
A third of Americans now show signs of clinical anxiety or depression - xoxoy
https://www.washingtonpost.com/health/2020/05/26/americans-with-depression-anxiety-pandemic/
======
aszantu
As a person with a history of depression and social anxiety I really do feel
calmer since the crisis started, as if my state of mind was made for this kind
of life. Less people on the streets, it's quieter, no one breathing down my
neck in the supermarket, home office, no expectations on how to pick my
clothes, how to behave, no trying to hide the weird stuff I eat (carnivore,
high meat, raw, cooked and aged whatever gets on the plate), no forced
socializing.

~~~
warent
Do you live in a city? It sounds like you might enjoy living in a small town
much more. Many small towns are very similar to what you just described all
the time.

~~~
kitotik
As a self-proclaimed weirdo and staunch individualist, small towns can be very
difficult to just mind your own business in. Literally everything you do or
don’t do tends to get noticed and talked about amongst the residents.

There’s something to be said for the anonymity of large urban center.

~~~
_jal
Absolutely. I grew up in a tiny town, and loved the ability to get way out in
the middle of nowhere with no humans around. And hated practically everything
else about it.

Small towns make your business everyone's. There's a desperation for gossip
that's just gross to me, and worse, if you don't play along, you're an
outcast. Which worked fine for me, except it makes you a target for local
shitheads.

I get why others might like it if they're social extroverts who fit whatever
local majority-normal is, if not, a city is a far better place to live.

------
conistonwater
Diagnostic criteria for anxiety and depression are very broad because they are
necessary as _tools_ for practicing doctors seeing patients (as opposed to
applying them to a random selection of people). If you turn the process back,
and just ask how many people in the population fit under them, you'll always,
even in normal times, get an unexpectedly large number. That doesn't imply
that anything is wrong or that anything needs to be done about it, doctors
don't use them like that. This is approximately the same phenomenon that
causes medical students to self-diagnose themselves with every disease they
learn about: one of the fundamental factors missing from such a diagnosis is
that they haven't walked into a clinic. It's not a bug in the diagnostic
criteria, it's just a misapplication of them.

One of the main ways of fighting over-diagnosis is to not apply diagnostic
criteria for every known condition to random people who you have no a priori
reason to suspect they might have those conditions.

~~~
anbende
I'm a PhD in clinical psychology, currently working with clients, whose
research has focused on the psychometric evaluation of questionnaire measures.

I have no idea what you're talking about. The diagnostic criteria are not
"very broad because they are necessary as tools". The diagnostic criteria are
meant to be sufficient criteria for diagnosing a disorder. Questionnaire-based
measures act as a scientifically validated proxy for a clinical interview to
determine this. With a sufficient score on one of several validated diagnostic
questionnaires, you can typically say with 80-90% certainty (specificity is
the technical term for that percentage) that the person would receive a
diagnosis from a clinical interview.

Psychologists and epidemiologists can and do research prevalence of mental
health conditions by randomly sampling the population. This does not "over-
diagnose" mental health disorders. That's absolute nonsense. Over-diagnosis is
only an issue in cases where prevalence is below the false positive rate
(technical term is "sensitivity") of the test. That is not the case here.

If you looked at the linked CDC study, they even mentioned the instruments
that were used to support this statement. The PHQ2 and GAD2 are validated very
brief measures of depression and anxiety that are sufficient for estimating
the likelihood of a depression or anxiety diagnosis respectively. Likelihood
of a false positive on the PHQ2[1] and GAD2[2] are both around 20%
(100-specificity), which is just fine. Both of these are more than sufficient
for epidemiological purposes if not for individual Dx.

The fact of the matter is that nationwide prevalence for diagnosable disorders
IS high, and it's on the rise. Coronavirus has made people anxious and
quarantine has made them depressed. And a LOT of people need help.

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906530/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906530/)
[2] [https://www.hiv.uw.edu/page/mental-health-
screening/gad-2](https://www.hiv.uw.edu/page/mental-health-screening/gad-2)

~~~
cshimmin
Hold on, do I understand correctly your comment about the 20% false positive
rate? So even if exactly ZERO Americans were experiencing depression, a random
sampling would indicate 20% of Americans are showing signs of depression? And
if it's 20% for both tests, that would would correspond to a 36% false
positive rate for at least one condition [0]. So the headline that a third of
Americans are showing signs of anxiety or depression is consistent with what
you'd expect to observe if there was zero (or very small) true prevalence? How
does that work out?

[0] assuming test results for anxiety and depression are uncorrelated, which
seems unlikely. But even if they were 100% correlated, the joint FPR would
still be 20%.

~~~
anbende
The situation is a little more complicated as these tests ALSO have a false
negative rate. And that false negative rate is also about 20%. As well, the
false positive rate is for scores _at threshold_ , which is 3 out of 5. If
they score a 4 or a 5, the false positive rate drops dramatically.

As well, this isn't an antibody test. Diagnosis is not dichotomous but
dimensional. A false positive on depression inventory does not mean the person
actually has zero symptoms. It means that their symptoms might actually be
mild rather than moderate because of the way they interpreted one or more of
the questionnaire items.

In general, the way to look at this is that of the people who took the test,
80% of those who scored at threshold would likely receive a diagnosis from a
clinician.

~~~
conistonwater
This doesn't address in any way the point being made about false positives
leading to overly high estimates of prevalence in the general population,
whereas nullc's comment is probably quite close to explaining the issue.

~~~
legacynl
> This doesn't address in any way the point being made about false positives
> leading to overly high estimates of prevalence in the general population

It does if you are aware of the fact that these tests are never used on its
own to diagnose depression/anxiety.

The GP or psychologist determines if the client exhibits symptoms of
depression, and THEN performs the test, often in combination with other tests
that test similar things. Afterwards the results of those tests (as well as
the dialogue that's been had with the client), are used in conjunction to
determine if a diagnosis is appropriate.

