Comment by PaulHoule | Hacker News Reader

Comment by PaulHoule | Hacker News Reader

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I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW.

I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thought Vanlafaxine was a comfortable ride but it raised my blood pressure to the "go to the ER" range. Call on the phone and lean in about adjusting your meds. (2) Getting an appointment for talk therapy can take a while these days. (3) In a hard case you can get a more complex medication cocktail from a psychiatrist but the wait could be worse than the talk therapy. (4) People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress. 2 hours a day of cardio helped me deal with a business development process that went on for years before ultimately failing.

> People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress.

This is giving the military way too much credit for organized stress management. If military people give the impression of doing "insane amounts of cardio" it's because that's what the physical fitness tests are biased towards.

And we also won't talk about the fact that getting a psych diagnosis, especially in fields like aviation, can end your career, while managing stress via alcohol gets a wink and a nod as long as you don't have an alcohol-related incident.

Or avoid medication for anything but treatment resistant depression.

SSRIs are not well understood. Their side effects are not great. Getting off them is miserable. I had them. I felt dead inside. Mission accomplished. Depression was gone, so was my desire to eat, have sex, or do anything else. I wasn’t depressed, I was a zombie. 8 adjustments and medications later I got off them and realized they’re yet another pill to fix a problem 98% of people can fix other ways if they tried.

I do not understand this intense desire to be medicated. Exercise, go outside, talk to people. Get good sleep. Once the rest of your life is squared away get some meds if necessary. Psychiatrists and psychologist walk the razors edge of quackery every single day. Talk therapy is a program to take tremendous amount of money from people and funnel it into their account. It’s absolutely nuts the average talk therapist bills at over 300 dollars an Hour. There is no reproducibility in mental health. in their “science”. Therefore, there’s no reason to believe their magical pills will fix problems they barely understand at a biological level.

As a final note people in the military do a ton of cardio because running and rucking is hard work you train for. It is certainly not to “stay sane”.

yeah... i did forget to add meaningful community and spiritual activities to that list but people can have just as strong objections to them as they do to the other things on my list!

100% I have found the same, SSRI's definitely make things worse and I stay away from them, and regular exercise has offered the biggest consistent/persistent improvement in mood.

Medication is the fastest way to make some positive progress before you completely spiral and majorly fuck up your life.

Would you rather take a pill and keep working while you sort things out or would you try to rebuild everything after you burn it all down? Talk therapy and exercise may be just as effective or more so long term, but may not be effective enough in the short term.

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Pfizer ad or not I'll say my AD experience was positive. I got it prescribed by a psychiatric NP in a time when my job situation was about to go to hell but I was planning to tough it out till I got the project done.

I did get the sexual side effects but because men often come too quick it can be a blessing as much as a curse, personally I found it took longer to orgasm and when it did happen it was a much more complex and richer experience with a definite periodization I haven't had before or since.

When I was taking ADs I did have problems I blamed on the ADs that really had to do with the "non-drowsy" antihistamine I was taking crossing my blood brain barrier anyway.

When I did stop ADs I tapered over a month and the physical effects were not bad at all. It was the beginning of a time of personal growth that I can look back on now and think it worked out great but was challenging for the people around me for a while.

Please don't respond to a bad comment by breaking the site guidelines yourself. That only makes things worse.

https://news.ycombinator.com/newsguidelines.html

We've asked you to stop posting like this to HN. I understand that the topic is sensitive and personal, but being this aggressive in HN comments is not ok and we ban accounts that do it.

You've been a good contributor to HN for a long time and most of your comments aren't like this, but there is also a long history of us asking you to stop posting personal attacks:

https://news.ycombinator.com/item?id=46012112 (Nov 2025)

https://news.ycombinator.com/item?id=21867262 (Dec 2019)

https://news.ycombinator.com/item?id=21327013 (Oct 2019)

https://news.ycombinator.com/item?id=17371604 (June 2018)

https://news.ycombinator.com/item?id=16017705 (Dec 2017)

Moreover, your account has continued to be in the habit of posting aggressive comments recently, including personal attacks (e.g. https://news.ycombinator.com/item?id=46478121, https://news.ycombinator.com/item?id=46463522). This is not cool.

I don't want to ban you but it's important to preserve this place for its intended purpose of curious conversation (which depends on thoughtful, respectful comments), so if you'd please review https://news.ycombinator.com/newsguidelines.html and stop doing this going forward, we'd be grateful.

As a long time Usenetter, I don't care about the first two sentences being abrasive, but the material in quotes is insinuating that the replied-to grandparent at some point contained that verbatim text. I have a hunch that it did not, which is not cool. Particularly because the text is negative, making the false attribution defamatory, which is a different category from insults.

Yes, using quotation marks to make it look like you're quoting someone when you're not is a trope of internet aggression and something we've long asked HN commenters not to do: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que..., and is one of the reasons why the GP comment was abusive.

Dunno why you are being downvoted, probably cope. It is well known by now that antidepressants are only marginally effective on average [1-2]. You're right they should probably only be prescribed for quite severe or treatment-resistant depression. Although the treatment-by-severity effect has been somewhat disputed [3-4], it has rough support [5], and makes sense since it is dubious that we should be giving ineffective medication with serious costs and side-effects to people with moderate depression.

[1] https://ebm.bmj.com/content/27/2/69.abstract

[2] https://ebm.bmj.com/content/25/4/130.abstract

[3] https://link.springer.com/article/10.1186/1744-859X-12-26

[4] https://doi.org/10.1192/bjp.bp.116.187773

[5] https://jamanetwork.com/journals/jama/article-abstract/18515...

My take is pessimsitic estimates of AD effectiveness assume you get one Rx and don't follow up and adjust dose and medication choice. I was lucky when I took ADs to have a good primary care doc who had a psychiatric nurse practitioner working at his office and being a good self-advocate.

The "sequential treatment" or "tailored treatment" approach is at least plausible and what is done in practice, yes, if the prescribing doctor is good, and if this is feasible for the patient.

However, since this takes time, and most depression is temporary, it is hard to know if you really are tailoring the medication to the person in many cases, or it has just been long enough you are seeing regression to the mean (or a placebo response, which is still strong even in treatment-resistant depression https://jamanetwork.com/journals/jamanetworkopen/fullarticle...).

There aren't really any double-blinded or even just properly placebo-controlled / no-treatment controlled studies to test this, but the closest thing to looking at the sequential approach also doesn't find very impressive results (https://bmjopen.bmj.com/content/13/7/e063095.abstract).

I do believe the drugs help some people, and almost certainly take some experimentation / tailoring. The average effects are just very weak.

The military does insane cardio because when the enemy knows where you are sometimes you have to run hard and fast in hopes you can get to safety before they can kill you. I've known people who likely would have died in Afghanistan without that insane cardio.

it might help with stress too, but that isn't as clear

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