> They talked extensively about how brain chemicals work and how medications help to balance out those chemicals
The only problem with this is that it's essentially a PR line that both doctors and the general public have mistaken for science. We don't know all that many facts about how brain chemicals work with regard to mood disorders. We have empirical results from clinical trials and broad use of antidepressant and antipsychotic medications, but there is no basis to believe that medications "balancing out those chemicals" serve to repair mood disorders.
If the medications helped, then great, I know they have helped a great number of people, but they also fail to help a great number more and these success stories have an unfortunate tendency to marginalize people that do not get good results from medication. It often results in victim-blaming, to make sufferers of depression wrong for stopping their medications for legitimate reasons (let's face it, all of these results are highly subjective), and for overstating the ability of our current medications to cure all mental ills.
it's essentially a PR line that both doctors and the general public have mistaken for science
That sound derogatory.
Did you expect her to go into detail about serotonin, what the latest Science tells us it does, what serotonin uptake inhibitors do, etc?
The woman wrote an article that is really just an ice breaker on how she and her partner dealt with acknowledging that there was a depression problem and getting help for it. She felt that her contribution to the problem of depression was to relay a little of Wil Wheaton's story from her perspective.
but they also fail to help a great number more
No one has said that every case is the same. In fact, TFA specifically mentions that fact as well as anecdotally telling us about how Wil had to change his dosage and medication to meet his specific and dynamic neurological profile.
The problem wasn't that 'medications help to balance out those chemicals' is an oversimplification, it's that the theory doesn't have a lot of support. The evidence for the monoamine hypothesis is far from conclusive. I agree with the parent that 'chemical imbalance' is a PR line if stated as a medical truth. (I am only commenting on the class of medications mentioned in the article)
It's a PR line because everyone wants mechanism explanations, and the truth, "If we poke at people's brains with sticks shaped in these ways, their mood improves" is unpalatable.
That "sticks shaped these ways" happen to affect neurotransmitter levels is a great guide to finding others, especially the great moves in safety from MAO inhibitors -> trycyclics and the like -> 3rd generation started with Prozac, is sort of besides the point. That they make a really significant difference for lots of people is.
Not that wikipedia is the last word, but, "[...] companies such as Pfizer continue to promote drugs like Zoloft with advertisements asserting that mental illness may be due to chemical imbalances in the brain, and that their drugs work to "correct" this imbalance. Most academics believe that the advertisements are oversimplified and don't fully explain what is happening."
I didn't say it wasn't an oversimplification, I said oversimplification isn't the problem. You seemed to misunderstand the complaint of the first post you replied to.
You said, "it's that the theory doesn't have a lot of support"
I was simply pointing you to a reference that showed that "academics" use the exact same language regarding chemical balance of neurotransmitters as the original author.
Notice that it didn't say, "Academics disregard the chemical balance explanation because it lacks evidentiary support."
> Numerous studies to identify reproducible changes in neurotransmitter levels in the cerebrospinal fluid of clinically depressed patients, or to induce or correct depression by manipulating brain serotonin levels, were inconclusive and fraught with methodological limitations.
> Gordon McCarter, PhD, an assistant professor of biological sciences at the College of Pharmacy of Touro University in Vallejo, California, agreed that the evidence for an "imbalance" in neurotransmitters causing depression is "circumstantial" and "more and more tenuous." He noted the dearth of studies showing any measurable difference in serotonin or norepinephrine between depressed patients and controls
> "The Diagnostic and Statistical Manual of Mental Disorders does not list serotonin as a cause of any mental disorder; it is simply one neurotransmitter that continues to be investigated. And the prescribing information for the SSRIs does not claim that their mechanism of action is to correct a chemical imbalance, although this is exactly what the advertisements claim."
> "We suspect that many consumers believe the serotonin theory to be more scientifically based than it is, and that they might have chosen an alternative approach to their distress if they were fully informed.
The entire "chemical imbalance" model is a lie designed to make drugs easier to sell, and here's a simple pair of facts which prove that the science is bunk:
SSRIs increase levels of serotonin at the synapse when administered by preventing serotonin re-uptake and recycling, improving mood.
SSREs decrease levels of serotonin at the synapse when administered by enhancing serotonin re uptake and recycling, improving mood.
Two drugs with opposite effects achieve the same qualitative result, even though it can't be said that they produce similar quantitative results. Thus, vastly different quantitative profiles are correlated with the same qualitative results; X + 1 = X - 1.
On top of that, there's no way to even measure levels of synaptic neurotransmitters in vivo.
There are multiple serotonin receptor types, and the "selective" types of reuptake modifiers don't affect all of them all the time in all people.
That said, too much or too little serotonin absorbed by a specific set or another can have wildly different effects.
Too much serotonin is not a good thing. So you need to balance it. For some people, this means SSRIs, for some it means SSREs. That's the explanation for the imbalance model, and it does make sense given the science.