I think it's rather arrogant to assume that
psychologists/diagnosticians/statisticians are oblivious to the fact that
tests have reliability/validity measures. Of course they are aware, that's
their job.

~~~
conistonwater
I'm not sure what you're replying to, I made that exact point upthread and was
responding to the disagreement that followed.

------
Exmoor
>“What’s worrying is the effect this situation is clearly having on young
adults.”

I wonder if this is a perverse side effect of normalcy bias [0]? For me, a
person in middle age, I can look back at my life and see a lifetime of fairly
stable history with only a few traumatic events (9/11, 2008 crash). If you're
22, the current circumstances make up a much larger portion of your life.

>The toll has also hit the poor much harder, according to the Census Bureau
data — throwing into even sharper relief mental health disparities that have
long existed.

This seems completely, and sadly, reasonable. You probably couldn't design a
situation in a lab that would screw over the poor more than COVID-19.

[0]:
[https://en.wikipedia.org/wiki/Normalcy_bias](https://en.wikipedia.org/wiki/Normalcy_bias)

~~~
freeone3000
9/11 happened to me in grade school. Iraq war happened thereafter. Then the
financial crash. Then the subprime crash. And now covid. My life is shaped
MORE by crises than by stability - not just the current one, but ALL of them.

~~~
coliveira
Yes, the US looks increasingly more like a 3rd world country. One crisis after
another.

~~~
war1025
Europe was an even worse place crisis-wise for the majority of the 20th
century.

The sad thing about humanity is our living memory only goes back fifty years
or so. Everything past that is just "back in the old days" and we forget how
extremely recently all those things were even on a human timescale.

~~~
coliveira
The US had its share of bad times in the 20th century too, including the
largest depression ever, but at least it invested in economic development.
Currently, the goal seams to be reducing all social investment and let the
financial industry take control of everything.

------
karatestomp
Shit, our terrible healthcare system's given me what'd probably qualify as
clinical anxiety for longish periods _several_ times in the last few years,
and that's despite being well into the top 20% most economically-fortunate
Americans, _consistently having health insurance_ , and not having _really_
serious or chronic medical problems in my immediate family.

~~~
Ididntdothis
Same here. I am totally terrified of being in an accident or having a serious
disease and then getting wiped out financially as I have seen others in
similar situations. If you are lucky things usually work out but it can easily
happen that you are liable for a $60000 helicopter ride or a $300000 hospital
bill because somebody (not even you) has filled out some paperwork
incorrectly.

~~~
burntoutfire
> I am totally terrified of being in an accident or having a serious disease
> and then getting wiped out financially

For majority of people through history, a serious accident or disease would
wipe them out biologically, not just financially. Were they totally terrified
throught their lives because of it? I don't think so. It's all a matter of
perspective.

I personally try to accept that my life will end, the ending will likely be
agonizing and nasty, and it can happen at any moment. I don't know a lot about
meditation, but I think some strains of meditation schools tend to focus a lot
on this fact, with daily contemplation of decaying bodies etc. It's an ancient
tradition which may actually contain a lot of wisdom.

------
presiozo
I wonder what's the correlation between this and people being underpaid. I'm
fortunate enough to have my own house after graduation so I don't have to pay
rent. But I have friends that don't have this luxury and man, they are
struggling. Besides eating and rent they can't afford anything else in a
month. No question here what's giving them these feelings

~~~
virvar
I live in Denmark, where we lift a lot of the burden of civilisation together,
to give everyone access to education, health/elderly/child care as well as a
solid security system for those who get unemployed.

And here society is hard enough these days, pressing more and more people
beyond their limits. I really wonder how you all do it in America.

~~~
paulddraper
The United States and Denmark are very different countries.

The U.S. has nearly 4x as fast population growth, 2x as many immigrants, 10x
the incarceration rate, much greater religious and racial diversity, 100x more
billionaires, 17% less GDP per capita, and 3x as much debt/GDP.

I'll refrain from opining as to what is cause and what is effect, but the
differences are many.

~~~
adventured
> 17% less GDP per capita

US GDP per capita was 9% higher than Denmark for 2019.

[https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...](https://en.wikipedia.org/wiki/List_of_countries_by_GDP_\(nominal\)_per_capita)

> 3x as much debt/GDP

Denmark has a dramatically greater household debt to income ratio than the US,
and is one of the most indebted countries in the world. They're in horrible
debt shape. Their household debt as a percentage of disposable income is 282%,
the worst in the world; that contrasts with 105% for the US, which is only
slightly worse than Germany at 95%. Denmark's quality of life is coming at the
expense of the future, as they load up massively on debt today to fake their
standard of living.

Take a look:

[https://data.oecd.org/hha/household-
debt.htm](https://data.oecd.org/hha/household-debt.htm)

~~~
mydongle
>Denmark's quality of life is coming at the expense of the future, as they
load up massively on debt today to fake their standard of living.

It's probably worth it in the end. How much longer do we have to endure low
quality of life for the sake of some future? Let's say you endured and now
your son becomes an adult. Is that now the time to start improving things and
enjoying a better quality of life? Probably not, people will say it isn't time
yet and we aren't ready, therefore your son will have to sacrifice his
happiness and wellbeing too, for his children.

The average person in Denmark will probably die of natural cause, after a
relatively happy and fulfilling life. Doesn't seem like they're getting any
worse either for it.

What do we have to show for our sacrifices? Nothing it seems. The powers that
be will cry about muh inflation all day and won't bail out people, but they're
ready to bend over and print money if the corporations and ultra rich need it
though.

------
supercanuck
I mean how much data and analysis do we really need at this point to realize
America is a complete shit show at the moment.

Statistics be damned, Inductive Reasoning needs to take center stage here.

~~~
paulddraper
Ah, very insightful.

Is there a consensus on what makes it bad and how it should be remedied?

------
jjice
I'd like to see anxiety and depression rates associated with age and social
media usage. In my personal experience, social media gave me a lot more
negative feeling than positive. I know a lot of people handle it better than I
do, but I'd still like to see.

