
We Need New Ways of Treating Depression - dpflan
https://www.vox.com/the-big-idea/2018/2/25/16997572/causes-depression-pills-prozac-social-environmental-connections-hari
======
elptacek
If this is a way to treat depression, maybe dialing back the crap way we treat
each other is preventative. I've been angry for a long time that I have to
take medication because most of my life was full of people who seemed to get
some sort of perverse pleasure out of making me feel bad for things I cannot
control (like being female, nearsighted and unattractive). Somehow it's not
possible to simply disagree with someone else and state your contrary opinion,
but rather to escalate quickly to aggression and personal attacks. Somehow
it's not possible that we can organize ourselves so that a greater number of
people can have their physiological needs met, much less feel safe and heaven
forbid we should feel love/belonging or have a modicum of self-esteem because
how would advertisers ever sell anybody anything? And along comes the internet
where anyone is entitled to say anything from a distance and not have to look
into the eyes of the human being they're taking a scrap of dignity from.

~~~
dec0dedab0de
_...I have to take medication because...of people who seemed to get some sort
of perverse pleasure out of making me feel bad..._

In my head I boiled your comment down to that, and it hit pretty hard. I have
had people encourage me to take anti-depressants because of my reaction to the
way they're treating me.

~~~
agumonkey
I'm on your "friends" side with family members. You made me reconsider some
aspects of the situation.

------
aaavl2821
There's a story Andrew Solomon tells that's not unlike the Southeast Asia
anecdote. Andrew traveled the world trying to understand how other cultures
experience depression as a way to deal with his own depression

In one African village, he asked the residents what they thought of western
depression treatments. They said "why don't you bring people outside, so they
can feel the sun on their skin? Why don't you dance with them, so they can
feel energy of others? Why, instead, do you shut them in a dark room, alone
with a stranger, to talk about things that make them sad?"

It's an interesting talk, and one that illustrates just how little we know
about depression

~~~
jvogt
> Why, instead, do you shut them in a dark room, alone with a stranger, to
> talk about things that make them sad?

FWIW, this isn't really how therapy goes. At least from my CBT experiences,
its a few minutes of talking about what we're currently struggling with, then
decoding those topics to learn how we distort our experiences and memories
towards the negative / stressful.

Then usually the "homework" would be small actionable steps to build up habits
to become aware of these distortions, as well as habits to make other healthy
choices.

Not discounting Andrew's story one bit, just putting a bit more light on what
modern therapy aims towards.

~~~
starpilot
The general idea is true though. For a depressed person, we aim to isolate
them with a clinician instead of surrounding them with friends. We even use
"therapy" as a kind insult: "You should go to therapy!" as if mental illness
is something to be shamed.

The overall notion is that there's something wrong with people who are
depressed, and that we'd rather wash our hands of it than help them. We have
similar attitudes toward the homeless and the incarcerated. It's a very
puritan/Calvinist attitude, that "certain people" are innately bad, but
pervasive in even progressively minded Americans.

~~~
d0lph
Friends/therapist is a false dichotomy, any good therapist encourages
socializing.

Depressed people are not mentally healthy, it's a condition that can lead to
suicide. Being sad is not bad, but when someone is diagnosed with depression,
or any mental disorder, it's because it's affecting their lives negatively.

Also the rooms have do have lights in them.

------
DubiousPusher
> We offer, and are offered, drugs as the first, and often last, recourse.

This is one of the many mental health memes I wish would die. I've lived my
entire life with several close family members and friends who have severe
mental illnesses. I have been to hundreds of appointments across dozens of
providers. I have never NEVER seen a doctor give a patient a once over and
then prescribe meds.

I understand there are bad psychiatrists out there. Just like there are bad
mechanics, bad accountants and bad everythings. But I believe the vast
majority of psychiatrists understand the limits psychoactive medications. I
think it would be farely rare that a psychiatrist doesn't also discuss
lifestyle changes and recommend some kind of talk therapy along with
medication.

~~~
ravenstine
I think many psychiatrists prescribe first because people who are clinically
depressed have such a high rate of suicide that it's better to first reduce
the risk pf death before further treatment.

I'm not saying that applying that principle so broadly is a good thing, but I
can see where they're coming from.

~~~
gnode
Sometimes antidepressants can increase the risk of suicide, however. This is a
commonly enumerated side effect in their advice leaflets. One theory of
depression is that it's evolved to take away our motivation to kill ourselves
in the face of extreme adversity.

~~~
DubiousPusher
True, the link between antidepressants and suicide is a current area of study.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034101/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034101/)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/)

In no way do I want to diminish how serious these drugs are. They can have a
profound effect on a person's behavior that occurs in a very short period.

