
What to Do When a Loved One Is Severely Depressed - johnny313
https://www.nytimes.com/2018/06/07/health/depression-suicide-helping.html
======
spdustin
I feel like this should be left here:

Everybody you meet has a secret smile, and a secret pain.

If your secret pain feels like a weight you can no longer carry, please talk
to someone. Anyone. Lay down your burdens, and give your shoulders a rest.

If you're in the US, there's the National Suicide Prevention Hotline:
1-800-273-8255

LGBT folks in the US might also consider The Trevor Project Lifeline:
1-866-488-7386

I don't know about international numbers or other region- or culture-specific
services; perhaps others can reply with the ones they're aware of.

~~~
Someone1234
If you're in the US, you may also wish to think twice before calling the cops
on a loved one, particularly if they're only a danger to themselves (and not
you or others). Police in the US rarely receive training[0] in dealing with
suicidal individuals, and are instead trained to escalate the situation and or
use violence for a resolution[1].

There are numerous examples of the police turning up on a suicide call and
killing the individual, even when unarmed[2][3]. They simply aren't qualified
to deal with suicidal individuals and should only be used when other's safety
is at stake.

[0] [http://thehill.com/opinion/healthcare/375040-police-need-
mor...](http://thehill.com/opinion/healthcare/375040-police-need-more-mental-
health-training)

[1]
[https://www.theatlantic.com/national/archive/2014/12/police-...](https://www.theatlantic.com/national/archive/2014/12/police-
gun-shooting-training-ferguson/383681/)

[2] [https://www.thedailybeast.com/unarmed-teen-killed-by-
police-...](https://www.thedailybeast.com/unarmed-teen-killed-by-police-was-
simply-backing-his-moms-minivan-out-of-garage-lawsuit-claims)

[3] [https://www.mercurynews.com/2017/11/02/santa-clara-da-
clears...](https://www.mercurynews.com/2017/11/02/santa-clara-da-clears-
officer-who-fatally-shot-mentally-ill-suicidal-man/)

~~~
mywittyname
I suspect this is a driver of the increased suicide rate. People are afraid to
tell others because they don't want to deal with the police/authorities, so
they don't get the help they need.

My sister attempted suicide as a teenager and the police that responded spent
hours ransacking our home and further tormenting my family for no good reason.
Then to think of her being locked up in the hospital (I wasn't able to see her
for at least a week).

If I were having such thoughts, I certainly wouldn't tell anyone for this
precise reason.

~~~
megaman22
There also seems to be this weird stigma about admitting that you have ever
contemplated suicide. People seem to take that as some sort of signal that you
are completely unhinged.

Maybe I'm a nutcase, but I've taken the time to prepare a set of scenarios
under which I would no longer want to live, and think about what would need to
be taken care of to exit the world without undue burden on those that depend
on me. That seems like an eminently rational thing to do.

~~~
phkahler
>> ...but I've taken the time to prepare a set of scenarios under which I
would no longer want to live, and think about what would need to be taken care
of...

I believe professionals would categorize what you wrote there as "planning
suicide". So long as you have not started "taking care of" those things you
have not begun executing your plan. Planning is a rather big step beyond
contemplating - I hope you're doing better now. You may also want to consider
that actually getting your affairs in order could be an enabler.

~~~
megaman22
See, this is exactly what I am talking about.

It's evaluating a set of contingencies. Like, the general staffs of armies
make war plans that they will never execute, unless the particular parameters
fall in place, all the time. To do otherwise would be irresponsible.