I'm also curious if this is associated with more diagnoses because we've
become more aware of these issues as a society, or if this can be associated
with the internet and our modern "always on" lives. My guess is that the
former is more of a reason, but I'd love to see some studies in this area.

------
Havoc
I find the direct linkage to corona to be a little misleading. My gut feeling
says this is a broader sign of the times:

* Rising youth unemployment

* Gig economy & the uncertainty that comes with it

* Crushing study debt

* Little hope of owning property

* Rapidly increasing inequality

* Offshoring & automation

* Healthcare system where serious sickness can lead to financial ruin

* Debt fueled systems (or credit score if you prefer - a system that kicks people when they're down)

I'd venture that the sane response is anxiety or depression. But yeah sure go
ahead and blame it on the immediate trigger - COVID

~~~
pathseeker
>* Rising youth unemployment

Before COVID?

>* Little hope of owning property

This realistically only applies in a few hot cities in the US and to low
income groups. The middle class still can easily achieve home ownership in
most of the US.

>* Rapidly increasing inequality

This is just a political talking point. It has no realistic impact on the day-
to-day life of the bulk of the population. Whether Jeff Bezos has 1 billion or
1 trillion doesn't really matter to someone making 90k living in Chicago.

>* Healthcare system where serious sickness can lead to financial ruin

Again, this doesn't apply to a huge portion of the US population because they
have health insurance. Remember that the reason that healthcare is so hard to
change in the US is because it works for the majority of the population.

~~~
Gibbon1
> Again, this doesn't apply to a huge portion of the US population because
> they have health insurance.

Let me guess you've never had to use yours for anything major.

~~~
pathseeker
I have. Procedure totaling about $90k. HDHP covered everything after the first
$4k. HSA that company contributes to covered the first $4k. My expense = $0.

Instead of talking about anecdotes or making lame personal accusations, just
look at the data:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690297/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690297/)

------
davidw
US politics are making me seriously anxious. Will I have to leave if I want my
kids to grow up in a healthy democracy? Where would we go? Will there be
violence before/after the election or transfer of power?

More than anything, I don't have much of a sense of hope for something better.
Maybe things go ok and "the bleeding stops", but it'll still be a long,
difficult slog to start fixing all that's broken.

Oh, yeah, and there's _also_ a deadly pandemic on the loose.

~~~
hedora
You forgot that global warming will displace 1/3 of the earth’s population by
2070, and that the WHO is now estimating that the coronavirus response will
lead to 1 billion starving people (1/7 of the population), up from their
beginning of year estimate of 135M.

That’s 10x more people than died in WWII (including civilians on all
continents). As a percentage of population, it’s 3x more than WWII.

In the WHO numbers, I don’t think starvation implies death, but it’s clear the
earth has never seen a humanitarian crisis of this scale.

(Edit: my percentage of population math was off. It’s 4-5x WWII on that
metric.)

------
pstuart
I'm a very mild type II bipolar, and I recognize that depression is a
biochemical affair, but the situational aspect cannot be ignored either.

I have ongoing anxiety over the fascist coup that has taken place in the US,
as well as the fact that we're cooking the planet and being actively blocked
to try to remediate that. I don't know how to be at peace with that.

~~~
whiddershins
I might encourage you to reconsider the reality tunnel you are subscribing to.

Not because it is false, but because it is opinion-based, and interpretive,
and reliant on certain assumptions. If it is making you miserable, it might be
worth exploring a different, equally compelling, version of reality.

~~~
pstuart
I'm always welcome to new input, but the two cases I cited have compelling
facts behind them.

Being that I'm not thrilled to carry these notions, I'd be more than happy to
have my mind "changed".

Go for it: change my mind. I'm not spoiling for a fight -- I genuinely don't
like being "wrong."

~~~
penagwin
Not op, but to phrase it another way, consider if it's benificial to worry
about - vote for who you want etc. But that doesn't mean you have to watch
every political "event" \- you'll just burn yourself out.

I'm not saying bad things aren't happening - just that if there's nothing more
you can do, try not to envolope your life with it. It's like high school drama
- it can feel like it's your entire world but in reality it doesn't
necessarily matter.

~~~
pstuart
I understand what you're saying and I would if I could (and I try). But my
understanding of things is that shit's gonna get a lot worse.

If it was just me I'd say fuck it, party and watch the world burn. But I have
kids, and I don't want to go down without a fight.

~~~
ramblerman
Get worse how? apart from the pandemic, what has fundamentally changed in the
US that is _so_ bad. The world will go on, and yes maybe the balance is a bit
more on the right, but the pendulum swings on. The partisanship is just a way
to keep you tuned in to the news, it's a farce, there is not _that_ much
difference between democrat and republican.

So the real question is, would you like to pass on this kind of anxiety to
your kids, or give up this fatalistic bs, and start filling your days with
more quality content.

~~~
pstuart
Get worse? I believe that global warming is going to come at a faster clip
than predicted. I'm still naive/hopeful enough that if the world collectively
worked to remediate it we could get through ok.

I don't see that happening until shit hits the fan and its effectively way too
late.

Couple that with the political landscape that indicates this election is going
to be a shit show and if Trump is properly voted out will not leave office.
Instead his plan is to light the fuse for Civil War II.

If you think I'm Chicken Little crying that the sky is falling, then that
tells as much about you as it does about me.

As for you judging my parenting: I've been very guarded about these worries
around my children. That said, my teen age daughter has insisted that she will
never have kids. It was only a couple of months ago that she confided that it
was because she didn't think she'd live long enough to do that.

Bear in mind that this teenager, being a teenager, pays as little attention to
what I say as possible and this realization was entirely her own.

So there you go, Mr. Happy Go Lucky Ramblerman, who just thinks wishing things
away will make it all better. It won't.

It's my duty as a citizen and a father to pay attention and do whatever I can
to speak up or act whenever I can. I don't do this often enough or well
enough, but I will continue to try.

So again, thanks for telling me how to parent. I look forward to you accepting
the favor in return.