It's ridiculous to talk about "balance" when you can't actually measure any of the quantities you're trying to balance and don't even have a clear picture of what "balance" looks like qualitatively, never mind quantitatively.
Sure, blast a brain with drugs that aren't well understood and it'll behave differently, maybe "better" than before, relatively speaking-- but that's not a scientific model so much as a pragmatic clinical solution.
It's ridiculous to talk about "balancing" the flavors of your soup when you can't actually measure any of the quantities you're trying to balance and don't even have a clear picture of what "balance" looks like qualitatively, never mind quantitatively.
Sure, dump in a bunch of spices that aren't measured and it'll taste different, maybe "better" than before, relatively speaking--but that's not a scientific model so much as a pragmatic cooking solution.
It's obvious you don't know very much about serotonin. Here's why:
SSRIs bind to the serotonin transporter SERT. The 'selective' part means that it has a much higher affinity for SERT than other monoamine transporters (e.g., DAT or NET). Although you're correct that there are various serotonin receptor subtypes, there is only one known SERT (there is only one gene).
SSRIs do exhibit extremely weak affinity to serotonin receptors but it is so low that it doesn't matter which subtype has a higher affinity than another. If you want to latch on to 5HT receptors with interesting ratios and affinities, the correct psychiatric drug would be an antipsychotic.
Please stop defending the chemical imbalance model when you do not understand the science at all. Thank you.
Do those two drugs achieve the same effect in the same patients? There are plenty of treatments with opposite effects that achieve the same qualitative result, in different patients with different conditions that merit different treatments. Could that simply be the case here, or do both kinds of drugs typically work in the same people?
What is scary is that some doctors / people consider medication a panacea for curing mood disorder when it can actually get worse initially. Clinical results are much better when it is combined with behavioral therapy (skills training on how you talk to yourself in your mind). Antidepressants take weeks to have a consistent effect on serotonin levels and a lot of patients only on medicine might initially feel hopeless because it seems the medicine isn't working, yet it might be working enough increase motivation (but not mood). This is part of why antidepressants may increase risk of suicide (you might have more motivation to take action without yet experiencing enhanced mood). PLEASE - if you or anyone you know is going to start taking antidepressants, combine it with behavioral therapy, and realize the mood changes take time to work.
Damn, I know of a similar story, but very different ending. I had a family member with depression try to get help. He started on Lexapro, and ended up committing suicide a week later. I had to sit there and read testimonials of people that lost friends and family attributed to taking lexapro to the mother of the deceased while she was beside herself, yet in insistent that I read.
I self medicate with marijuana. And more than just using it to make me happy, smart, excited and hungry. I grow pot medicinally as well and that makes me feel really happy. There is loads of scientific evidence that points to having a garden and lessening depression. From my experience, I can say that growing marijuana really lends itself to a lot of the benefits of having a garden. Because you can harvest 5 to 6 times/year it makes it something you need to work on every day. Progress is relatively fast, and if you do a good job, you can take it to a shop and get enough spending cash for that new macbook apple just announced. And if you are a champion, you can find your nugs in magazines. (my ghost og kush is featured in culture this month...) But ultimately nothing feels better than smoking my own herbs on Friday night after a long week of gardening and programming.
Just throwing it out there as another alternative for someone that is struggling. Been there, you just gotta find the light.
> He started on Lexapro, and ended up committing suicide a week later. I had to sit there and read testimonials of people that lost friends and family attributed to taking lexapro.
I don't want to belittle you're experience, because losing a friend to suicide is always brutal, but I do feel that its important to look at reports of anti-depressants causing suicide with a critical eye.
Almost all ant-depressants carry a warning that they can cause suicide, but there are a couple of factors in that:
1. Almost by definition, people who are prescribed anti-depressants are more likely to commit suicide in the first place.
2. I can't find the source on this one, but I've certainly been told by psychiatrists that the first few weeks after going on anti-depressants carries a higher risk of suicide than before going on them. The theory is that during those first few weeks you've been given enough of a kick by the drugs to provide a bit of motivation, but you've not yet had the chance to address the actual cause of the problem. That combination can result in having just enough motivation to carry out your desire to kill yourself.
Unfortunately you'll often see doctors prescribing medication without then following it up with the necessary therapy to help their patient move on from whatever got them into the situation got them to this point to begin with.
>That combination can result in having just enough motivation to carry out your desire to kill yourself.
Have we ever had a testimonial from a failed suicide in these circumstances? In my case, as my depression and anxiety issues started going away, I suddenly realized how much of a complete weirdo others must see me as and felt shame comparing myself to others in my peer group who, without depression holding them back, have become much more successful. It was a brutal eye-opener for me. I guess when I was depressed I really didn't consider these things or they simply didn't bother me.