~~~
anonfunction
I think what is missing is what set of circumstances would trigger you to
execute your plans. If it’s “world wide epidemic which causes extreme pain and
suffering with less than 5% chance of survival” that is one thing. However if
you are planning your suicide in case you lose your job or your significant
other cheats on you then that would be concerning and reason to seek help.

~~~
mirimir
There's no need to imagine such an epidemic. We're all going to die. And
sometimes that involves extended periods of pain and suffering, with no chance
of survival. In civilized places, voluntary euthanasia is available.
Elsewhere, one needs to plan ahead.

------
danschumann
One thing that helped me was seeing depressed thoughts as transient entities,
not belonging to me, but just passing through my mind once and a while.

It's like a weird dream. If you have a weird dream, you don't think, "oh I'm
weird", you think, "that was a weird dream". It's the same with depressed
thoughts: if you see them as "oh that's a depressing thought", rather than,
"I'm depressing", then it's easier for those thoughts to go away. (usually
when your blood sugar goes up or something like that)

~~~
tkxxx7
This is very important. One of the first steps of recovery is refusing to
identify with depressive thoughts.

~~~
serpix
also the first steps to enlightenment. Applies to all thoughts and emotions.

------
caio1982
"Remember, people do recover from depression"

That IMHO seems to be as much of a taboo as having depression itself for a lot
of people... it's hard to convince someone that depression is seriously real,
and equally hard to convince people [affected by their loving one's]
depression is not like terminal cancer.

~~~
weego
Recovery is just another step in the process.

You don't forget what it's like to start to suffocate in the abyss.

You don't forget what it's like to know that dying is easier than any other
option available to you and that it's a blink of an eye away.

It scars you

~~~
idbehold
Occasionally Fugazi's "I'm So Tired" will come on and I am instantly reminded
of the worst parts of my depression. It's been years and years since I was
that severely depressed, but that feeling can overwhelm me in an instant when
I listen to that song. Just remembering the terrible place I was in brings
tears to my eyes because I know how close I got to never experiencing all the
joy in my life that came afterward.

~~~
mikec3010
I had a similar experience when driving by the house I lived in when I was at
my worst. It was a dark subtle dread unique to that experience. It made me
come to realize just how badly I was and how far I have come

------
questionsuch
As much as I know all of these things, the attitude my loved one has has
killed the love out of me. Constant negativity, agitation, it's just tiring. I
just can't seem to not take it personal, and to have a mindset that it is the
disease and not the person.

I can't figure out how to start loving the person again.

~~~
serpix
Four years ago I was at this point. I talked with a number of psychologists
and therapists about this. One of them said: "Have you wondered if your
anxiety is really because of your relationship". And so began the steps to
disengage and end the relationship.

I don't regret it now. I could not and still cannot keep my empathy separate
from the suffering of others. The alternative would have been to harden my
emotions and become like a rock. My opinion is that depression does transfer
and it is contagious. Just as laughter and joy is contagious. I choose my
company wisely now and cannot bear to be around negativity anymore, it just
catches and makes me numb to everything.

I choose being sad and ecstatic even while they alternate to extreme highs and
lows. I refuse to heal anyone anymore.

~~~
phkahler
Whatever anyone says about this, don't feel bad about it. We are not all the
same - some can deal with it and some can not. Therapists actually have a high
burn-out rate because listening to other peoples issues can get to them. It's
great that you've established this boundary for yourself.

------
mikec3010
This is the quintessential video for understanding clinical depression. A
Stanford lecture given by Dr Sapolsky:

[https://youtu.be/NOAgplgTxfc](https://youtu.be/NOAgplgTxfc)

I highly recommend watching it to better understand the disease.

~~~
camel_Snake
Someone else (maybe it was you) shared this recently on hn and I watched it
and don't regret a single minute. Insanely informative and the style of
presentation where one covers the history of our understanding of a topic is
possibly my favorite.

------
jMyles
I started reading with a lot of interest, but this line caused me to close the
window:

> In some cases, calling 911 may be the best option.

It seems so tone-deaf. More accurate is:

> In cases where life is at stake, consider calling 911, but if you do, know
> that police will likely respond first and may not be trained to deal with a
> mental health crisis. In some cases, people have been brutalized or even
> killed after seeking help from poorly trained law enforcement.

~~~
phailhaus
If only you had continued reading one more sentence!