------
courtf
I believe the existential crisis so many are experiencing has been caused by
the pandemic, but perhaps not in the way one might expect when approaching the
problem rationally. Yes, we are more isolated, and perhaps concerned for the
safety of ourselves or our loved ones, or even for some abstract concept of
community or society, but depression is characterized by anhedonia: the
inability to feel pleasure. Are we all sitting around, so preoccupied by the
crises of the day that we have become numb to pleasure? That doesn't describe
depression, although perhaps anxiety. I would describe depression as the loss
of most strong feelings, not only pleasurable ones, and that is why death
becomes so alluring: fear of death has been numbed as well.

No, an existential crisis is rooted in the meaning, or lack thereof, we are
able to ascribe to our lives. And the pandemic has in many ways restricted our
connections to those sources of meaning. Whatever stories we were telling
ourselves about our life's purpose, the plotlines we imagined for ourselves,
have been disrupted. The student has had their university all but taken from
them. They cannot experience it in quite the same tangible way as they once
did. The same is true for the worker who derives his meaning from labor. For
many, that connection has been damaged, if not severed. It is the loss of
meaning that accompanies the dawning realization that our sources of meaning
were nothing more than illusions to begin with.

We realize now that life goes on without these guiding influences; that the
rituals we perform do not in fact earn us the favor of the Gods. We come upon
the idea that perhaps life really is meaningless and that we were in fact only
existing previously because of a foolish, irrational faith. It has been thrust
upon us, entirely by happenstance (and not because of any rational deduction
or brilliance on our parts), that we are fools, rubbing our prayer beads and
voluntarily deluding ourselves into thinking that some bit of our finite,
meaningless lives could somehow persist alongside the infinite.

"For man to be able to live he must either not see the infinite, or have such
an explanation of the meaning of life as will connect the finite with the
infinite."

~~~
daseiner1
fine points up to the third paragraph. you said yourself that the pathways of
meaning have been blocked - of course then things would feel meaningless!
there’s doesn’t need to be a _M_ eaning to life for life to have _meaning_

~~~
courtf
I agree, the meaning of life is just that simple: to be alive. No greater
meaning exists, and that's fine. We can live life without so much meta-
analysis.

To arrive there though, we often need to see other personal sources of meaning
exposed as illusory, or at least I did. I am trying to describe that process
in the third paragraph.

~~~
daseiner1
Good to hear; it’d be hard to be capable of the perception of the start
without also being capable of seeing the road past & through the conclusion at
the end of your comment. I just tend to take issue with the naïve cynic
nihilist take i detected in the latter half of your initial comment.

ps you may enjoy Nietzsche if you haven’t been exposed to him yet - his
project essentially starts with - OK, we’ve been freed from the prison of
(religious) dogma, now what? His greatest aim, imo, was to answer the question
of the (totally true, accurate) nihilistic observation you’ve reached. start w
_beyond good and evil_

------
particleandwave
The quarantine made my depression and anxiety disorder much worse. About two
weeks into quarantine, I started feeling paralysing sorrow about everything
that ever happened to me, and the view of the future became grim.

I guess the time alone made me confront my problems in a way I couldn't
handle, so I resumed my psychotherapy and went back on anti-depressants. I
still haven't figured out the way to get out of this only-bad-thoughts loop.
Morning Yoga helps a bit, and sports, in general, seem to take the stress
away, though not for long. Maybe someone can share their experiences coping
with that?

------
ReticentVole
The 'cure' of endless and pointless lockdowns is indeed proving worse than the
disease, particularly when the CDC estimates overall mortality from the virus
will be only 0.4%:

[https://www.wcnc.com/article/news/health/coronavirus/data-
cd...](https://www.wcnc.com/article/news/health/coronavirus/data-cdc-
estimates-covid-19-mortality-rate/275-fc43f37f-6764-45e3-b615-123459f0082b)

For reference the seasonal flu is 0.2%, for which we do... precisely nothing.

~~~
marcell
I'm confused by the downvotes on this. The comment is quoting CDC numbers,
this is not some fake news report.

The 0.4% mortality for coronavirus is the CDC best estimate.

The 0.2% is from the CDC website for the 2017 flu season.

Edit: The parent comment has apparently been flag removed. But it was claiming
that the reaction to coronavirus (lockdown) is worse than the damage from the
virus, and used the above comparison to flu mortality to support this claim.

I'm not sure why this comment was flag removed, since it used data to support
a position.

~~~
entee
Nearly 100,000 people have died of COVID19 and there’s good evidence that this
is a substantial undercount. All this in a context where we shut down
transmission vectors (being indoors, with lots of people). Most estimates I’ve
seen suggest we’ll hit 150k-200k deaths by end of year. 2017-2018 flu season
killed about 80,000 with no mitigation efforts. Just on the face of it, this
virus is far more than 2x deadlier than the flu.

~~~
read_if_gay_
> there’s good evidence that this is a substantial undercount.

I don’t know about the US, but most European countries count anyone who died
_with_ corona as a covid death. No matter how clearly you died to something
else.

~~~
samsari
While that may be true, most European countries still undercount the true
death rates since there are large discrepancies between each country's
official covid deaths and excess deaths.

~~~
natrik
Playing devil's advocate, how are we sure excess deaths are due to covid and
not the lockdowns instead? (Suicides, cancelled surgeries, etc.)

~~~
pinkfoot
Ok, playing systems-engineer here: we'd call those secondary COVID-19 deaths
caused by the either _de facto_ or _de jure_ lock-downs.

Why, oh why, are some people so obsessed with lowering the number of COVID-19
related deaths at every possible opportunity? Its weird.

~~~
luckylion
> Why, oh why, are some people so obsessed with lowering the number of
> COVID-19 related deaths at every possible opportunity? Its weird.

Maybe they want to minimize the amount of secondary COVID-19 deaths?

~~~
pinkfoot
Fair enough, but WHY?

Here is a less contentious example:

1\. consider a severe, long drought

2\. this will damage the livelihoods of many in the hinterland - farmers and
those in the small town that service them

3\. many may be driven to suicide.

Would you not agree that such excess suicides are 'caused by the drought'?

