
We Need To Talk About Depression - ajiang
http://techcrunch.com/2014/06/14/we-need-to-talk-about-depression/
======
thathonkey
We do need to talk about mental health. As a culture. But, sorry, I am not
going to read Techcrunch article about it.

Even publications that dedicated to following mental health (and ostensibly
authored by "experts" in the field) tend to do a dubious job of describing
what is an extremely complicated problem to which THERE IS NO QUICK FIX. Read
that again. Addressing mental healthy problems is very hard work and treatment
plans vary by individuals (not even by disease) so even once you find a doctor
you like - no easy task - and whether you go into psychotherapy or the
psychiatric [aka prescribed] route or both - you have a long, hard road ahead
of you which will require a lot of patience from you and those that you
maintain relationships with whether they are work or personal.

There are lots of mental health disorders of which depression is a common
symptom. It's important to work with a doctor you feel comfortable with to
figure out if you suffer from depression, or if the root cause is some other
disorder (OCD, bi-polar, anxiety are common amongst SDE types) which routinely
causes you to feel depressed for days or weeks (or god forbid, months) at a
time.

Even if you are comfortable going the medication route (and there are many
reasons why this choice should not be made lightly, especially if it is via
anti-depressants or another - they're all habit forming and bring their own
set of side-effects and problems), it is a long an arduous process to find the
right one/right dosage/etc. that will work for you (if there even is one).
Each one takes weeks to see results typically.

Anti-depressants help some people greatly. Others will struggle with them and
find them counter-productive to their treatment. There is no one-size-fits-all
treatment plan. Mental health is a subject that doesn't get attention in any
facet of American culture.

PS. There is no evidence to suggest that the software industry suffers
disproportionately from mental health issues compared to any other.

~~~
jonnathanson
You're right in many ways, but you should read the article. It's not your run-
of-the-mill tech article about "depression" being a temporary sadness brought
on by work-related stress, the founder's lifestyle, or any of that typical
pablum. It's the personal story of someone who is clinically depressed, has
been hospitalized for that depression, and wants to make understanding of
depression -- actual depression, not strawman-depression -- more widespread
and accepted.

Why should she have written this for TechCrunch? Why not? The tech industry
exerts enormous pressure to signal that one is a rockstar, that everything is
better than fine, and that you're not just keeping up with the Joneses; you're
lapping them. It's about time the tech press talked about depression as it
really is, and not "depression" as a neutered buzzword for stress. And it's
about time someone -- anyone -- restarted the national dialogue regoing about
clinical depression and mental health.

In 2014, the stigma surrounding depression is every bit as harsh as it was in
1998, when I was diagnosed. In some ways it's even harsher. That really sucks.
We need people to talk about it, and to be honest, the more people talking
about it, the better. If one of those places happens to be TC, and so long as
TC isn't peddling a watered-down version of the topic, I'm all for it. By the
same token, if Sam Altman wants to talk about depression and wants to do his
part to alleviate the stigma, I'm all for it. None of these articles is ever
going to be perfect, or capture 100% of the issue. But I'm glad we're getting
these articles, nonetheless. For decades, this was something people just
didn't talk about or admit to in public. I'll take public.

~~~
michaelochurch
_In 2014, the stigma surrounding depression is every bit as harsh as it was in
1998, when I was diagnosed. In some ways it 's even harsher. That really
sucks._

I think it's worse. People are more aware of the illness itself, but there's
more conformity, which means that it's harder to find accommodation for
symptoms that are mild but embarrassing (e.g. needing a quiet room, instead of
an open-plan hell, to recover from a panic attack).