It really brought up a feeling of hopelessness, like I wasted my youth and thus will never catch up, or will always been seen as defective in some way. I guess it doesn't bother me much anymore, but given sudden clarity like that can be intimidating. I imagine if someone is already suicidal, it can be a tipping point.
> I suddenly realized how much of a complete weirdo others must see me as and felt shame comparing myself to others in my peer group who, without depression holding them back, have become much more successful. ... It really brought up a feeling of hopelessness, like I wasted my youth and thus will never catch up, or will always been seen as defective in some way.
Preach it brother! I feel the same damned way.
> I guess when I was depressed I really didn't consider these things or they simply didn't bother me.
I revel in my weirdness when my mood is different from others-- they're just polyannas. Makes it harder to make that appt. to get the meds adjusted.
Nah, I don't think your comment belittles my experience at all. You bring up all the points that people were talking about around the time of the tragedy (last October). The point of my comment was to show there are windows open when doors seems closed, if you know what I mean, rather than sensationalizing what happened to some random guy x I that I know. Good points!
There is little doubt that antidepressants can cause new suicidal thoughts in children. In general use antidepressants can cause manic behavior and other psychological issues.
This is a very tricky subject where language fails us a bit - what exactly is a 'suicidal thought,' or 'suicidal ideation' as clinicians put it?
You can be depressed and think that you want to die, or that everyone else would be better off if you were dead, or that being dead would be preferable to stewing misery...but feel too apathetic to do anything about it. With or without drugs, you can be in a more active mode where you feel like doing something about your problems, but still feel miserable or be acutely conscious of the pit of misery that you just left, eg if you're bipolar and having a manic episode. So the drug or mood swing might correlate with the impetus to commit suicide, eg getting up and going somewhere to do so or making use of tools to that end. But is the 'suicidal thought' the desire to stop living, or the practical action upon that desire? As someone with some first-hand experience in this area, focusing on the latter seems like blaming the period for the ending of a sentence, while avoiding engagement with the semantic content thereof.
I'm not saying that drugs or other factors can't induce the idea by any means, but most discussions of this issue seem to involve a heft does of post hoc ergo propter hoc, ie the correlation = causation fallacy.
Suicidal ideation covers active thoughts ("this is the method I will use; this is my plan; here is a note") and passive thoughts ("I wish I wasn't here anymore"; "they'd be better off without me" etc).
Depression covers a broad range of behaviours and severities.
But to say "anti depressants can cause odd thinking in some people during the first few weeks of use, and people starting anti depressants should be closely monitored" is not controversial. You mention bipolar - it is important to be very careful with SSRIs and people with (possibly undiagnosed) bipolar.
As a counterpoint, there are a lot of problems with marijuana use for depression treatment.
1) It's inebriating, so you shouldn't drive or operate heavy machinery after using marijuana. It's definitely possible to control your dosages a bit using a vaporizer or pipe, but it takes a fair bit of experimentation to determine your tolerance level.
2) It's short-acting. Whereas the contemporary antidepressants affect baseline mood over a period of time, the mood-enhancing effects of marijuana will largely wear off after 3-6 hours.
3) It's illegal to grow in the US without a license and has varying legality regarding consumption, buying, and selling throughout the world. This might not matter for some people, but it should be a strong consideration for people with families or people who work in environments with routine drug testing. As a child of a parent who used to grow marijuana illegally, it stressed me out as a kid learning to be anti-drug in school yet dealing with the drug-using and growing parents every day.
Also (to those reading this) be careful to look up the fact(?) that for some psychological profiles, marijuana can actually aggravate existing tendencies for mental disorder. I have no idea of the rates, so maybe it's very rare, but I've heard of it happening.
One basic example: I've heard some with anxiety say it calms them down. I've heard others say it makes them freak out.
For some folks it can cause a psychotic episode; this happened, for instance, to an acquaintance who was also bipolar.
Carl Hart's book "High Price" had some interesting anecdotes about how drugs interact with underlying brain chemistry, environment, and cultural expectations to give different experiences.
With bipolar stay well away from mind altering substances unless its under professional supervision. The combination of an already delicate brain chemistry, recreational drugs, and quite probably a cocktail of mood stabilisers and anti depressants isn't a pretty sight.
> For some folks it can cause a psychotic episode; this happened, for instance, to an acquaintance who was also bipolar.
I believe I've also met a bipolar person who had a psychotic episode from pot, though the dude apparently was doing an insane amount; claimed to be having THC flashbacks, which I'd never heard of.
I'm one of those people for whom weed brought about psychosis (requiring a three week hospital stay -- I was certified). I smoked for ~13 years before this happened; I definitely had other negative side effects but nothing nearly that drastic. I don't smoke anymore.
I do do a lot of other stuff (meditation, CBT, ...) and life is pretty good these days.
