
The Other Side of Depression - ColinWright
http://www.annewheaton.com/the-other-side-of-depression/
======
flatline
> 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.

~~~
cryoshon
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.

~~~
neohaven
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.

~~~
cryoshon
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.

~~~
ForHackernews
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.

~~~
andreasvc
What is your point? That is definitely not a scientific model.

------
rickdale
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.

~~~
jon-wood
> 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.

~~~
drzaiusapelord
>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.

~~~
morganw
> 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.

------
robg
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.

[1] [http://www.nytimes.com/2013/11/19/health/treating-
insomnia-t...](http://www.nytimes.com/2013/11/19/health/treating-insomnia-to-
heal-depression.html)

[2] [http://news.sciencemag.org/brain-behavior/2013/10/sleep-
ulti...](http://news.sciencemag.org/brain-behavior/2013/10/sleep-ultimate-
brainwasher)

~~~
girvo
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 :)

------
tokenadult
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.

[1] [http://www.amazon.com/Manic-Depressive-Illness-Disorders-
Rec...](http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-
Depression/dp/0195135792)

[2] Combination psychotherapy and antidepressant medication treatment for
depression: for whom, when, and how. Craighead WE1, Dunlop BW.

Annu Rev Psychol. 2014;65:267-300. doi: 10.1146/annurev.psych.121208.131653.
Epub 2013 Sep 13.

[3]
[http://emedicine.medscape.com/article/1859039-overview](http://emedicine.medscape.com/article/1859039-overview)

~~~
namenotrequired
Thank you very much, this is insightful.

> Encouraging words (NO, not just "cheer up")

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.

~~~
notjosh
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!)

~~~
namenotrequired
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.

------
cordite
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.

------
yawgmoth
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?

~~~
overgryphon
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.

~~~
mercer
> 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.

------
josh-wrale
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.

~~~
ronaldx
OK, but not mentioning it potentially brings social stigma to everyone. It's
important to talk openly about mental health issues.

------
trvd1707
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.

~~~
jon-wood
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.

------
greatdox
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!

------
dpweb
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.

------
doki_pen
Is this astroturfing? It reads like an ad.

------
ajarmst
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](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.

------
Theodores
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.

~~~
Theodores
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:

[http://www.amazon.com/Blood-Medicine-Blowing-Deadliest-
Presc...](http://www.amazon.com/Blood-Medicine-Blowing-Deadliest-
Prescription/dp/0452298504)

~~~
taiki
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.

~~~
hga
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.)