~~~
luckylion
Yes, but it's not quite the same, because the suicides etc for COVID-19 are
not directly caused by the virus, but by our reaction to it, and some believe
it's an over-reaction.

I'm not an expert on the actual, real dangers, e.g. how many and who will die,
so that's not what I'm concerned with. If they're terribly high, doing what
ever is necessary to stop it is right, I consider that obvious. "Flattening
the curve" makes generally sense to me, in a "let's make sure our hospital
system doesn't collapse" kind of way.

I live in a county of a bit over 300.000 people in Germany. We have 10 known
active cases in the county. We're still in a very constrained soft-lock-down,
i.e. schools not running normally, half the offices not open, mandatory masks,
public services on emergency-only-level etc. We're still taking damage
economically, obviously. Lots of people are scared to death in a very real
way, and are _still_ afraid to leave their houses.

Is it still the right call to remain in this state today? Will it be when we
have 0 active cases, but there are counties nearby that still have more than
0? By saying "well, everything that happens happens because of COVID-19",
we're removing our agency from the equation.

------
Pfhreak
I've dealt with depression and anxiety for many years. I just want to tell
anyone who happens to read this: it's ok to ask for help, it's ok to go to
therapy, it's ok to use antidepressants.

Find the tools that work for you and keep asking for help when you need it.
(Believe me, I know how hard it is.)

~~~
spicyramen
Isn't antidepressants in America one of the reasons of the opioid crisis...?

~~~
CaptainZapp
I assume that's a genuine question and that you're not trolling.

Opioids are a very different class of drugs than anti depressants (including
medication to treat anxiety).

While people with mental issues may use opioids for self medication, no
reasonable psychiatrist would ever prescribe such medication for psychological
issues.

Oxy and their ilk were massively pushed by Purdue and their "colleagues" as a
non-addictive pain relief if applied correctly.

They lied, of course, and that's where the US is now with the opioid crisis,
since those drugs were massively over-prescribed.

It can't be mentioned enough that if you have serious mental issues then
appropriate medication may be one of the pillars to help you out of the
deepest circles of hell.

While it maybe a crutch (sometimes temporary, sometimes long term) it can be
immensely helpful if properly prescribed and monitored and seriously be the
difference between life and death.

edit: slight clarification

------
crocodiletears
The nation's been psychologically wrong-footed during an election year where
the incumbent is the most controversial president in decades (one who's been
impeached, even), the challenging party's primary process has been subjected
to accusations of corruption and favoritism (at best) by the presumed
nominee's opposition, and been riddled with suspicious errors. That alone
would be a memorable storm and a half for our political history, but it
coincides with a sweeping collapse in institutional trust, economic hardship,
concerns of government overreach, and fear of mortal peril.

And we're just inaugurating the decade.

~~~
samdamsamm
America has a profound ability to diagnose individual problems, and an active
inability to diagnose social problems.

The American psychological industry cannot be let off the hook. DSM-5 is a
handbook for how to blame society’s failures on individuals. We need
scientific doctors capable of considering not only the realities they are
allowed to accept but also the realities of the actually existing world in
which their patients live.

We desperately need legitimate mental health institutions, but for-profit
healthcare and for-profit education cannot provide that.

~~~
curryst
> DSM-5 is a handbook for how to blame society’s failures on individuals

I staunchly disagree with this, this has never been my experience with any of
the psychologists/psychiatrists I have seen (I've seen somewhere around 6 over
the course of my life).

Blame has never been a component of any psychiatric treatment I have
experienced. The DSM is a book of diagnostic criteria to identify the issues
you are experiencing, to help guide the provider in finding an appropriate
means to help the patient cope with their problems. There is no question of
blame; blame is basically irrelevant to the treatment.

I also don't think identifying someone's problem as being a result of society
is clinically productive. Is telling a depressed person "Listen, you're just
getting screwed over by society" going to be helpful? I think not, because the
corollary to that is "and you can't change society, so you're stuck like
this".

I do think it is important to consider how society is impacting the mental
health of all of its members, but I don't think that discussion belongs inside
your doctor's office.

~~~
JacksonGariety
> "and you can't change society, so you're stuck like this"

I think OP meant that psychologists/psychiatrists don't recognize the social
nature of mental illness at all. Just because you can't change society doesn't
mean you should tell patients that they can lift themselves out of depression
through sheer willpower, healthy eating habits, and exercise. Those things can
help but if you don't know how you're going to pay rent next month and you've
got two kids, you're going to have serious anxiety.

~~~
whatshisface
Being anxious about a freight train heading straight towards you is not
"anxiety" any more than grieving for the loss of a loved one is "depression."
Medical doctors have absolutely nothing to do with the natural and accurate
negative feelings associated with not being able to make rent.

~~~
JacksonGariety
But in most cases depression _is_ a natural response to the difficulties of
life. It's like when your immune system triggers an inflammatory response to
infection. It's painful but natural; and the cause is external. Willpower
can't cure depression any more than it can reduce inflammation. But in the
case of mental illness, the external agent is socioeconomic hardship, family
dysfunction, loss of a loved one, etc.

------
munificent
I recently read "Man's Search for Meaning", written by a psychologist who
survived several years in concentration camps during the Holocaust.

Frankl's main thesis is that humans have a deep need for _meaning_ in their
life, which he defines as producing some kind of work, caring for others, or
having enriching experiences. This strongly resonates with me. I believe
America's consumer culture undermines this need. Many work "bullshit jobs"
only to be able to afford to consume things — the work itself is not _for_
anything more meaningful than a paycheck. Mass manufacturing lets us care of
most of our material needs ourselves so there is less culture around caring
for each other than there used to be. There are an infinite number of
"experiences" available, but most are simply consuming a thing created by
someone else and endlessly reproduced. There is nothing particularly enriching
about watching the latest Hollywood spectacle, nearly instiguishable from the
previous ten movies in the franchise.

Frankl observed about his fellow prisoners that people could survive anything
if they had something to live _for_. But when our lives are meaningless and we
fill that void with shallow pleasures and distractions, we are ill-equipped to
have the resilience needed to get through something like the current pandemic.
When something bad enough is going on that Netflix no longer takes your mind
off it, then to what do you turn?