Finding a medication regimen that works for a person is a serious undertaking.
It often takes years. A person may have to taper on and off dozens of
different regimens to find a good effect while minimizing side effects. The
constant personal changes a person experiences through this process can strain
relationships, ruin careers and much worse.

------
jdietrich
Caveat lector: Johann Hari, the author of this piece, was involved in a major
integrity scandal in 2011. He resigned from his job at _The Independent_ after
being accused of habitual plagiarism and admitted to vandalising the Wikipedia
articles of journalists who had criticised him.

[https://en.wikipedia.org/wiki/Johann_Hari#2011_scandals](https://en.wikipedia.org/wiki/Johann_Hari#2011_scandals)

His recent book _Lost Connections_ , on which most of his recent articles
about depression have been based, has faced widespread criticism for
misrepresenting the evidence on depression and how it is treated.

[https://www.theguardian.com/science/brain-
flapping/2018/jan/...](https://www.theguardian.com/science/brain-
flapping/2018/jan/08/is-everything-johann-hari-knows-about-depression-wrong-
lost-connections)

[http://www.independent.co.uk/voices/johann-hari-
depression-a...](http://www.independent.co.uk/voices/johann-hari-depression-
anti-depressants-psychiatrists-pills-therapy-change-lifestyle-job-
psychology-a8151606.html)

[https://anotherangrywoman.com/2018/01/08/five-things-
wrong-w...](https://anotherangrywoman.com/2018/01/08/five-things-wrong-with-
johann-haris-comeback-book-that-i-spotted-from-the-extract-alone/)

------
tachyoff
We need to stop giving people reasons to be miserable then. I know too many
millennials working two or three crappy service jobs for peanuts, never going
to the doctor because being a server or Uber driver doesn't provide health
insurance, and constantly ha-ha-only-seriously joking about becoming
alcoholics for it to be just a coincidence that so many people are depressed.
Oh, and I'm sure our disgusting sugar-laden diets aren't helping anything
either. But maybe some basic social safety is necessary? I'd be pretty
miserable too if I were afraid a single ambulance ride was going to bankrupt
me (as it all too often does to Americans).

------
JonCox
Here's a nifty idea.. start researching cheap, low harm, but powerful drugs
again, instead of banning the research.

Perhaps some new ways of treating depression using LSD or suchlike will come
from the research. Perhaps not. Hard to know while the science is banned.

[https://www.maps.org/research/other-
research](https://www.maps.org/research/other-research)

------
throwaway____
I think that the effects of food/digestion are still hugely overlooked as an
underlying cause/catalyst of mental illness in general, and not the other way
around. Here's a clinical psychologist and professor of psychology who
discovered the same thing for both himself and his daughter [1]. They only eat
meat now, basically.

[1] -
[https://www.youtube.com/watch?v=A6g_geYeL4U](https://www.youtube.com/watch?v=A6g_geYeL4U)

------
sgtmas2006
Social Prescribing has only ever had a negative outcome on me, as well as most
medications. Zoloft made me extremely suicidal, Lamotrigine for mood
stabilization made me lose my hair. The only medication that's ever worked for
me is addictive, and prone to abuse. It helps with my severe social anxiety,
and prevents rumination. Because of the addictive nature of it, I do not take
it.

I understand that things such as "social prescribing" may help some, but it is
detrimental to me. I have no desire to be forced around a group of people that
I have no known common interests, and may have none.

I feel that reading the majority of discussions to treat depression fall short
in my case, as a lot of them involve other people or outdoor activity. My
general disregard for other people and existence as a whole tends to be an
issue.

I'm sure this can help some, but it seems to just be what most people
understand already.

~~~
SkyPuncher
> Zoloft made me extremely suicidal

Were you on an upswing in your mood?

There's a tough period with anti-depressants where people are on an upswing to
a more positive position. They haven't yet broke free of overwhelming suicidal
thoughts and low mood, but now have energy and motivation to actually do
things. Unfortunately, that means suicidal thoughts that seemed too difficult
now appear possible.

It's a really interesting and tough situation. Being suicidal can actually
indicate things are working properly, but will still need 4 to 6 weeks to get
you to a more positive place.

~~~
sgtmas2006
I was actually quite low. I didn't want to put it as harshly as I explain it
to people close to me, but it took me from a position of "I want to die, and
probably will kill myself semi-soon." to "My shotgun is loaded, 41 steps away
from me. In a flash the world could be gone, and my thoughts would vanish and
I would be at peace."