Thank you for openly sharing here. The biggest concern I have about self-medication is a doctor isn't involved to know when helpful uses turn problematic (consider more challenging drugs shown to help brain health). In the case of marijuana the ridiculous regulations mean that the pharmaceutical companies have had a monopoly on validation studies for over 50 years. That looks to be changing and hopefully soon.
Eerily similar to a family member's journey, though without the gardening bit (just yet!), so I am glad you shared this. Self medication isn't always bad, but there's certainly a lot less data to work with in trying to find out the proper dosage and the legal gray areas for certain states or countries.
The brain is an bodily system, just like any other. Disease can strike its workings and doctors can help with modern science.
That said, we're still understanding how the brain works. One recent study showed that depression often has an associated and underlying, undiagnosed, sleep disorder [1]. Treat the depression without treating the sleep disorder and the depression comes back. FYI: This work has not been published yet.
Given that scientists have just figured out that sleep clears the brain of toxins [2], similar to the lymphatic system clearing the rest of the body of waste, these results shouldn't be surprising. We don't know the exactly reasons why people get depressed, but the evidence is clear. Depression has a root physical cause just like any other illness.
N=1, but yeah fixing my sleep pattern, while getting a work an exercise routine has pushed my depression into "remission" for the past two years. The problem was, I couldn't do all that when I was depressed, so I used Lexapro as a band-aid, I went on it for 4 months to stabilise while I sorted the other stuff out. Now I'm doing great! I'm wary of going on the medication for long periods of time, as the last time I was on it for more than 6 months the mental and physical side effects became horrendous. But it did help, and I'm glad I'm here today :)
I had better jump in here right away, because the last thread about depression on Hacker News basically got swallowed up by an n=1 anecdote, and while anecdotes are wonderful (we all prefer to make decisions based on anecdotes we feel we can relate to rather than based on statistics), it takes a lot more than one anecdote to represent a complicated subject.
As my last keystrokes about depression here on Hacker News pointed out, there isn't just one disease known as depression. Depression is a symptom pattern (prolonged low mood contrary to the patient's current life experience) found often in the broad category of illnesses known as mood disorders. Behavior genetic studies of whole family lineages, genome-wide association studies, and drug intervention studies have all shown that there are a variety of biological or psychological causes for mood disorders, and not all mood disorders are the same as all other mood disorders. I know a LOT of people of various ages who have these problems, so I have been prompted for more than two decades to dig into the serious medical literature[1] on this topic. (I am not a doctor, but I've discussed mood disorders with plenty of doctors and patients.) I've seen people who tried to self-medicate with street drugs end up with psychotic symptoms and prolonged unemployment, and I've seen people with standard medical treatment supervised by physicians thrive and enjoy well off family life. The best current treatment for depression is medically supervised medication combined with professionally administered talk therapy.[2]
The human mood system can go awry both by mood being too elevated (hypomania or mania) and by it being too low (depression), with depression being the more common symptom pattern. But plenty of people have bipolar mood disorders, with various mood patterns over time, and bipolar mood disorders are tricky to treat, because some treatments that lift mood simply move patients from depression into mania. And depression doesn't always look like being inactive, down, and blue, but sometimes looks like being very irritable (this is the classic sign of depression in teenage boys--extreme irritability--and often in adults too). Physicians use patient mood-self-rating scales (which have been carefully validated over the years for monitoring treatment)[3] as a reality check on their clinical impression of how patients are doing.
As the blog post kindly submitted here points out, a patient's mood disorder influences the patient's whole family. The more other family members know about depression, the better. Encouraging words (NO, not just "cheer up") are important to help the patient reframe thought patterns and aid professional cognitive talk therapy. Care in sleep schedules and eating and exercise patterns is also important. People can become much more healthy than they ever imagined possible even after years of untreated mood disorders, but it is often a whole-family effort that brings about the best results.
Would you mind sharing a little on how to go about this exactly? To be clear, I'm not surprised that "cheer up" isn't the right way - but I don't know what is. I don't even know how to talk positively to, say, cancer patients, let alone sufferers of mood disorders.
I had cancer when I was younger, and the best place to start is to ask yourself: "Do I need to say anything at all?"
Unless you're a close friend (with whom the patient is completely at ease), then you're putting them in a position where they feel like they have to act strong, smile, and thank you for your concern. (For my situation, I got dozens of phone calls from people I hadn't heard from much in years. I had more than enough on my mind than to appease their desire to show their concern.)
Your concern is definitely appreciated, but you need to choose your moments.
As for what to say? I guess that differs culturally and your relationship. I'm Australian, and I was totally okay with a simple "ah, shit mate, that sucks" over a "if you need ANYTHING, call me* (*but don't actually call me)" - I know I can call for help, and dozens of people can help, but all I really wanted was to be treated like a normal human. For instance, I was bald from the chemo and got a multi-colour clown wig as a joke present, which made me smile so much. It was a sense of "everything is normal despite being in the midst of chaos." I could count on my friends to distract me from the horrible reality of the situation when I was stressed/sad/confused.