~~~
caleb-allen
It seems that American culture and/or economics have, in recent decades, moved
toward primarily consumption rather than primarily production. My point of
view is that the backlash and anger against capitalism I perceive from younger
generations is a result of how unfulfilling consumerism really is.

I think individualism and personal liberty has been conflated with a selfish
sort of consumerism, from the end consumer up through corporate cultures. Want
something new? Buy it! Are you a business wanting to make inroads in a new
sector? Don't research and produce. Acquire!

It is no surprise to me, then, that corporate debt is at an all time high,
corporations and individuals are less prepared and resilient than ever, and
that this crisis is violently exposing that.

~~~
munificent
_> I think individualism and personal liberty has been conflated with a
selfish sort of consumerism_

Yes. It's important to note, too, that this isn't something American people
spontaneously decided to do. It was a deliberate strategy by rich business
owners to _sell_ the country on the idea of consumerism being great (because
it was great for their businesses).

------
kbos87
I went through a several years long period of pretty extreme anxiety. I went
through sleepless nights, racing thoughts, near panic attacks on public
transportation (for seemingly no reason!) In retrospect, it was a pretty
terrible time, despite the fact that a lot of things were going well in my
life from an outsiders perspective.

I can honestly say that therapy along with a lot of introspection got me to a
much better place, despite my doubts from time to time. For anyone going
through it, know that it actually, honestly is something you can get past with
help.

------
Exmoor
[http://archive.vn/7dj2r](http://archive.vn/7dj2r)

------
werber
I thought i had conquered my anxiety with lifestyle changes and then this
happened. For someone who depends on their community but lives alone, this is
major. I’m sick of people shaking me off for feeling depressed despite their
introversion or their social circle being their family. For those of us alone,
and isolated, who are extroverted, this blows the big one. I feel crazy every
day. I’m not even sure if i want to code anymore. I miss meetings. I find
myself crying with no reason everyday. Like I’m a middle aged man and this is
honestly the hardest non self induced hardship I’ve ever dealt with. Oh...
damn

------
logicslave
I'm telling you, the elite of this country in the 90s and the early 2000s sold
this whole country up the creek. Both sides of the political spectrum pushed
ultra capitalist policies and broke the common fabric of America. All
meaningful blue collar work was outsourced, large swaths of intelligent highly
competitive workers insourced from other countries, artificial boosting of
financial assets, etc. The old America is rotting, the new America we see is
bright and shiny. This will take a long time to fully surface, 50 years maybe,
but it will eventually.

~~~
fermienrico
Not just America, but all nations have decided that let's gut out the local
manufacturing of goods, allow complete exploitation of labor in one country
and then reap the benefits. Now there is only one place that knows how to make
stuff. Executives benefited tremendously at the expense of their homeplace.
This way the entire fabric of the country tears apart and gets so tangled that
voices of reason, science, truth and liberty gets drowned and no one knows
what to believe anymore. The state of democracy is in danger. From top-bottom
to left-right, the entire nation is dividing and these troughs will not be
easily coalesced. Don't worry, services are starting to go to this centralized
authoritarian regime too, not just physical goods.

~~~
luckylion
> The state of democracy is in danger. From top-bottom to left-right, the
> entire nation is dividing and these troughs will not be easily coalesced.

Divide et impera. But it doesn't even have to be a conspiracy and "class
warfare", it seems that "enemy action" is hard to tell apart from "we've just
let things happen and this is what happened".

------
tathougies
Well, duh, the expected prevalence of any disease diagnosed entirely by the
fiat of a group of people enriched by the disease being more prevalent is
pretty close to 100%.

In other words, to a hammer, everything looks like a nail.

This is not to deny the reality of depression and anxiety but to cast doubt on
the diagnostic criteria purveyed by a special interest group whose members get
richer and more respected the more they can convince the world that the thing
they do is needed. All professions justify their own existence.

------
boomboomsubban
Though this is a troubling outcome, the questions asked seem a little vague
for the times. Basically everyone will "feel down" or "feel nervous" given the
risk facing them and their loved ones.

I feel nervous every time I go to the grocery store, but it would need to be
causing problems in my life to be clinical anxiety.

------
catalogia
I feel fortunate that I have a south-facing balcony I can sunbath on during
the day. Sunlight is a great antidote for many people when they're feeling
blue, but this has now become inaccessible to many. Sunlight through windows
just doesn't cut it; glass blocks too much UV.

------
forgingahead
Probably correlates very closely with the increase in hysterical media and
news reporting.

~~~
orwin
Either you're overestimating how most people consume news media, or i'm
underestimating it.

Unless you think the fact that journalists are more often depressed and/or
anxious make their reporting more "hysterical". In this case you might be onto
something.

------
rb808
I can't read the article but does it say what it was before covid? I'm not
sure if this is a virus related thing or just a longer term trend.

------
ConcernedCoder
What a world we live in...

Tucker Carlson on Fox News yesterday tried to directly correlate the findings
in this study to other news agency reports ( lies according to Tucker ) on the
coronavirus... see the video @ around 6:50ish headlining this story on Fox
News:

[https://www.foxnews.com/opinion/tucker-carlson-cnn-msnbc-
are...](https://www.foxnews.com/opinion/tucker-carlson-cnn-msnbc-are-peddling-
panic-moral-judgment-not-science-and-data-in-coronavirus-coverage)

------
idoby
With psych stuff, I can't help but wonder how much of it is shooting the
arrows and then placing the target...

------
tracerbulletx
In las vegas, our unemployment rate is very close to hitting a third so. No
surprise there.