> But remember that interactions with law enforcement can vary wildly,
> depending on race and socio-economic background. In cases where you’re
> concerned that calling police could put a person in danger, try to come up
> with an alternate plan in advance.

~~~
jMyles
Indeed you're right. I can't believe I missed that sentence, and I agree that
it does a lot to address my concerns.

------
chris_wot
I am an Australian. You must NOT take your loved one to an ED if they mention
they have had suicidal thoughts. You simply cannot trust that they will be
treated with respect and dignity.

Two and a bit years ago I was having suicidal thoughts. I had an episode and
left the house in distress, but eventually arrived back home where my wife
comforted me and my suicidal thoughts went away, and yet I was ripped from my
bed and taken to hospital where I was thrown into a seclusion room for five
and a half hours. There is no clinical documentation, I’m not in the seclusion
register, there was no explanation given, I wasn’t assessed until hours later
someone turned up, said I was fine and not only did I leave the room - I left
the hospital!

The authorities do not care, they leave you powerless, stripped of your
dignity and autonomy and in some cases your life can be at risk. The following
review was done last year by the NSW Chief Psychiatrist and it is absolutely
damning:

[http://www.health.nsw.gov.au/patients/mentalhealth/Documents...](http://www.health.nsw.gov.au/patients/mentalhealth/Documents/report-
seclusion-restraint-observation.pdf)

I have been trying to get justice and answers for two and a half years. I went
to the body who is meant to investigate these matters after the health service
denied I was even in seclusion, they did nothing.

The Hospital has now acknowledged I was in seclusion. They have literally just
now started to find out about my lack of clinical records it’s, but they don’t
think they’ll ever find out who threw me in that room.

I now have severe PTSD, completely distrust the medical profession and will
never speak of suicide to any medical professional ever again, and I strongly
believe that anyone who does so takes a grave risk of being abused or
mistreated by uncaring “professionals” who act more like jailers than carers.
Certainly an ED is the very last place you want to go to - they simply do not
care about depressed or suicidal people and you will almost certainly be
thrown into a psych ward. Your rights will be servely curtailed, your decision
making ignored and removed and it can be very hard to get out of such places.

------
metamet
Someone close to me once shared this as the best representation of how
depression feels to them.

It was really helpful in helping me understand in a way that I hadn't been
able to before.

* [http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-...](http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html)

* [http://hyperboleandahalf.blogspot.com/2013/05/depression-par...](http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html)

------
weliketocode
A friend of mine died last year in his 20s from related issues.

It's unfortunate to see the events bringing it to light, but I'm glad to see
the issue receiving greater public attention.

In the US at least, suicides have been and continue to be much more prevalent
than homicides.

~~~
pm90
Its not just the US. Its widespread in India and spans different age groups as
well: from destitute farmers to students from pretty wealthy families. And I'm
sure in other countries as well... so yes I too am glad this is getting more
attention.

------
kyleperik
Great article, but what is this about? Is this really true?

> But remember that interactions with law enforcement can vary wildly,
> depending on race and socio-economic background.

~~~
Klathmon
Sadly yes.

I honestly don't have any numbers to backup my feelings, but I know that a lot
of people truly fear the police, and possibly for good reasons.

A while ago we had to call the police on a loved one that we were fearing was
suicidal. By the end of the whole night the only thing that happened was the
loved one was stuck with a rather large hospital bill as they were admitted
(then discharged the next day), and they were cited for having the
registration of their car be several months past due BY the cops that were
sent to their house.

There are also countless stories online of people (often minorities) calling
police or having the police called _for_ them, but they end up getting injured
or even killed in the process. There are also reports of cops entering the
house of someone that was reported as suicidal with their guns drawn...

Not to mention that with drug laws in the US, someone with contraband or
illegal drugs in their house or on their person might be risking everything
just interacting with police.

I don't really want to get into the debate about how police should act, or a
debate about guns or laws or racism or what is warranted or not or drug laws
or whatever else right now, but I do want to point out that for some people,
the police might be more of a "threat" than help. And even if statistically
the police aren't that likely to hurt someone, the frequency that it's
happening and the growing resentment on both "sides" can make it so that many
people will want to attempt other solutions before involving police.

~~~
kyleperik
Honestly I wasn't trying to start any sort of debate either, I just didn't
know that was really something people have to be aware of.