And that is your job. Be a sincere option for distraction and advice when you're called upon. Trust them to ask for help when they need it..and they're much more likely to ask for it if they know you won't be overbearing/over-worried/judgemental/etc.
I don't know how well this advice applies to depression, but I think it's a good framework for being a good friend through most hardship.
(Sidebar: I'm more than happy to be a sounding board for approaching any cancer related issues you've got. Email's in my profile. I've heard all kinds of things, so don't think any question or issue is too simple or stupid!)
Thanks very much, your response is helpful. Thanks for the offer, too. Thankfully, I'm not struggling with this personally now, but I'm sure there are people here who are.
You don't have to say much. For example, my wife will ask 'is there anything I can do?' when I'm having a particularly bad time, and while the answer is often just 'no,' her asking the question that way acknowledges the fact that I'm struggling without putting me under pressure to come up with an answer. For me the most important thing is knowing that someone is available without feeling that they're waiting on me.
Chronic depression is a bit like an old AM radio; you can mitigate the lousy signal with the tuning knob and moving the antenna around, but you can't fix it and call it done; the station that's clearly tuned in today might stay clear tomorrow or be mired in static. As a patient, one can learn to separate oneself from one's mood, so that feeling miserable doesn't have to be attributed to an objective exterior cause. But learning that takes time, and inability to distinguish between one's emotional and the quality of one's environment was a major problem for me when I was younger.
The most helpful thing you can do is be around to listen and allow the depressed person to vent without pushing them to identify an actionable solution, frustrating as that may be. Asking questions can also be helpful, to inform yourself about what the other person is experiencing. For example suppose you were talking to a blind person; you get the basic idea of being blind but you don't know what it's like, so it's quite reasonable to wonder, say, how the person chooses groceries or decides what clothes to put on in the morning. When depression is chronic one develops a variety of coping strategies (which work more or less well at different times), and articulating that sort of thing often helps me get out of a trough and recover my sense of agency.
One other thing that's very common for people with depression is muscle pain, because the inner tension is often mirrored by a physical tension. It's hard to describe, but the physical tension can even act as a focus for the bad feeling. A backrub or a neck rub can go a long way, if the depressed person is feeling up to it. Other times one may not want to be touched and is better off just going to bed or somesuch.
Thanks so much, this is very helpful. I'll remember that asking questions is usually okay; I'm often afraid that patients prefer not to think or talk about it, or that I'm the 30th person asking about it and they're tired of it, etc.
The problem of depression is, simplifying, an inability to experience happiness. Telling a depressed person to cheer up is like telling someone with a broken leg to stop having a broken leg, or telling someone with lung cancer to just stop having lung cancer. Not only is it not helpful, it's insulting because it reveals a huge misunderstanding of the issue.
My current impression is that while efficacy is demonstrated for many drugs, how they work is poorly understood or not at all. Do you know of good reviews that cover what we know about why some drugs work and others don't? Preferably in more detail than 'free seratonin serum levels were increased.'
You are correct that how any of the drugs work is currently poorly understood. Presumably, there are individual biochemical differences in either drug receptor sites on nerve cells or in metabolism of the drug after ingestion that make some kind of treatment difference, but there are not convenient medical tests yet to predict which kind of patient will respond to which drug. When I advise friends about pondering different medical treatments for most disease, my pickling in the research on human behavior genetics in the weekly journal club I attend suggests that you look to what works for your close relatives. If a particular medicine seems to be helpful with few side effects for a first-degree relative (parent, sibling, or child), give it a try. If a particular drug has been useless for someone closely related to you, for whatever condition you are concerned about, start your search with some other drug. And so on. Eventually we MAY get to a deeper genetic understanding of individual differences in response to prescribed medicines, but we are a long way from that so far.
Not every mental illness is a chemical imbalance, it might be neurological in nature, or it could be stress based, or maybe you just need a psychotherapist and learn some coping skills?
It seems to discuss the basics of neuroscience and how the brain and mind work. It also discusses medicine and how to fix things. It might be a good read for you.
I do believe you've neglected to mention Cognitive Behavioral Therapy and mindfulness meditation.
You did mention cognitive talk therapy with a professional, but my reading of David Burns' books (and my subsequent personal experience) leads me to believe that it can be effective when done by someone by themselves (and in combination with medicine and or talk therapy).
Indeed. The popular book by Burns (http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808...) in an earlier '80s edition before the behavioral angle was added made a significant and permanent improvement in my life, all done by myself, although with medicine and talk therapy added to the mix (my depression is not standard "unipolar affective disorder" and medicine is key to improving it, but not a complete solution).