------
austincheney
I suspect a third of Americans are now displaying symptoms of mental health
disorders that were already present. Mental health disorders are drastically
under reported in the US, and due to various stigmas most people are unwilling
to except mental health illnesses as actual illnesses until they are prepared
to harm someone.

This is the number one problem most police officers deal with when engaging
with the public. Many people have mental health disorders they are not aware
of resulting in all manners of poor decisions and disorderly conduct. Some of
these disorders are severe and demand medication and some are exaggerated by
existing medications. I recommend talking with experienced police officers and
listening to some of their war stories.

My sister-in-law is also a managing mental health counselor and says the
number of undiagnosed mental health disorders could represent as much as 40%
of the population.

In my own experience I find that people hide from this by frequently changing
their social situation and environment through out the day, such as driving to
an office. When you are stuck at home full time with nowhere to go suddenly
coping and distraction mechanisms are gone which becomes clear to the
coinhabitants. I am on my fifth military deployment so I have gone through
this a few times, and you can readily see the people lacking of a regular
rhythm of emotional stability and stress management. You are with these people
all the time as you live, socialize, and work with them. On a military
deployment you can’t rely on a frequent change of scenery to hide your
insanity.

The most common example of excuse that people would hide behind pre-pandemic
is finances. Bad financial situations are stressful, but stress is not a
mental health disorder. Extreme stresses though often exacerbate pre-existing
illnesses. In that regard bad finances don’t produce mental health disorders
as frequently as suggested but instead exaggerate pre-existing conditions that
become more clearly identifiable.

The difference between stress and a mental health disorder is something called
_homeostasis_ , which is the ability of the brain to return to a state of
regular emotional equilibrium following an incidence of high stress. The
military refers to the cognitive process of actively maintaining homeostasis
as _resiliency_ and it’s part of our annual training. The inability to return
to resume functions of prior behavior following a major stressor is likely the
result of a mental health illness.

[https://www.academia.edu/4970988/Mental_Health_DSM-
V_mental_...](https://www.academia.edu/4970988/Mental_Health_DSM-
V_mental_disorder_and_homeostasis_dream_sleep_and_day_time_interaction_of_cerebellum_and_cerebrum_in_the_regulation_of_behaviour_emotion_and_cognition)

------
amriksohata
I strongly feel there is a link between modern foods and our gut/brain axis
that is causing a lot of this.

~~~
atomashpolskiy
You may be interested in watching Robert Lustig's lectures.

------
eee_honda
no paywall:

[https://archive.fo/https://www.washingtonpost.com/health/202...](https://archive.fo/https://www.washingtonpost.com/health/2020/05/26/americans-
with-depression-anxiety-pandemic/?arc404=true)

------
DyslexicAtheist
if you want to understand what's going on zoom out and look at the last 200
years of civilization and society. Nietzsche is probably the best resource who
predicted this. You can read _" Ecco Homo"_ or " _Thus spoke Zarathistra "_
and see the parallels in our modern life. He predicted the herd mentality
which we've created. We despise and fear mental pain which is required for
growing and most of us rather Netflix'n'Chill than read a book. Parents who
put their kids on Ritalin or give them a tablet to be quiet.

Then as part of the herd-mentality we have the social-justice-warriors and
activists and the cancel-culture preachers who try to fill this void with
their own faulty logic (as a way to cope with their own pain - knowing
something terrible is happening but drawing dangerous and false conclusions
they are nothing but fools).

Today we have also the PsychologyIndustrialComplex which is filled with people
who have no idea what they're talking about. It's no surprise that the product
of all this is collective depression, rising nihilism and anti-natalism, and
hate. Technology's (and Science and Academia in general) role in this is to
produce ways of "making things easier" (coping mechanisms) but no longer to
produce greatness. So science and knowledge as taught today is not the way out
but part of the cause.

Here are a few videos, though you should probably read the books if you can:

1) Nietzsche and Psychology: How To Become Who You Are
[https://www.youtube.com/watch?v=gfyCzLbcAvk](https://www.youtube.com/watch?v=gfyCzLbcAvk)

2) Nietzsche and Morality: The Higher Man and The Herd
[https://www.youtube.com/watch?v=tE67Ye91Ii0](https://www.youtube.com/watch?v=tE67Ye91Ii0)

3) Nietzsche and Thus Spoke Zarathustra: The Last Man and The Superman
[https://www.youtube.com/watch?v=WnhMJl11JUo](https://www.youtube.com/watch?v=WnhMJl11JUo)

4) Nietzsche and Thus Spoke Zarathustra: Becoming Gods
[https://www.youtube.com/watch?v=1XrVnjpVdWE](https://www.youtube.com/watch?v=1XrVnjpVdWE)

there is also _" The conspiracy against the human race"_ by Thomas Ligotti
(which was stolen by the producers of "True Detectives" for a monologue
without giving credits).
[https://archive.org/details/TheConspiracyAgainstTheHumanRace](https://archive.org/details/TheConspiracyAgainstTheHumanRace)

------
JSavageOne
As an American it's not surprising at all. Six figures of student loan debt,
job insecurity, healthcare insecurity, rampant poverty / homelessness, the
most despicable president to disgrace the white house (who didn't even win the
popular vote), stay-at-home orders because the U.S. couldn't manage the
crisis, lack of community (doesn't help that 99% of the country is sprawl),
rampant obesity, and general lack of hope. The U.S. is more and more
resembling a failed state, a mere shadow of what it used to be.

~~~
idoby
As a non-American, why do you care about who is in the white house so much?
How does it affect your life concretely?

Try watching less talking heads/browsing Twitter less, maybe, and you'll feel
better?

~~~
tjs8rj
This is very true, as an American. There's almost no difference in the vast
majority of daily life for most Americans if you just pretended like the
president doesn't exist.

~~~
themacguffinman
Scant comfort for immigrants whose residency and livelihood are under threat,
or Americans who have lost loved ones indirectly due to bad decisions made by
the president, or non-Americans who have to live in a world shaped by American
action or inaction on foreign policy.