That's very sad. I feel bad not knowing that's the way things are now.

~~~
Klathmon
It's absolutely not like that everywhere, or for everyone, but for many it's a
real problem, and it's not one that has an easy solution.

And I'm kind of upset that your comment is getting downvoted so much, as it's
a very valid question.

Growing up I was taught to trust the police, that if something was wrong to go
to them and they will help, that they were safe and would protect me. But at
this point in my life I'm honestly not sure if I would teach the same to my
children. And that thought terrifies me because I honestly can't think of a
scenario where these kinds of feelings end well for society in general.

~~~
drak0n1c
Statistics show that such a danger is very tiny compared to the benefit of
seeking the aid of law enforcement for every race, even if you don't filter
out cases where the officer was purposefully antagonized. Social media and
24/7 news is incentivized to publicize negative outliers. Similar to fear
around radical terrorism - there is a pattern, but statistically it's not an
issue worth altering your lifestyle around.

The discussion is largely rooted in anecdata and can be interpreted multiple
ways due to the relatively low number of lethal events:
[https://www.washingtonpost.com/news/wonk/wp/2016/07/13/why-a...](https://www.washingtonpost.com/news/wonk/wp/2016/07/13/why-
a-massive-new-study-on-police-shootings-of-whites-and-blacks-is-so-
controversial/?noredirect=on&utm_term=.0d154ec29d91)

~~~
Klathmon
Which is only one part of my comment, and it's the one that (in my experience)
people worry about the least (but it's always the one that people like to talk
about the most).

What about the problem of police causing massive medical bills? What about the
issue of fearing police involvement because they may charge you with a petty
crime that can cause you significant issues? Or the worry that you could be
arrested and jailed for having small amounts of marijuana which is legal just
a few states over during an interaction with police? What about the worry of
putting an office with their gun drawn in front of a suicidal person?

And even if none of that actually happens ever in "real life", the fear of it
happening can be just as bad. It causes resentment, it causes kids to grow up
fearing the police, it causes police to fear those who hate them, and
instinctively act less friendly and helpful to them.

It's a problem that from where I'm standing looks like it can only get worse
and worse. The police are no longer thought of as on "your side", and telling
people that "statistically they aren't that likely to kill you" isn't going to
solve anything.

~~~
ams6110
I know a few cops, and they tell me that they don't worry about small amounts
of weed (even though it's not legal here) because the local prosecutor doesn't
want to bother with those cases. He has bigger fish to fry.

It's not that way everywhere, but many cops are going to look at the big
picture and try to do what's "right" rather than be anal about arresting
people for minor transgressions.

------
whitepoplar
A couple things that helped me when I was severely depressed and suicidal:

1) I _can_ kill myself, at any time, if I want to. I'm in control and nobody
can take that away. Paradoxically, understanding that made me feel better,
because if I know I can do it at any time, why do it now? May as well wait a
little while.

2) Make a checklist of essential tasks and get into a habit of doing those
things _no matter what_. Some examples: shower, brush teeth, floss, use
mouthwash, clip nails, walk 10k steps, do dishes, make bed etc. Check them
off. It doesn't matter what's on the list, but it is important to check off
100% of the items each day. Put every small task you can think of on this list
and you'll feel good when you check each of them off.

3) Take a good multivitamin + vitamin D

4) Eat healthier. Fresh steamed spinach and wild salmon always made me feel a
little better for whatever reason.

5) Get out of the house! Walk! This is really important.

6) Go to the gym. Aim for at least a couple minutes of sprints per day (I like
the rowing machine for this). Sprints are holy time in that suicidal thoughts
will completely disappear, if only for those few minutes.

7) Walk through a dangerous part of town. Nothing gets rid of depressive
thoughts faster than rising blood pressure and a fast heartbeat.

8) Get rid of as much decision-making as possible in your life. Turn decisions
into mechanical rules. e.g. don't think "do i want to brush my teeth today?"
You need to brush your teeth in order to cross it off your list.

9) Sleep will naturally improve on its own, over time, if you exercise, move
around, and eat healthier, so don't worry if you currently have trouble
sleeping.