What's new and upsetting is the _competitive_ conformity of the Millennial
generation (or maybe I'm just biased against my won age group). Gen Xers in
1995 may have had to show up for work at 9:00 and wear slacks, but they didn't
rat each other out. They knew it was them against the system. The rising
generation seems to have more house-slave types who'll rat each other out. I
don't mind conforming (to a reasonable degree) and I don't mind competing, but
when people _compete to conform_ I just want to punch everyone in the face.

~~~
methodover
About the need for a quiet room -- I totally agree with you. I wonder how many
engineers talk about needing a door which can close for reasons like 'I need
to focus' when the real reason is 'I have an anxiety disorder which is
exasperated by chaos and eased by quiet.' I know I've said the first without
mentioning the second.

In fact I turned down an offer purely because of an office plan which would
put me between a Ping pong table and a room full of people (in an open office
plan).

------
kevingadd
Not just depression. Other related health issues like Bipolar Disorder are
terrifyingly common in SV and other tech communities; far too many of my past
and present coworkers are clearly suffering from symptoms that typically
indicate depression, mania, or other issues.

Worse still, some people I know are aware and accepting of the fact that they
have issues, but they refuse to treat them because they fear antidepressants
or mood stabilizers will impact productivity. One person I know explicitly
refrains from treating his bipolar disorder because he thinks manic episodes
make him productive. :-/

No one treatment is appropriate for everyone, but far too many people are
willing to throw away their health in order to chase after the startup dream,
despite the fact that it can hurt everyone around them in addition to
shortening their own life.

~~~
Nanzikambe
I have no idea why the comment by "anon48191" is dead - it's extremely
relevant and part of the point raised within the article.

~~~
anon96342
Thank you Nanzikambe.

This is anon48191, I apologize for using yet another anonymous user. As
outlined in my, unfortunately dead, comment I have reasons to stay anonymous
(check shadowdead if you're interested in my original comment).

I would also like to quickly address the comment by Flow:

It might very well be that people around me already know. However, there's a
big issue between knowing and officially knowing. Further, I never talked
about medication. I personally don't believe much in medication. The steps I
was considering were talking to a psychiatrist and take it from there. However
as soon as I do this, it is bound to become public, as in public within my
circles.

I will not question Flows intention in their comment, their knowledge or
familiarity of the issue. However, and you'll have to take the word from an
anonymous commenter on the internet for this, I am most definitely depressed,
if not worse, and outright claiming my (however anecdotal) comment is wrong,
seems a bit harsh.

~~~
Flow
I've been fighting exhaustion/fatigue, and some degree of depression that
seems to always come with exhaustion, for more than 10 years. It's been a
journey to put it mildly, but now I know myself better than ever.

From what I've read and learnt during these years, is that exercise seems to
be the most effective treatment. This is the only thing I've not tried
seriously yet.

Medication has helped a bit. I can say they are no quick fix, you have to give
them at least 3-4 months before you stabilize and can start to reason about
how you feel and how to proceed. I hesitated before I tried them, and feel
that it was quite dumb and a waste of time to not take them earlier.

The last thing I'd like to mention, is Cognitive Behavioral Therapy, CBT. It
worked really well for me. I managed to do several things I wanted to do for
years, and the feeling was incredible to finally get out of the catch-22.

Here in (Nordic Country), CBT is not a crazy sign. I know a lot of people that
go and have CBT sessions for things like to reason about how to unstuck their
life, solve issues at work.

It's no more weird than having a personal trainer at the gym.

From your wording it seems you really feel you need to do something. I don't
think your mental health will get better without you changing or doing
something about it.

Perhaps you could take a few CBT sessions for your depression, but officially
say it's because you want to accelerate your career? Soften your friend and
coworkers by sending them links to articles about becoming more efficient at
work via CBT?

It's really unproductive and shameful that mental health issues are so
stigmatic.

Thank your for replying to me instead of just drive-by down-voting. I wish you
luck finding a solution that fits you.

------
n72
Does YC have an in-house shrink? I've always thought that if I ran an
incubator, one of the first things I'd do is institute twice-weekly meetings
with a shrink. I think such an arrangement would pay off amply in the long
run. I know when I was my mid-20s, if I'd had a shrink to help me combat some
issues which had the side effect of leading to severe procrastination, I'd
have been considerably more productive. To me it just seems like a no-brainer
from an investment point-of-view.

~~~
josai
I've thought the same thing. I'm constantly amazed that companies don't
consider the health of their employees, both physical and mental, worth
investing in. It's my firm belief that it would pay back many times over.

I like your shrink idea (though probably once a week is enough). If it was me,
I'd also encourage daily 1-hour exercise (gym, soccer, walking, whatever). It
really helps.

~~~
michaelochurch
_I 'm constantly amazed that companies don't consider the health of their
employees, both physical and mental, worth investing in. It's my firm belief
that it would pay back many times over._

Oddly enough, the "old-style" corporations that have gone out of style, did.
At many investment banks, you can still schedule a confidential appointment
with an on-site doctor or therapist.

