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I don’t know. Doctors nowadays (especially in the US, it seems to be less prevalent elsewhere) seem very quick at prescribing medication.

And while I don’t doubt that there are serious physiological conditions that warrant, even necessitate, medicating, my impression is that the first response to “depression” in general shouldn’t be medication.

I’ve been depressed in the past, in my 20s even severely. Clinically, you could say. But in the end, every one of those depressive episodes were because something was not right in my life.

Whether I acknowledged it or not, whether I even realized that there was a problem, once I figured the issues out and took the sometimes very painful and exhausting steps to sort them out, the depression faded away.

Over time, I’ve become better at introspection to figure out what’s really bugging me, and also in recognizing a budding early depression as warning signs.

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As someone with treatment resistant depression, it is odd people are against medication. Medication is proven safe and effective for treating depression. Therapy and medication should be used immediately in conjunction because 1. therapy is most effective when paired with medication, and 2. depression is a vicious cycle. The longer someone spends depressed, the more likely they will spiral into deeper depression, isolation, unemployment, etc.

No one should delay any part of depression treatment.

Same for me. Its so odd having an illness, and taking medicine against that illness, and mostly reading an "universal truth" that the medication that helps you is bad someway. As you say, therapy but also getting a better sleep hygiene, better nutrition and exercise is so much easier with medicine.

Note what I actually wrote:

> And while I don’t doubt that there are serious physiological conditions that warrant, even necessitate, medicating, my impression is that the first response to “depression” in general shouldn’t be medication.

It’s very well possible that you, and the person you answered to, are solidly part of the “needs medication” fraction. I do not believe that medication against depression is bad in general.

I know a surprising number of people who take ibuprofen daily but will avoid stretching and exercising.

Ive read from people having written more than 600-700 applications and are still without _any_ job - and those may have a mortgage.

How shall "proven and safe medication" help here?

Agree that medication isn't necessarily the answer - mine was therapy not pills. But all of it is still medical assistance. And the medication helped me get started on the therapy, I'm not sure I could have got to a place where the therapy could have helped without it.

Glad your journey has been positive, well done :)

There’s little reason to avoid prescribing medication alongside other approaches. It’s not that meds are the only option or they should be reserved for the most severe cases, it’s people’s reactions are different and there’s no way to tell without trying them. For some people they really do work wonders and you simply don’t know ahead of time.

Not everyone has a support structure they can count on as they fall apart. So some people just need help to get through a rough period even if a solution isn’t long term viable. When a spouse dies being able to function for the next few months can mean keeping the roof over someone’s head.

> There’s little reason to avoid prescribing medication alongside other approaches.

There absolutely are downsides and risks. There is a reason the SSRIs carry a "blackbox" warning for youths due to increased suicide risks. There's a reason they should only be used under supervision of a doctor and need to be tapered off of.

That is not to say they aren't useful and necessary for some/many people but they aren't and shouldn't be a catch-all treatment.

A very specific edge case: If you ever think you might want to become a pilot, even just to fly small airplanes, the FAA still considers ADHD, depression, social anxiety, and other conditions where you are prescribed medication, to be disqualifying. And this is a "have you ever in your life" question on the medical form. So if you're prescribed ADHD medicine, even as a child, I understand that while it's not impossible, you are going to have a major uphill battle if you ever want to fly airplanes.

Mm. I'm glad for you that you can just think about your problems harder and get better, but that's not the reality of it for most people with depression.

Meds don't magically make you happy and they don't magically get you out of fixing the problems in your life. They make it easier and therefore possible to do so. I'd describe it as the crane that lifts up the heavy weight enough for you to shuffle out.

If you can just think harder about your problems, by all means, do that. But there's zero virtue to rawdogging it when help is available, especially as this can easily lead to an isolation spiral and become deadly.

Yes, I believe thinking can be hampered by depression...

>I don’t know. Doctors nowadays (especially in the US, it seems to be less prevalent elsewhere) seem very quick at prescribing medication.

My experience from being a mental-health patient is that things take too much time. For me I struggled with how it seemed like that the society universally had agreed that medication for my condition is bad. Taking medicine doesn't mean that you cant threat your illness in other ways as well, in my experience taking medicine helps you to be able to take the changes you need in life.

As someone medicated I actually fully agree with you.

Depression is also a broad spectrum condition (much like autism). Years ago I watched this lecture by Sapolsky[0] and it really helped. Breaking down the different classifications is really helpful. The SSRIs always made me feel worse, and this (along with a lot of other research) helped make sense of it. A few years back I was diagnosed with ADHD and a psychologist friend encouraged me to give Adderall a try. It was the first time that medication "worked" and it really made a big difference in my life. The big reason why being that psychomotor retardation and anhedonia were my biggest symptoms. When coupled with an anxiety disorder it creates a strong negative feedback loop.

But here's the thing: medication isn't the cure. For me it alleviates (not eliminates) symptoms but at the end of the day it still requires work from me to ensure I create a positive feedback loop and don't let myself fall into that destructive loop. This is all stuff I had to learn on my own and through reading and seeking out friends with people who are more experts in the area. That's where I think our care system fails.

The best thing I can recommend to people is to be introspective. Each journey is personal, but whatever your issues are try to find the early warning signs. For me it can be little things like the dishes piling up or my desk getting messy (these seem you be common). Things like depression build up, so look for the signs. And most importantly, open up. This was the hardest for me and makes me feel demasculated and embarrassed much of the time. But I've also found it to help build stronger relationships with my partner and friends. That it helps open a door to communicate both ways. Maybe you open the door for you, but you also open a door many are too nervous to open themselves. It's worth the discomfort and gets easier with time. (Talking behind a handle is a great way to start too. So make alt accounts if you need to. That's how I started)

[0] http://www.robertsapolskyrocks.com/depression.html

you took amphetamine and weren't depressed suddenly? in my experience, that lasts a bit, but give it another decade or so. it tends to bite in other ways.

What ways?

Going to depend on your dosages. I try to stay low and will take breaks to help reduce dependency. I actually really dislike the feeling of a high dosage and it does have negative effects at that end.

Also remember that everyone reacts differently to things. SSRIs work great for some people, but not for me. So it's worth trying different classes of medicines too but also to make sure that when having more dangerous ones. I made sure close friends knew too

> were because something was not right in my life.

THIS! Thats the reason why I always refused to take any medication: Doctors said you could "try X or Y and in some days I should feel better" - while the problems where mainly because of problems at work or within relationship.

Why should I take medics if I have problems at work with bad colleagues? This logic never made sense to me.

And my 2ct: If this wouldnt be a hardcore capitalist society in which most people struggle despite the fact living in a rich country, possessing nothing and having no homeownership, then there would be near zero demand for any psy medics.

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