10) This book is pretty good, but only read after you've eaten healthy, gone
outside, and exercised: [https://www.amazon.com/Guide-Good-Life-Ancient-
Stoic/dp/0195...](https://www.amazon.com/Guide-Good-Life-Ancient-
Stoic/dp/0195374614)

What _didn 't_ work for me was: thinking about all the people i'd hurt,
calling a hotline, any decision-making that wasn't mechanical and required
reasoning, insight, or motivation.

If you're suicidal right now, start by putting some shoes on, going outside,
and sprinting until you can't breathe anymore. Do this 3 times.

------
viburnum
Good stuff, but I've learned the hard way that most therapists have no idea
what they're doing. If someone is not feeling better after 6-8 sessions, they
need to get a new therapist. It's all too easy to get into a codependent
relationship with a therapist that only enables the depression or anxiety to
persist.

~~~
astura
I had a therapist that once suggested taking herbs for an non-treatable
medical issue and another time antibiotics for a cold.

I can't believe I actually paid money to see her.

~~~
lazyasciiart
I had a therapist once who suggested that my anxiety was the product of
excessively high expectations, and I would feel better if I stopped expecting
colleagues to do things like tell the truth. I quit therapy, and also quit
that job. I felt much better after doing both!

~~~
chris_wot
So you essentially stopped having high expectations of your therapist and
consequently stopped paying her :-)

~~~
lazyasciiart
Yes, and I suppose if I'd had the option of stopping the company from paying
my colleagues I would have been fine with stopping my expectations of them as
well :)

------
brownkonas
Not sure if this is substantiated or refuted by any clinical research, but
through experience I believe depression to be a side effect of the mind being
absent any existential threats that would, as an animal, threaten your
survival on a daily basis: searching for food, maintaining shelter, guarding
yourself or each other from predators. As we become farther and farther away
our primal origins, the mind needs to invent challenges, obstacles and worry.

~~~
mikec3010
That's one theory. Another is that our society has so many more intangible
responsibilities, obligations, serious decisions, and opportunities for
failure (oh and consequences, every single action through out the day brings
consequences that our minds are overloaded and constantly anxious.

And research has found that anxiety and depression are tightly linked.

------
xivzgrev
I have struggled with depression for over half of my life. This sentence
really struck me: "If you want to say something positive, focus on
highlighting what he means to you".

I teared up because it is so true.

Give it a try if someone you love has depression.

------
0xcde4c3db
> A severely depressed friend needs professional assistance from a
> psychologist, psychiatrist, social worker or another medical professional.

This is an example of a troubling pattern often seen when talking about
"depression". Depressed mood can be a symptom of numerous medical conditions.
That means you need to write down _all_ observed symptoms and see a doctor to
diagnose or rule out those conditions. It's a bad idea to jump straight to
psychology or psychiatry just because your most distressing symptoms are
psychological. It's an especially bad idea to get committed to a psychiatric
hospital with an undiagnosed chronic condition that psychiatrists don't
specialize in treating.

------
rectang
I'm uncomfortable with the idea that someone who is in agony must be kept
alive at all costs.

~~~
backpropaganda
I used to think like this, but not any more.

The agony is temporary. The not being alive is permanent. It's an irrational
suboptimal decision that they would regret 2 years later. It makes sense to
help them.

It's like helping your friend quit smoking. They will be agonized for a few
months, but eventually will get out of the addiction and be thankful.

~~~
rectang
I agree that in general that is the right approach.

However, some people suffer with chronic depression for their entire lives.
What makes me uncomfortable is that no exceptions are ever allowed. Every
sufferer must continue to stay alive indefinitely no matter how much pain they
are in.

I understand why this idea will forever be taboo, but it still bothers me.

------
mhkl
What I did is watch the 8 hour docuseries at www.brokenbrain.com and learn
from 50 doctors what the various causes are and how to treat these caused. It
did help me a lot to understand depression but my depressed son does not want
to watch the docuseries. Sigh.

~~~
ajkjk
Why should he want to? When I was very depressed I would have hated nothing
more than being made to watch 8 hours of something meaningless to me.