The depression stigma isn't as strong at the banks as it is in technology
companies and in startups. I'm basically unfundable (cyclothymia, aka "bipolar
3") by VCs, but my condition, because it's well-treated, would be a non-issue
at most financial firms (even at high levels).

------
LordHumungous
It's not just limited to startups. The " _everything is awesome!_ " cult of
constant positivity is becoming standard throughout corporate America,
particularly the tech sector. IMO it is a counter productive attitude. Does
ignoring the negative possibilities of life really increase your chance of
avoiding them? It seems to me that recognizing those possibilities head on is
a healthier and saner way to go through life.

~~~
ForHackernews
Barbara Ehrenreich wrote a good book about this subject:
[http://www.amazon.com/Bright-Sided-Positive-Thinking-
Undermi...](http://www.amazon.com/Bright-Sided-Positive-Thinking-Undermining-
America/dp/0312658850/)

------
joshontheweb
This probably won't be popular here but I have suffered from depression since
I can remember and the best remedy I have found so far is psychedelics. Not
too often but in higher doses as Terence Mckenna recommends. Psilosybe
Mushrooms in particular are good at helping me to shed my fears, love life,
and create out of passion. Mileage may vary but I thought I'd put that out
there. Any others who have similar experience?

~~~
lilsunnybee
Just a safety warning for some readers: if you have a past history of
delusional thinking, other types of psychosis, or a family history of either,
this is not good advice. Psychedelics, especially at higher doses, can trigger
harmful psychotic episodes quite easily in susceptible people, which is bad
for personal safety and mental health, and can cause lasting damage to
relationships with friends and loved ones, as well as potentially wreck a
career.

~~~
cmapes
I'll chime in here that I witnessed a long time friend who has a family with a
history of mental illness go down this road. For him all it took was one LSD
trip. My personal position is that psychedelics are the "going nuclear" of the
substance space. They are not toys and hold the power to create and to create
awe inducing destruction.

------
QuantumChaos
Where is the evidence that depression is qualitatively different from being
unhappy, or feeling downtrodden and apathetic? All I ever read on the topic is
(1) scientific studies that associate certain diagnoses, with the
effectiveness of certain treatments, and (2) the claim by people with these
conditions, that they _are_ qualitatively different.

Is there any evidence against the following hypothesis:

What we call mental illnesses are (with possible exception of Schizophrenia
and Bipolar disorder), not qualitatively different from ordinary experience.
But in order to provide treatment (e.g. various kinds of therapy) it is useful
to assign labels to people. But this usefulness doesn't make mental illness as
"real as cancer", in the sense that it is a discrete category that we can
definitively assign people too.

One reason people prefer a diagnosis is that they prefer a label (even if it
does come with some social stigma) to the greater social stigma associated
with the same symptoms absent a "mental illness". Assigning such a label
allows people (both the individual with the mental illness, and people around
them) to view their symptoms in a different and more compassionate light. Most
importantly, it allows people to think rationally about the best course of
action for the person.

My claim is that if society could be more compassionate, without needing to
first assign a label in order to remove "blame" for people's symptoms, we
wouldn't need the category of mental illness as much. E.g. instead of saying
"I thought I was just a loser, but then I found out I suffered from
depression", a person might say "I thought I was a loser, but then I realized
that what society calls a loser is a person with certain characteristics,
thought patterns, and patterns of behavior, and I decided that instead of
judging myself for having these things, I would find the best approach to
changing them".

There is one more corollary to this, which is that "professional" help, in the
form of drugs or therapy, may not be the only or best approach for such
people.

~~~
perfmode
There is mountain of evidence:

[http://m.youtube.com/watch?v=NOAgplgTxfc](http://m.youtube.com/watch?v=NOAgplgTxfc)

~~~
QuantumChaos
would you be able to point to how specifically this video addresses my points?

I would be much easier to have a discussion if you did this, since otherwise
people who don't have time to watch a 1 hour video will have to take it on
faith that this video really addresses the questions I asked. And assuming it
did, it would probably be useful to have the points summarized here so we
could discuss them.

------
read
Being vulnerable is powerful.

[http://www.ted.com/talks/brene_brown_on_vulnerability](http://www.ted.com/talks/brene_brown_on_vulnerability)

 _You are vulnerable, but you are not weak._

    
    
      It is a sign of weakness to avoid showing signs of
      weakness.
    
      - Nassim Taleb

~~~
bronson
Came to post the same thing. ftfa: "Asking for help makes you vulnerable, but
it does not mean you are weak."

