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Comment by stegosaurus | Hacker News Reader

Treatment for depression is badly handled almost universally... It seems as if people still don't generally understand that it's more than 'feeling a bit sad'.

If you break your knee, you will (99.9% chance) go and see a doctor. If the first doctor doesn't fix it, you'll see another. Your knee is broken, unusable, painful and you have a drive to fix it.

A more serious injury will generally result in a friend/family member/passer by getting you to a doctor.

If you suddenly enter a depression... even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.). And if you see them and they give bad advice, you maybe can't be bothered to see the next one. Or you miss the appointment because getting out of bed was too hard. Etc.

It's more severe than most physical injuries because it affects your ability to seek help.

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Not to mention the social stigma that still(!) haunts depression (and virtually all psychological injuries). Few physical injuries have any sort of stigma - and the ones that do are usually associated with depression. Certainly it would be better if that stopped entirely (and, as with homosexuality in general, and gay marriage, it seems to be happening).

That said, I actually have sympathy for the stigmatizers. From their perspective a perfectly healthy person with no overt negative stimuli is profoundly unhappy for no reason. That's got to be frustrating because it's completely and totally opaque, untouchable, alien, and unaddressable. The condition stymies the compassionate person, making a mockery of their good intentions. That is frustrating, even angering, and is probably the cause of the ambient hostility that lingers around depression. Depressives behavior appears stubbornly self-destructive, which essentially and irreducibly thwarts the will of those that care for them.

It doesn't matter much if a person is sad for no reason, no one wants to be around someone who is sad.

This didn't deserve a downvote, it's a good observation of the problem. If you're depressed, it's very hard for people to be around you, and that makes the depression worse.

Yep. In fact, I think that (apart from clinical practitioners who might find it fascinating) the people best positioned to help the depressed are those who've experienced it themselves, and overcome it.

I'm depressed. It comes and goes, but generally in the middle of an episode I don't want to be around other people either, which I think compounds the issue.

I think one of the issues is that often when it comes to depression treatment precedes diagnosis, and treatments affecting the symptoms can make the diagnosis even more difficult.

People going to their GP with a 'I feel depressed' that get told 'well, here's a prescription for some pills, let me know if you feel better with them if not I can give you something else to try' would be the same as if somebody reports a thorny concurrency bug with your embedded multithreaded application and your first response is 'well, let's try to overclock/underclock the CPU to see if it improves things, if not maybe we can try to change the RAM next time'.

It is a lot cheaper for medical services as a whole to have GPs easily prescribe antidepressants and psychoactive drugs in general rather than have psychologists available immediately for anybody who might need them, but it does not make it right.

Others might not share my misgivings but I would only be willing being prescribed a psychoactive drug by a specialist (psychologist/psychiatrist) after a thorough evaluation and non-pharmacological therapy first, and even then very conservatively and after an explanation more objective than "you have a chemical imbalance in your brain" (which chemicals? what imbalance? what should be the normal values?).

There should be much easier and cheaper access to non-pharmacological treatment for mental issues, but maybe to have that one would need it to be destigmatized, which of course is a very slow process and might or might not be possible due to the identification we have with our minds: if our knee hurts we think "my knee hurts, it needs fixing" if our mind hurts we think "I feel bad, I am a worthless person" which is a lot harder to deal with unfortunately.

This is further compounded by the stigma & blame that surrounds mental illness, which can be quite severe in certain cultures/countries e.g. China

Add India to the list

Plus you can get banned from entering the US

http://www.cbc.ca/news/canada/toronto/canadian-woman-refused...

wow is this forreal?

I feel like laughing not out of happiness but out of despair(think: The Killing Joke) because I exactly understand what you mean by 'pointless'.

> even getting to the stage of seeing a doctor can fail, because suddenly everything is 'pointless' (bad wording. sorry.)

Everything actually is pointless, since all matter and energy will dissipate from entropy on a long enough time span. Also everyone you know will be dead in 100 years, most likely.

Also most of these people would go see their doctor if there was a million dollars in gold waiting there for them. It's not that 'everything is pointless' is the reason preventing them, but rather that there isn't enough significance in seeing the doctor.

Yes, all true, but you'd have to be depressed to not have the cognitive biases which prevent you from making this more than an academic observation.

I modified my original comment, so I guess I'll rewrite it. And I totally agree.

> Also most of these people would go see their doctor if there was a million dollars in gold waiting there for them.

I'll caution you against this thinking, in general. If you have a depression so severe it keeps you from seeking help, you're probably well aware that it's a matter of life and death. Even if you're not acutely suicidal, you live day to day just "running out the clock", hoping it doesn't get any worse before you die. The prospect of wealth or fame in your future is not only not enticing; it may well make you feel worse, as self-awareness of your inability to care reinforces your depression.

The idea that people who are not motivated by death will be motivated by money is, while not categorically false, surely fraught.

I can't agree with this. Having had a lovely time with depression a couple of times you could double that amount and it wouldn't even register. Depression isn't a lack of motivation, a lack of motivation is a symptom of the greater issue

Merely anecdotal evidence of course, but I don't think you're on the right path here

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