What helps (I would think) with depression would be things like "fitting in",
"feeling valid", "feeling purpose", "not feeling shame", ""not having social
anxiety", "sleeping well", "being fit", "having a healthy community", "having
fulfilling hobbies", "having a healthy friend group", "having healthy family
relationships".

not "knowing more about how depression works".

~~~
gowld
You listed a pile of goals, not tools. Understanding how depression works can
be a tool.

~~~
ajkjk
I'm not saying that a depressed person wouldn't want to understand how
depression works, just that they don't _necessarily_ want to, and it's wrong
to be annoyed that they don't.

~~~
ajkjk
Addendum:

I also don't believe that doctors _really_ talk what the 'various causes are'.

I've been depressed, very much so, and I've read books that summarize
scientific reading about depression like The Upward Spiral[0], and I feel like
they _miss the point_ , somehow. Like: we're great at finding treatments and
things that work for individual people, but I sort-of think that the problem
with depression is fundamentally _everyone else_ , ie, 'society is sick', and
we treat it as a personal problem because well of course doctors can't
prescribe fixes to society, but they can for a person, so it's all stopgaps
that don't address the "real problem".

I think that often depressed people have an idea of this -- that it is the
existence around them that is sick, somehow -- and so no amount of suggestions
(which indeed _might actually help_ ) quite gets to the bottom of that because
it is the world that is fundamentally wrong. (Or specifically it is the nature
of how they currently fit into the world.) From a treatment standpoint yes of
course they should do the things that will probably help them, and people
around them should be empowered to get them to do the things that will help
them. But for the person that is struggling that really doesn't _feel_ like
the answer, and I think that they're not wrong.

(By 'society is sick' I mean that the person does not, for whatever reason,
exist in the mentally healthy setting that their brain was 'designed' to exist
in -- a healthy community, the right kinds of relationships, the emotional
mentors and sources of wisdom that provide the right kinds of useful guidance,
a body that works the way that it's supposed to, physically and mentally, etc;
and a world around them that makes sense, that they can feasibly _cope_ with,
which is exactly the opposite of the nihilism induced by news of politics and
global tragedies.)

[0]: ([https://smile.amazon.com/Upward-Spiral-Neuroscience-
Reverse-...](https://smile.amazon.com/Upward-Spiral-Neuroscience-Reverse-
Depression/dp/1626251207))

------
mendelsd
Ensure they are getting adequate folate, noting that normal blood levels may
not indicate functional sufficiency [1][2]:

"Folate deficiencies may lead to an increased risk of depression and poorer
antidepressant treatment outcomes..."

"...deficiencies may be caused by improper absorption and utilization, often
due to genetic polymorphisms."

"Supplementation with the active form of folate, (methylfolate), which is more
readily absorbed, may be effective in the prevention and treatment of both
depression and dementia."

"...(methylfolate) indicated efficacy as adjunctive therapy or monotherapy in
reducing depressive symptoms in patients with normal and low folate levels..."

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/19909688](https://www.ncbi.nlm.nih.gov/pubmed/19909688)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/17900207](https://www.ncbi.nlm.nih.gov/pubmed/17900207)

~~~
ridgeguy
Yes. There is a subset of patients with depression who have either of two
different genetic polymorphisms for methyeneltetrahydrofolate reductase. This
may be causally linked to their depression. [1]

Supplementing diet with a modified form of folate appears to diminish
depression in patients with these particular polymorphisms.

My understanding is that this is still a matter of controversy.