I still need to learn this.

------
alx
[https://www.youtube.com/watch?v=QnfOOoTOrDE](https://www.youtube.com/watch?v=QnfOOoTOrDE)

28c3: Geeks and depression panel

------
Balgair
"When you are up to your neck in shit, start singing"[0].

This is from a very popular commencement speech this year at UT. Im curious to
HN's opinion of this attitude in the light of the OP. I think that the
scenarios are different, as the SEALs training is specifically against
something, but the founder's depression arises from the against yourself.
Possibly some of the lessons in the struggle for a good life and doing a good
job that the SEALs have can be used to the benefit of founders and other tech
workers. I think the quote I had there is a great one. When you are really in
the dumps, go out and sing as a reflex.

Possibly a good way to overcome the depression that many feel is to develop a
better sense of yourself, so as to recognize _when_ to just reflexively start
singing.

[0][http://www.artofmanliness.com/2014/05/24/manvotional-want-
to...](http://www.artofmanliness.com/2014/05/24/manvotional-want-to-change-
the-world-start-by-making-your-bed/)

------
Maria1987
Excellent blog! Reminded me of Silicon valey series :)))

For me, It is encouraging to see that people in the same insane positions of
starting their own company are facing similar problems with me and I am Not
the only crazy person around! Starting your own company and fighting the
unknown lonely steps of success is undeniably hard,scary and depressing but
with some weird manner also extremely rewarding! The high risk always comes
with the high satisfaction.

people like me and many others, need to hear it get encouragement and an
indirect form of support so useful and valuable to keep you going! I found
great pleasure watching silicon valey series for this exact reason; and
listening to real people having similar issues is even better x

------
lostapathy
I would encourage everyone thinking about depression go watch this TEDx talk.
He's not the most traditional speaker, but his story made a huge difference in
how I understand depression.

[http://www.ted.com/talks/andrew_solomon_depression_the_secre...](http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share)

------
lilsunnybee
If you're experiencing depression, consistently lowered mood, heightened
anxiety, or other mental health symptoms, especially if you don't have a
history of it, be sure to rule out physical causes and simple nutritional
deficiencies as well with your doctor, in addition to pursuing psychiatric
medications and / or therapy.

Especially if frequent tiredness and exhaustion are strong components, you
could be experiencing a change in endocrine function, particularly thyroid, a
sleep disorder, or any number of other medical conditions.

Sleep disorders especially are often underdiagnosed, and can go untreated for
years in lieu of just treating psychiatric symptoms instead (I know this from
personal experience). Conditions such as hypothyroidism are often similarly
underdiagnosed. So if you're feeling extraordinarily tired all the time, and
anemia and other nutritional and medical causes have been ruled out, get your
thyroid levels checked and a sleep study done too, or at least bring it up
with your doctor.

But also don't hesitate to seek out treatment for mental health problems even
if a known medical cause can't be found or has yet to be identified. It's all
physiological causes really, but there's a lot we still don't know about the
human brain and body, and treating symptoms, especially if they are having a
significant negative impact on your quality of life, is just as important as
trying to find a cause.

And last but not least since we are talking about depression and depression-
related conditions (such as bipolar, etc.), I just wanted to raise a little
awareness for borderline (BPD) too. For those of you that have strong
emotions, maybe a little impulsive, and/or a troubled childhood and suicidal
tendencies, or have people in your life like that, you should find it really
worthwhile to read up a bit on BPD:

[http://en.wikipedia.org/wiki/Borderline_personality_disorder](http://en.wikipedia.org/wiki/Borderline_personality_disorder)

It's a diagnosis which has gotten a bad but undeserved stigma over the years,
that needs better awareness and understanding.

Whether you identify strongly with a BPD profile or not, if you struggle with
strong emotions and/or suicidal tendencies in your life, a lot of Dialectical
Behavioral Therapy (DBT) coping strategies and methods might be particularly
helpful to you in dealing with those feelings:

[http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy](http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy)

Stay healthy and happy hackers, but don't be afraid to ask friends, family,
and professionals for help when you need it either!