CBT has an excellent evidence base and if you had read the references already posted to this thread you would have known that.
Mindfulness also has good evidence, but tends to be used with more severe forms of depression or other diagnoses such as borderline personality disorder.
The comment "sounds like voodoo to me" is unconstructive. I don't care what something sounds like to you. If you had said why it sounds like voodoo, why you have a problem with any of the research that supports it or the Cochrane reviews or the NICE guidance then there's something to talk about.
I looked at the Wikipedia articles and they referenced studies where the conclusion ranged from "needs further study" and "slight effect". It seems like it might be more placebo effect (granted this is still a real effect) but it means that you can probably use any sort of similar "therapy" in its place.
No double blind studies. "The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in."
"This study concluded that CBT is no better than non-specific control interventions", which I already guessed at in my previous comment.
"Taken together, trials using psychotherapy do not meet the qualifications of high quality evidence."
What do you find implausible about the thesis that if you think bad things about yourself, you can make yourself feel bad?
(Granted, I don't know about the "behavioral" addition to cognitive therapy, but the latter is on a sound footing in every way, from theory to practice, and I can personally attest to it being effective.)
'“Depression is not an emotional disorder at all! Every bad feeling you have is the result of your negative thinking.” In this paper, I intend to give this conclusion some good natured trouble.'
I had been on medication for a full year and it really helped me become more stable and content with life. I asked my doctor to increase my dosage because some days it just did not seem to be enough. He did, however it did not have the benefits I had hoped and it became harder to do things. So I started to ween myself off and now I am not dele dent on it.
However, like Wil, I seem to be getting angry at the most trivial things. I am considering starting again, but I am about to graduate and take my last finals in a week or two.
I have been scared of taking medication because of what ADHD meds did to me in my youth. Though now, knowing everybody on my mothers side and my sisters needed help for depression at some time or another, I highly support getting help in this domain.
What do people do when they're unsure if they're "depressed enough" to be depressed? What about people who are "used to it" and consider themselves good at "dealing with it"? Go to a doctor anyway? Where do people start? With their regular physician? How do people find a therapist that won't jump at medication unnecessarily, and won't ignore you if you think you need it?
Well, I recommend in general getting this book: http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808... (the good basic, for "patients" vs. doctors book on cognitive therapy (now cognitive-behavioral therapy, but I read it before that addition), and take the Burns Depression Checklist at the beginning of chapter 2. Based on your score, you'll get a rough idea from "no depression", "normal but unhappy", then "mild depression" all the way to "extreme depression". Based on that you can then know appropriate steps to take.
I'd add that I'll bet anyone can benefit from going through their thought patterns applying the insights of congnitive psychology, the therapy side of which says, very roughly, one way to make yourself depressed is to think incorrect bad thoughts about yourself (which includes how you view other people viewing you, etc.).
(Which is not to say there aren't also pure biological causes (see tokenadult's excellent comment: https://news.ycombinator.com/item?id=7530847), family history eventually revealed that's a factor in my particular type of depression, but it's certain that self-applied cognitive therapy from an earlier edition of this book made a big difference for me, it's just not enough.)
If you have the money for it, I'd recommend just hiring a therapist privately, who will be able to talk through your problems with you and help you decide what the best course of action is. It may well be that adjusting your routine can help, or it might turn out medication is a good idea.
If you can't afford to do so privately, and you're in the UK, the advice below should help you navigate the NHS bureaucracy and (eventually) see a therapist.
Start with your doctor, GP will probably attempt to put you on anti-depressants immediately and then leave it at that. If that's not what your looking for, refuse, and ask for a referral to a specialist. If that doesn't work, ask to see a different GP. Eventually you should get referred to an actual psychiatrist. They're also going to want to stick you straight on medication, but you'll at least get an appointment with them now and again to discuss that, but they can refer you to a therapist.
As you may be able to tell from my tone, over the years I've have acquired very little respect for the way the NHS treats mental health. There are a few individuals doing fantastic work, but they've always been hamstrung by the bureaucracy involved in making anything happen.
You can get prescribed antidepressants from most primary care physicians in the US if you don't want to look for a therapist. However, it's worth Googling around your area to find psychiatrists or therapy offices.
Don't be afraid of not being depressed enough. I made the mistake of doing that and got to a really bad place before I finally sought help. It's also worth noting that, by the time you actually get in to see a doctor, get prescribed something, and then wait the required time period for the medicine to actually start working, you'll be about 2-3 months out from feeling better.
When seeking depression treatment, another thing that was kind of obvious in hindsight (but not so much at the time) is that no one is going to magically come and save you from depression, not even your loved ones. You have to take the initiative to seek help yourself. For months I stalled because I didn't want to go through the process of finding a doctor, and it really ended up biting me in the ass.