The prior thought process was accompanied with self-destructive methods.
Abandoning friends, work, hobbies, etc. My real emotional escape has always
been video games. They keep my thoughts from wandering, and I pour everything
in to them. I believe my use of them in that way accompanies my skill at them.
(Top 10 PUBG 2 seasons ago, A+ ESEA, Global Elite in CS, top 50 crusader D3
S13, etc.) My accomplishments in video games really help my suicidal
tendencies, but they also hamper them. My depression seems to sway between a
desire for success, freedom, skill, and a general over-arching hate of the
meaningless-ness of existence. On a downswing it can depress me, on an upswing
it can inspire me. I don't know enough about the topic from a professional
perspective to determine how common that is for people.

~~~
SkyPuncher
This is exactly where the "suicide warning" on anti-depressants come from.

The "I want to die" thought and the "my shotgun is loaded" thought are at
their core, the same "I don't want to live". However, the later has motive and
intent behind it.

The whole goal of anti-depressants is basically to give you motive and intent.
In many cases, that can be really good but it also means you have motive for
the suicidal thoughts that still linger around.

------
fit2rule
I've been saying it for years - depressed? One-way plane ticket to another
culture, preferably completely foreign: solved.

And I've seen it work, time and again. So many times, I cannot be swayed: if
you're depressed, you need to move. The deeper the depression, the more
convinced you are that there is no solution: the further you need to fly,
friend.

No, its not easy. (Except it is). Yes, you will have to learn a new language
(except that is fun and very rewarding once you do it). No, your culture is
not important, you can shed it in an instant - all it takes is that boarding
pass, man.

~~~
Bakary
Funnily enough I became depressed from precisely this move. I don't think it
is bad advice, however. But it did make me chuckle.

------
icc97
This story is by Johann Hari who has an interesting TED talk about addiction
[0]. He put addiction down to the amount of connections that people have and
seems to be arguing something similar in this article too. Googling bought up
this criticism of the video [1] for some perspective (with Hari, to his
credit, answering the criticisms).

[0]:
[https://www.ted.com/talks/johann_hari_everything_you_think_y...](https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong)

[1]: [https://www.thefix.com/content/4-things-hari-gets-wrong-
abou...](https://www.thefix.com/content/4-things-hari-gets-wrong-about-
addiction)

------
dpflan
This article about depression is also on the front page at the moment. Seems
good to link for more references and discussion:

>
> [https://news.ycombinator.com/item?id=16491986](https://news.ycombinator.com/item?id=16491986)

------
shellkr
I can not talk about how things is done in other countries... but everyone who
reads Psychology (and/or psychiatry) in grade school knows about Aaron
Antonovsky and the "sense of coherance" theory. Everyone in health care who
study assistant nurse and up knows about this theory.

So this is not something new or unknown about. It is not biology or social..
it is biology and social. Both play a part.

I live in a Scandinavian country and we are very aware that loneliness is an
important cause for depression. The problem is.. you can't force people to be
social. Family might be the problem. So drugs can be a solution until you find
a more permanent solution.

------
goodroot
Not a mention of plant-based medicines and psychedelic, spirit-centric
treatments of depression? There's enough data at this point that this seems
willfully obtuse. We need new ways, yes, and they're out there. These new ways
need champions.

Ayahuasca changed my life and banished two decades of born-into depression. I
have seen dozens of people transform thanks to this medicine. I've seen
similar, incredible transformations from Psilocybin. Daily meditation keeps me
in balance and singing tunes of contentedness. They're out there!

------
ltwdm
I have doubts about the authors intentions: Look up the wikipedia article and
in the past he has done things of questionable integrity to be popular. He is
a good storyteller and there is strong criticism from the medical
professionals about his skewed views about ineffectiveness of current
treatment methods. He does not cite enough references for such a hevayweight
topic. I have no problem in him presenting a new perspective, but this is more
of getting into the bestseller book list by telling you what you wish to hear.

------
bobthechef
The article should read more like "We need new ways of identifying and
defining depression".

------
mhkool
www.brokenbrain.com is what you should look at.

------
mkstowegnv
Ancient wisdom and modern science support the idea that exercise and nurturing
are highly effecting in fighting depression. I once spent a day in a log cabin
splitting wood, dancing and baking bread and thought to myself if everyone in
the world could do one of these things every day most of the world's problems
wound evaporate. My specific favorite prescription for the slings and arrow of
outrageous fortune is an aerobic, geometric, tribal form of dancing that is
challenging but easy to learn with a subculture that welcomes and celebrates
beginners - contradancing [1]. I also recommend listening to uplifting music
such as Stan Roger's Mary Ellen Carter [2]

1
[http://www.burningmancontradance.com/home/contraintro](http://www.burningmancontradance.com/home/contraintro)
2
[https://www.youtube.com/watch?v=Fhop5VuLDIQ](https://www.youtube.com/watch?v=Fhop5VuLDIQ)

------
getcrunk
How about god and hoping for paradise. World's made to break you