------
Mz
We need to get a lot better about dealing with the biochemical piece of
depression but mostly we need to get better at dealing with the social
constructs that keep people stuck with "unsolvable" problems. That seems, more
often than not, to be the real roots of depression.

------
bayesianhorse
Having gone through this, my recommendation is to avoid talking about
depression while depressed...

~~~
jamesbritt
Interesting. I, too, battled depression and I don't think talking about
depression was a problem for me, even when depressed.

The catch here is that talking with people who don't actually know much about
depression (e.g. the "just cheer up" crowd) can be a problem.

~~~
bayesianhorse
I've found that depressions lead to a particular kind of reality distortion
that is hard on most relationships. As is lack of interest, of course.

------
h1karu
Isn't the real story here the over-pathologization of normal human experience
in order to turn a larger profit (for the drug industry and the mental health
industry) ? With the way these disorders are currently defined I'm convinced
that every human being on earth could be diagnosed at various points within
their life.

I'm not suggesting that these symptoms don't exist, but rather that they've
been a perfectly normal part of human life since the dawn of man.

It's perfectly natural for people to go through periods where they have less
energy than other periods, overeat or under-eat, have difficulty concentrating
or making decisions, feel anxious. This is normal stuff depending on the life
circumstances especially if you're drinking any amount of coffee because that
will lead to periods of highs and lows. It does not mean you "have depression"
as if there was some flu virus that you became infected with it simply means
you're a human being.

I would argue that legitimate diagnosis should be reserved for people who are
either suicidal or who's symptoms strongly suggest elements of self-harming or
harming others.

~~~
keithflower
No.

Some conditions are overdiagnosed, and there is a too-cozy relationship
between medicine and pharma that is disturbing to many of us.

However, to make a diagnosis based on Diagnostic and Statistical Manual (DSM)
criteria almost without exception (one exception is for bipolar II disorder)
require that symptoms (and several symptoms are required usually for any given
disorder) must cause significant impact on one's lives, eg,

"...sufficiently severe to cause _marked impairment in social or occupational
functioning or to necessitate hospitalization_ to prevent harm to self or
others, or there are psychotic features."

or

"...symptoms cause _clinically significant distress or impairment_ in social,
occupational, or other important areas of functioning."

EDIT: (based on your own edit) - reserving diagnosis and treatment just to
those at risk for self- or other-harm is going to harm many suffering people.
I don't think you understand what depression really is. It's not caffeine
withdrawal or the flu. Even when no suicidal ideation is present, it's a
serious disease with real costs to the individual and to society, just as real
as cancer.

Beyond depression, I think you'd agree that even in the absence of harmful
behavior or ideation, people who experience auditory hallucinations in the
course of depression, or OCD sufferers who are unable to work because they
must wash their hands hundreds of times a day, or who have PTSD triggered
simply by backfiring engines, or who have dozens of other DSM diagnoses, all
have legitimate illnesses that deserve much more than the terrible,
stigmatizing suggestion that their illnesses somehow are not real.

~~~
h1karu
> It's not caffeine withdrawal or the flu. Even when no suicidal ideation is
> present, it's a serious disease with real costs to the individual and to
> society, just as real as cancer.

My argument is that it's not an "epidemic of depression" that we're dealing
with but rather an "epidemic of over-diagnosis". I would argue that the
industry is in practice being far too loose with the definition of
"significant impact on one's lives". I think articles like this one blur the
line even further by making it sound like everyone who has experienced a few
of these symptoms suffers from depression. People read stuff like this and
then start telling themselves "I'm depressed" and because of this mistaken
belief many of them wind up being medicated inappropriately.

This epidemic of over-diagnosis has reached such vast proportions that I
imagine the majority of people in the tech industry have been prescribed some
kind of psychotropic drug to treat some form of mental illness at some point
in their life. I wish I could get accurate statistics on this to prove my
point.

As a side note I do think that caffeine induced psychosis is 100% real
(because it's a very powerful drug) and the symptoms often mimic that of
depression or bi-polar and can even be inclusive of phenomena such as
hallucination. I don't have any credentials but my opinion as a layperson is
that I think it's incredibly irresponsible to write a prescription or to give
a diagnosis for any mental illness to a patient who has not first completely
cut caffeine out of their lives.