When something isn't right a long period of time, it's easy to lose perspective on what being well looks and feels like. It may be well worth it to explore your options now while it isn't urgent, until waiting until something changes and you can't deal with it anymore.
Therapists don't prescribe medication- the best they can do is refer you to a doctor or psychiatrist. They can often answer questions about medication though, and help you decide whether that path is right for you. Therapy isn't about medication, it's a different tool altogether.
> When something isn't right a long period of time, it's easy to lose perspective on what being well looks and feels like.
I've found that this is one of the big reasons that many people I know don't seek help, or waited (too) long to do so. Especially for people living alone who can acceptably 'curate' their existence when around others, it's very easy to lose perspective on what is 'normal' or 'healthy'.
It's made me wonder if it might be good to consider going to a psychologist something akin to a yearly dentist checkup.
Seconding jon-wood's suggestion of hiring a therapist. In your first question, longterm moderate depression can get worse, or you just may not be able to get out of it (easily) on your own. And letting it sit for a long time, I'll say the last time I dealt with depression I finally went to a therapist when I woke up one morning and realized I'd been "dealing with it" for 2 years. I couldn't get that time back, but starting with a therapist I was able to get back on track much faster.
In the US, if you're in college, go to your student health center. They have people who are very experienced with helping students with their issues.
If you're not, check your employers health offerings. Mine has an anonymous number that we can call, separate from HR and management, to get help and referrals. They even paid for the first 5 (6?) sessions before I went to my own insurance.
If your office doesn't have that, or you're not comfortable going through them, go to your regular doctor for a referral.
If you've got friends that you know have dealt with these issues in the past, ask them for a recommendation. You don't have to be specific, you don't even have to tell them you're depressed (or think you may be), just say you need someone to talk to and ask who they went to.
I'd suggest finding a good psychologist, preferably someone with a PsyD, who can't prescribe drugs. Mine's been good in letting me filter out a lot of issues, and try to get to a point where certain things are more manageable. She was also the one who said to speak with a psychiatrist for handling the medications. Having the two being separate for me has been helpful, even with real bad depression/anxiety.
I wish she would not have mentioned the kids' issues without their permission. Just the mention of such potentially brings social stigma to their life.
I liked the post because it shows the other side of a couple living with depression. I suffer from chronic depression and it is not easy to depend on medication every day with no prospect of "cure". The hardest part is dealing with the stigma associated with it, with people insisting that you are not doing the right thing and finding a way to get over it and free your self from medication.
I know that the "chemical imbalance" explanation is a poor excuse for "we don't know exactly how it works". But there are so many progresses done in our quality of living that were done because someone had a hunch and some practical, reproducible results showing that it worked. Think about the practice of washing hands when going from one patient to another in a hospital? When it was suggested, people couldn't see a connection with dirty hands and spreading diseases.
I lost a son that suffered from a mood disorder to suicide. It is heartbreaking and it happened when he was apparently getting over the hump of his darkest moments... I have other two children that also struggled with depression and what I found that worked the best for us so far is communication. Being opened about our struggles, talk therapy in conjunction with medication.
This may be utterly inappropriate, but I just want to convey my sympathy for the loss of your son, I honestly can't imagine anything worse. You have my utmost respect for managing to carry on, and supporting your family through it.
Since 2001 I have had schizo affective disorder. I has destroyed my career.
I tried to write about mental illnesses and the startup community, which I think is something that needs to be talked about. But my submissions get deleted and censored.
Sometimes your best talent has a mental illness, how do you manage them? Most just fire that talent when they discover they are mentally ill. It is something that has to stop!
Doctors are going to be very quick to put you on drugs. After taking the various drugs, talk therapy, etc..
As quaint as it may sound, diet and exercise (the only supplement to that I take is phosphatidylserine now) can really make a difference.
I'm not saying don't do the drugs (especially if your a severe case), but (at least my experience) the drugs are not necessarily as effective as things you can do without all the hassle/expense of prescription drugs.
Unfortunately (and especially because of the evidence of the cycle that begins with "the doctor increased has dose" and "added another medication"), Wil has a pretty good chance of having a poor outcome. Especially because his medical advice seems to include the deeply problematic "chemical imbalance' theory.
Reading Whitaker's "The Anatomy of an Epidemic" (https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic) should be required for anyone considering long-term use of neuroleptics, benzodiazepines, or anti-depressants. And for those who care for them.
I cannot help but feel sorry for Will. It would be my worst nightmare to be processed by American psychologists to be placed on Big Pharma's latest medications.
My second-worst nightmare is that a loved one is about to get help but then a "friend" convinces them about how eeeeevil Big Pharma is and they stop. The "friend" feels happy and walks away, while the close relations of the loved one have to deal with the latest relapse.
I view those who discourage people from taking their meds as the same as people who encourage alcoholics to "just take one drink."