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/)

~~~
mendelsd
A few interesting things to note on this topic:

1) Prevalence of MTHFR gene variants you refer to is very high, e.g. 10%/50%
for homo/heterozygous C677T SNP [1] (with frequencies varying substantially
between ethnic groups).

2) Effects tend to be stronger with two copies of a variant (homozygous), but
a single copy (heterozygous) may still be a concern, e.g. for C677T:
"Individuals with the 677TT genotype, have approximately 30% the MTHFR enzyme
activity of those with the 677CC genotype, whereas heterozygotes 677CT have
around 65% of enzymatic activity" [2]

3) It seems odd to me that pharmacological dosages of folate are getting
prescribed (I mean, it's a nutrient so why take it in doses that exceed the
nutritional range?):

"The most active form of folate has recently been approved in the United
States as a prescription medical food for depressed patients with folate
deficiency. Doses are usually 7.5 to 15 mg/d". [3]

"Another concern is that folate doses > 800 μg/d can result in high levels of
unmetabolized serum folic acid, reducing the amount of brain l-methylfolate
and leading to decreased monoamines, an outcome that potentially increases the
risk of or exacerbates depression." [3]

Folate RDA is 400-800 μg/d depending on pregnancy status [4]

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/28847029](https://www.ncbi.nlm.nih.gov/pubmed/28847029)

[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6)

[3]
[https://www.ncbi.nlm.nih.gov/pubmed/19909688](https://www.ncbi.nlm.nih.gov/pubmed/19909688)

[4] [https://www.mayoclinic.org/drugs-supplements-
folate/art-2036...](https://www.mayoclinic.org/drugs-supplements-
folate/art-20364625)

------
rjurney
It is unfortunate that stigma around mental illness causes most people to view
psychiatric hospitals as places to avoid at all cost, as they have a stigma so
terrible going to one is like dying multiple deaths. After that you're
'legally' crazy (whatever the fuck that means)!

In fact, if you need one, if you are severely depressed or hallucinating, a
hospital is exactly the place for you. You will most likely love it there.
They can help. They can really help. Everyone gets better in the hospital.
Everyone. Not "1/3 get better, 1/3 stay the same, 1/3 get worse." Everyone in
that sheltered environment rapidly improves. It is a vacation for the mind.

The question then becomes staying out of the hospital. Many people come back
every few years, get to know the staff quite well, etc. Others develop a plan
to address mounting depression early through ongoing treatment, partial
hospitalization, etc.

~~~
rjpr
Personally I'd avoid them at all costs due to the loss of control. You can't
just decide "I'm done" or "I don't like it here", you getting released is at
the discretion of people that you don't even know.

~~~
soared
You are part of the problem - you're making it seem like some evil doctors tie
you down. The reality is if you bring yourself to a hospital you just request
to leave and . Doctors have the ability to petition the courts to keep you
there. It goes to a US Court, not some evil medical doctor's back office.

[http://www.disabilityrightsohio.org/when-person-wants-
releas...](http://www.disabilityrightsohio.org/when-person-wants-released-
psych-hospital)

Even if you're forced to go a mental facility by family/friends/other, it must
be legally addressed within 72 hours, and a physician must see you within 48.

[http://www.lcnewschronicle.com/opinion/columns/4390185-judge...](http://www.lcnewschronicle.com/opinion/columns/4390185-judges-
view-how-civil-commitment-process-works)

~~~
rjpr
Did you read this at all?

> If you have admitted yourself into a psychiatric hospital, you can not
> simply sign yourself out and leave when you decide to do so. There is a
> process which must be followed in order to leave.

~~~
soared
That aligns with my previous comment. There is a fast legal process, not some
arcane movie-like entrapment like your comment implied.

~~~
rjpr
My comment implied no such thing. I was simply stating that you can't just up
and leave should you so wish, you getting released is not in your control.

~~~
soared
Except that its /rarely/ not in your control. I'm unable to find numbers, but
I find it hard to believe that any significant amount of people's requests to
leave are taken to court.

~~~
tptacek
I've never seen it be in someone's control, in the sense that they were able
to say "this isn't working for me, I'd like to leave now" and then were
allowed to leave.

I've also never seen it go all the way to court; rather, there's a statutory
period of time after a voluntary admission where you have to either be
released or taken to court, and that period is something on the order of an
entire business week.

The pattern I've seen is (even at the nicer facilities) one of facilities
staffed by nurses and counselors but with very overbooked psychiatrists, and
all decisions about care are ultimately delegated to those psychiatrists. It
can take days to make a decision happen just because of round-trip and
scheduling delays.

The (call it) 5-day clock only starts ticking when you're formally
acknowledged to have made a request to leave, too, so those same round-trip
delays can keep you confined for longer than the statutory window.

