projection, and for some it borders on blame-the-victim mentality.

I think diseases like depression are particularly problematic because people don't take them seriously and imagine that they're not all that serious, perhaps slightly made up, or not as solid and easy to diagnose and understand as a physical illness. Perhaps people need to come to respect it more.

In most cases CBT & exercise and better food is attacking the depression itself, directly.

> The key thing, however, is for people to lose that attitude of 'go get a life doing things I think are healthy/fun and you'll be happy' because, basically, that's b.s. projection,

Yes, I agree.

Yeah, I guess I'm saying CBT (+ related, I find SBT[1] very effective myself) >>> lifestyle improvements.

[1]:http://en.wikipedia.org/wiki/Schema_therapy

The phrase "clinical depression" distinguishes depression (in the clinical, officially-diagnosed sense) from depression (in the informal, no-more-cookies-angst sense).

If you want to know more about the technical meaning of "depression," consult DSM.

But "clinical" has no meaning. It is not mentioned in DSM or in ICD.

There are hundreds of types of cancer - does the DSM have a general entry called 'cancer'?

'Clinical depression' is a way of specifying something more problematic than simple sadness. When your sports team loses, you get depressed.

No, depression is enough to distinguish from simple sadness, or grief, or other forms of sadness which are not pathological. Depression is already defined as an illness, and not simple sadness. Prefixing nonsense words does nothing to increase understanding of the illness of depression or of the normal forms of sadness that people experience.

Medical professionals do not ever call something clinical depression. They'll use words like reactive or endogenous etc.

The solution to people mis-using the term depression to apply it to things which are not depression is to stop people mis-using that term, not to invent other terms.

> When your sports team loses, you get depressed.

No, you are sad, fed-up, gutted, sick as a parrot, annoyed, frustrated, mournful, etc. You are not depressed, because depression is an illness.

The other problem with "clinical" is that it is widely used by cranks - see for example "clinical nutritionist".

Let it go man. The distinction makes sense for a lot of people and you're just being a stickler and a contrarian at this point.

'Depressed mood' is regularly used in both psychology and medicine. "The patient arrived in a depressed state" does not mean that they have one of the ongoing illesses of Depression.

Medical professionals do not ever call something clinical depression.

I used to work in a neurology lab, and I heard consultant neurologists use the term. I do not agree with 'do not ever'. Unless you're counting medical specialists that take 13 years to train as somehow not being 'professionals'.

Just googling 'clinical depression' comes up with a few links of professionals (like the Mayo Clinic) using the term. The important thing to not is that just because a term might not be in the DSM does not mean that the term is not used or meaningless. Yes, I'll agree, it's not used to refer to one specific disorder, but that doesn't make it meaningless.

You are not depressed, because depression is an illness.

Depression is an illness. It is also a transient state. You're doing the same thing as those people who say "but 'kid' actually means 'baby goat'".

The other problem with "clinical" is that it is widely used by cranks

Fallacy of association: Cars are widely used by criminals, therefore we should not use cars. Would you really correct a co-worker who said 'bob is depressed because his team lost last night' with 'no he's not, because depression is an illness'?

'clinical depression' has a biological base and responds better to pharmaceutical intervention, and generally covers the diagnosable stuff in the DSM. 'regular' depression is just being sad because of life events - when your wife leaves you and your dog dies, that's when you get 'regular' depression.

> "clinical" depression is meaningless. Literally, it has no meaning.

That would be incorrect, sir: http://www.mayoclinic.com/health/clinical-depression/AN01057

In my experience, depression is something you can't cure. You can fix it for a while, but it always lurks, waiting to come back.

In my case, environmental changes ensure that it won't show up again as strong or as fast. I'm pretty sure I don't need medication right now.

But that's not to say I'm cured by any means. Just that I'm doing better and finding ways of coping with it.

Could you describe those environmental changes, I've been curious about this for a while.

Got decent furniture, got the roommate to get his own apartment and I am sprucing up the abode in general so that it looks like a person actually lives here, rather than inhabits the space. Using brighter colors that are outside of my usual blacks and browns. This is all very normal stuff for other people, I suppose, but its something I never really thought about. I wasn't paying attention to my surroundings much. As it stands right now, I wouldn't be ashamed to invite people over for an evening, whereas before, I kept my door shut so people didn't see the mess.

I'm making an effort to be more sociable, which is difficult. I'm middle-aged and haven't dated or had a relationship since high school and so I've got some real hurdles to overcome there. That part may be impossible to overcome, but I'm trying it, slowly.

The very affectionate cat I've had for a couple of years helps, too. A pet forces you to focus on something other than your own misery. Plus, it's hard to have a suck day when the cat is standing on your chest, headbutting you in the chin or trying to eat your hand while you type.

This isn't necessarily the answer for everyone. It may only be me. I do know that a year ago I was very miserable, felt worthless and dead inside, and now I don't feel like that anymore.

Have any forms of cognitive behaviour therapy or say innerchild/regression therapy helped or been explored? Have you explored dietary changes? Did you have ear infections as a child (relevant question)?

Yes and yes. Both didn't work, or didn't have enough effect to get me out of the no-motivation cycle. Ergo, SSRIs (which thankfully did work). Yes to the third question, too (as a matter of fact I had a cholesteatoma). Could you tell me how that is relevant?

It's not likely relevant, really. Sometimes people are depressed after flu or ear infection and attribute it to that.

There's some sense in:

1. If you're stressed and/or avoiding sunlight, you're more likely to be depressed and fall ill.

2. You feel less pleasure while severely sick. Personally, I notice my affect when thinking about everything is dramatically different. I discount it for that reason.

3. Depression apparently involves some feedback loops that can make it a fairly stable equilibrium; so the shift in experience during the sickness might linger (perhaps the isolation and lack of sun while sick lingers).

I don't see any studies showing a strong link. To present my own anecdote, I had a dozen ear infections before my teens and have never experienced depression. This is a very small bit of evidence, though.

Sorry for the delay in responding. Hearing can actually be related to depression. http://www.aitinstitute.org/ - the website / therapy is marketed towards children with autism as that is the largest group affected, and the most severely. There's an out-of-print book called "Hearing Equals Behaviour" by the researcher who 45+ years ago discovered a correlation between hearing and behaviour. People are 100% going to be depressed if they have a hearing imbalance at 1,000 Hz; Imbalance is if say in one ear the lowest you can hear is 11 Dbs, and the other ear you can hear at 14 Dbs - that shows an imbalance of 3 Dbs. The sound therapy I listed helps let the mind 'release' and equalize those imbalances. If you have an imbalance at 1,000 Hz then medication won't he, cognitive behaviour therapy won't help. I imagine it's possible to not be "locked into" a depressive state, but set into one temporarily with hearing-related issues early on - I'm unsure it would fruitful to investigate further.

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