Totally agreed here. I don't understand people who discourage others from taking medication to treat a medical problem, its akin to somebody suggesting that a diabetic should stop taking insulin and just man up instead.
In some cases doctors over prescribe to people who are suffering from situational depression, giving out medication instead of treating the root cause and finding a way to tackle the problems in somebody's life, but for others it is a medical complaint. Without knowing which category somebody falls into its grossly irresponsible to tell them they shouldn't be taking medication which in many cases quite literally keeps them alive.
My worst nightmare is when a friend tells me how she wanted to kill her 2yo son and husband in terrifying detail. Despite her physician's assurances, she stopped taking the happy pills. They are all alive & well and the dark thoughts dissipated within a week of cessation. YMMV.
It sounds like there was more to that situation than simple depression, there are many conditions that can be made worse by inappropriately applying anti depressants. Unfortunately it seems your friend was in that situation, but it doesn't make the drugs universally bad.
Yeah, doc was calling it post-natal depression. Two years after birth. I suppose it's possible, I'm no physician. I posit perhaps it was was an ambitious, accomplished woman programmed since birth through culture & genetics to be a 'mommy' and was having trouble coming to terms with the daily realities while losing her independence, selling her business & having no time left for herself. No gruesome thoughts, just feeling over-whelmed. The doctor was throwing pills at the problem, IMO and that is when she began having the images. Again, I'm no doctor but I am a person who hallucinates on Doans & becomes a drooling, incoherent wreck if I take Coricidan or Dramamine. YMMV.
For those down voters: I am British, we have the NHS.
Over here healthcare is not just another business, it is a public service. We grumble about the NHS but we love it too. With the NHS you don't have to second guess whether that doctor is after your wallet, or even think about it, he/she isn't.
By comparison the American healthcare system is something that, with a British perspective, appears to have something tantamount to 'Münchausen syndrome by proxy'. With the British NHS you can end up on pills all your life but there is not a business case for it. Meanwhile, in America, if you can be signed up for a smorgasbord of uppers, downers and a few off-label side orders for the rest of your days then Big Pharma is happy.
Here is one of my favourite books that describes what goes on:
I've been through the wringer with depression in the American system, this has not been my experience.
I've heard this particular chestnut often. In so far as I understand, if your doctor does this, they're committing malpractice. I'm not saying doctors don't do this, or someone's doctor doesn't, but this is not the norm. Not by a long shot.
Ditto. In fact, my psychiatrists have loved generics, they don't want cost to get in the way of treatment.
(Caveat: generic mood stabilizers (used for treating bipolar disorder) that are also anticonvulsants have I've heard a bad history of not working like the brand name, First World manufactured originals.)
The fact that Wil was prescribed Effexor (venlafaxine) instead of the almost identical but more expensive Pristiq (desvenlafaxine) is a pretty good indicator that this wasn't just an attempt to get more money out of him.
I was put on literally dozens of medications from age 10-18 to try to treat depression and anxiety. None of it responded the way psychiatrists or doctors claimed it was supposed to, for me. I only started to alleviate symptoms once I forcibly and against my parents' wishes took myself off of them. It was rough at first, but slowly I started to gain the social skills that I had lost over time due to being completely out of whack during the time I was on medication.
I've gone back and tried a few, but the only things that seem to have any positive effect are short-acting anxiety medications which I take maybe once every 2 weeks to help with a flare-up. The long-term depression is nearly gone.
I still would recommend that anyone that is in a deep depression that hasn't tried medication before try them, because it works well for most people. But if you are one of the unlucky ones that it does not work for, keep trying, as coming out the other side is definitely worth all the pain and suffering. You also get a wonderfully nice perspective and can empathize with others who are going through it, something a lot of people can't say.
(1) The NHS still has to buy the drugs, so there is still significant incentive to market them.
(2) While British doctors are not paid by their patients, they can be(and are) paid by pharmaceutical manufacturers to run trials, speak at conferences, advocate to other doctors, etc. (A notable, and infamous, example is Wakefield's MMR study, which was performed while he was receiving money for drug company litigants and trying to develop a competing product)Better than the US, but not perfect.
The only problem with this is that it's essentially a PR line that both doctors and the general public have mistaken for science. We don't know all that many facts about how brain chemicals work with regard to mood disorders. We have empirical results from clinical trials and broad use of antidepressant and antipsychotic medications, but there is no basis to believe that medications "balancing out those chemicals" serve to repair mood disorders.
If the medications helped, then great, I know they have helped a great number of people, but they also fail to help a great number more and these success stories have an unfortunate tendency to marginalize people that do not get good results from medication. It often results in victim-blaming, to make sufferers of depression wrong for stopping their medications for legitimate reasons (let's face it, all of these results are highly subjective), and for overstating the ability of our current medications to cure all mental ills.