When things go wrong, it's a frightening experience. Psychiatric hospitals
carefully control your access to the outside world. Visitors are allowed only
during limited visiting hours. Phone calls are allowed only during specific
phone hours. You reside in a room with one or more strangers also suffering
from psychiatric conditions, often significantly worse than your own. You're
required to take medication, and the medications issued are rarely the same as
a careful psychiatrist you had a preexisting relationship would issue. There's
not just a loss of personal freedom but also of body integrity.

Like I said: however suboptimal it is, this can all be for the greater good,
if a crisis situation has spun out of control and what's really needed is some
kind of circuit breaker to arrest the crisis and ensure that someone ends up
with access to professional psychiatric care. I'm not saying people shouldn't
go to the hospital! I'm saying that people encouraging others to go to the
hospital should be aware of what they're saying.

I also think you could stand to be a little bit less strident and a little
more specific. I think it's likely that you have a set of experiences with
acute psych care that differ from other people in this community. I've seen
_good_ acute psych care too --- in a university system --- but it was acute
outpatient, not inpatient.

------
dkrich
I was thinking about this this morning and couldn't help but notice the
apparent correlation between high profile people who have committed suicide
recently and their profiles.

All from arts/creative fields (Avicii, Kate Spade, Bourdain, Robin Williams,
Heath Ledger, I'm sure there are more). Is there any scientific research that
has explored the possibility that the wiring in the brain that makes people
creative has a propensity for depression?

Of course the sample size is small and could be selection bias, but would like
to hear from people who are knowledgeable on the topic.

~~~
Smudge
Doesn't really answer your questions, but I'd point out that it's possible
that we only hear about these suicides precisely _because_ they are from
professions that tend to produce high-profile celebrities. I'd counter your
apparent correlation with the fact that apparently suicide among doctors is
extremely high:

[https://www.washingtonpost.com/national/health-
science/what-...](https://www.washingtonpost.com/national/health-science/what-
ive-learned-from-my-tally-of-757-doctor-
suicides/2018/01/12/b0ea9126-eb50-11e7-9f92-10a2203f6c8d_story.html)

~~~
danso
Is's a common convention in newspaper obituaries and articles to not mention
cause of death as suicide, except in newsworthy situations.

Covering suicides in general were somewhat taboo unless they involved someone
noteworthy:

[https://www.poynter.org/news/reporting-
suicide](https://www.poynter.org/news/reporting-suicide)

------
resource0x
One great man's account of dealing with depression (the term hadn't been
invented yet at the time of writing, but you will recognize the symptoms)
[https://www.goodreads.com/book/show/26244.A_Confession](https://www.goodreads.com/book/show/26244.A_Confession)
Download:
[http://manybooks.net/titles/tolstoylother08a_confession.html](http://manybooks.net/titles/tolstoylother08a_confession.html)

------
braindongle
As a person who has experience with severe depression, studying evidence-based
psychiatry, and conducting psychiatric services research, I wholeheartedly
endorse the advice in this piece.

------
slx26
this is a very sensible article. kudos to nytimes and the writer. we also need
this kind of advice on tv, schools, etc. a better general understanding of
depression by society as a whole is not only one of the best tools we have to
deal with it, but also a great way to start building a better society

------
depressed_394
I really don't want to be asked if I'm having suicidal thoughts. Ever. By
anyone. If I say yes, someone might try to "help" me by having me confined to
a psychiatric hospital. Or worse. Having to lie about it is unpleasant.

I have suicidal thoughts regularly, but I am not going to act on them. From
most objective standards, my life is generally good. I've never had problems
getting dates - at least once I got the courage to try, though long term
relationships are hard. I have a job I like and find fulfilling. I'm well on
my way to having "fuck you money". Still depressed.

Since childhood (25+ years) I've been taking antidepressants. Have changed
them a few times, though not for many years. They allow me to be mostly
functional most of the time. Switching now might put me in a hole I can't get
myself out of.

Talk therapy has never really helped me. I don't really have any hope left of
ever not being depressed. I've thought about trying psychedelics or ketimine
therapy, but can't really find the motivation to do anything.

Fuck depression.