------
korethr
Given the stress of the current crisis, this does not surprise me. The topic
of the news for the past two months now is that there's a doom plague, a mask
might not save you, people are violating quarantine to spread the plague, the
economy is going to collapse, and Trump is making it all worse. People have
lost their jobs, are being told they can't work, that they must stay home,
they must stay away from other people, they must be afraid, etc and so forth.
So in light of that, it does not surprise me at all that depression and
anxiety are ramping up in the adult population.

Neither does the breakdown by age surprise me, with it being worst amongst
18-29 year-olds, and declining with age. I would love to see a finer breakdown
in that category. Here is my hypothesis:

For the youngest of adults, especially those just now entering adulthood or
their professional careers, this is probably the first societal shock they've
experienced. They did what they were supposed to according to The Plan of How
The World Works. They persevered through the soul-crushing hell that is high
school, and got the best grades they could, and applied for colleges, and are
ready to become adults. Or maybe they didn't get quite so good grades or
dropped out and were banking on being able to support themselves with some
kind of basic labor or service job. Or maybe they've taken out all the student
loans to go to college, and are coming into what's supposed to be the
beginning of their professional career to an economy that's about to collapse.
Or if they haven't graduated, now there's the uncertainty if whether or nor
they'll be able to finish their degree, with there being question about
when/if campuses will open back up, or whether the online classes offered as
substitutes will actually do any useful teaching. Regardless of the myriad
variations available in the above, the basic situation remains the same: here
they are, their life finally about to begin, and now the economy is
collapsing, everyone's dying, a fascist oompa loompa controls the government,
and generally the world is over. Well, shit. Now what?

I speak somewhat hyperbolically in describing the above, of course, but I
stand by my basic point: The youngest adults are beginning their adulthood in
fairly bad situation. And unless they're old enough to remember the previous
societal shocks that were supposed end the world, but didn't, it's all to easy
to come near the despair event horizon or even cross it.

Compare those who are a little older, or hell, a lot older. They've seen the
Housing Crisis, War, 9/11, the dot-com bubble, and so on and so forth. And
yet, they didn't die and are still here. Odds are, at least one of the
previous crises made their life worse for a time, or messed up what was
supposed to be a bright future or golden opportunity. And yet, they didn't
die, and are still here. And the older they are, odds are, the more times
they've seen that the world was about to end, and then didn't. And the more
likely they've internalized the lesson that in crises like these, how well
they come out of it depends largely on their attitude and how they apply
themselves to getting through it. And so we see that with the older and older
age groups, the anxiety and depression numbers are lower and lower.

This post might sound a bit ranty, and like I am projecting, and I'd be lying
if I tried to claim there weren't threads of that woven through it. But it is
not my intention for this to be just a "toughen up you whippersnappers and get
off my lawn!" type post. No, if I had to have a message for the youngest of
adults, it's this: I get it. The world just got turned upside down an nobody
knows what's coming next. But, the future is not over, and things will get
better. There are still opportunities to be found, and you _can_ come out of
this stronger.

------
nca-peripherals
Before this incident (I've been through a few disasters and violent
incidents), I was already on my 13th antidepressant (vilazodone) which doesn't
appear to be working. Also on propranolol, clonidine, atomoxetine,
carbamazepine, baclofen, gabapentin, and 40 mg/day of CBD. I buy CBD isolate
(pure CBD) in bulk and make my own sublingual tincture using a precisely-
measured ratio of ingredients comprising:

\- Organic coconut oil

\- Vitamin E T50

\- Grape seed / citrus extract

\- CBD

in a dark glass container filled into sterile saline spray bottles for use.

If you don't do this, then you're probably either being cheated or don't know
what you're taking.

Anyhow, so far this new antidepressant doesn't seem to be working so the dose
is getting upped. If this doesn't work, it's back to mirtazapine and weight
gain. The only other options involve anticholinergics, extrapyramidal issues,
electricity, magnets, and/or brain surgery.

I also have gradually, over the past few years, developed some sort of
neurological decline vaguely reminiscent of vascular, frontotemporal, or Lewy
body dementia or chronic traumatic encephalopathy (I was born cyanotic over
several hours because of incompetent Kaiser Permanente doctors and was hit in
the head extremely hard as a teenager twice and didn't receive proper medical
care).

I can barely speak, I stutter a lot, my memory is disappearing, and my level
of consciousness and clarity is declining. I can't code in any language
anymore and I used to work in Rust, Haskell, C, Crystal, and so on. My sleep
is a mess... one or a few hours here and there at all times of the day. I use
every bit of concentration to write this. If it's an incurable condition, I
will go somewhere very, very remote in Montana or Wyoming and breathe
nitrogen.

~~~
tokamak-teapot
It sounds like you're in a bad place. Lots of us have been there. Seek help
from others, please. There are people around, hopefully in your local area,
who can help.

~~~
Red_Leaves_Flyy
Sounds like they are and have been.

------
irrational
What age? I've noticed way more young people (teenagers and early 20s)
exhibiting signs of anxiety and depression than people my own age (mid 40s). I
never knew anyone with anxiety or depression growing up. But that probably has
a lot more to do with mental illness not being discussed back than it not
being around. But, even among me friend group nobody exhibited the signs that
I see so clearly prevalent among my own kids' friend groups. Is it social
media? Some chemical that has entered our environment? Is it something having
to do with growing up in a post-9/11 world?

~~~
ryanwaggoner
I think they would say that their future prospects are a lot dimmer than yours
were, precisely because boomers have strip-mined civilization for their own
benefit and left your kids' generation holding the bag.

At 37, I'm among the oldest of the millennials and I don't entirely agree with
that assessment, but I think that's what they'd say.

~~~
irrational
That doesn't explain teenagers. My teens and their friends are not aware of
that sort of things at all. That is more of a college-student mentality.

~~~
danharaj
Teenagers are sensitive to the cognitive dissonance that accompanies learning
how society works and their place in it, even if they're not yet able to
articulate those feelings. Some are more precocious than others but anything a
college student would be able to tell you about their relationship to society
was developing for years beforehand.

