
On Depression & Getting Help - revorad
http://robdelaney.tumblr.com/post/414007899/on-depression-getting-help
======
blhack
This is a very, very good lecture on depression:
<http://www.youtube.com/watch?v=NOAgplgTxfc>

Honestly, I think the disorder should be renamed. People associate being
"depressed" with the same feeling that they get if they drop their iPod into a
lake. They're sad.

General sadness is _one of many_ of the ways that depression as a cognitive
disorder can manifest itself. I can't tell you how many times I've talked to
friends with real, serious, dangerous depression and heard that there are
people who tell them that they just need to get over it and cheer up.

You can't cure cancer with ice cream, same goes for depression.

~~~
haploid
"[I] heard that there are people who tell them that they just need to get over
it and cheer up."

I do this. A great many of my friends and family do this too. I'm not sure why
you find it so difficult to believe that there are people who do this.

It's basically impossible for people without depression to imagine what it's
like to be physically incapable of eventually "cheering up" or "getting over
it". This is often compounded by the fact that depression( along with
asperger's )is the modern hypochondriac's condition of choice.

Combine inability to empathize with widespread attention whoring by people
claiming to have depression when they don't, and it's quite easy to see why
many people would react cynically or casually.

It's rather unfortunate for those who are genuinely stricken with mental
illness, though.

~~~
blhack
>I'm not sure why you find it so difficult to believe that there are people
who do this.

I didn't say that it was, I said that it was very common (which should
indicate that it isn't difficult for me to believe).

>It's basically impossible for people without depression to imagine what it's
like to be physically incapable of eventually "cheering up" or "getting over
it".

This. Right here, exactly what you just said is _the problem_ with people
understanding this disease. "Cheering up" has absolutely nothing to do with
getting over depression. This would be like feeding somebody with mono lots of
redbull so that they would have more energy and wouldn't be sick anymore.

>It's rather unfortunate for those who are genuinely stricken with mental
illness, though.

Yes, it is, and just about everything you wrote only serves to perpetuate the
general lack of understanding that most people have when it comes to cognitive
disorders.

------
rpeden
I can't emphasize enough how important it is to seek treatment if you feel
this way. For years, I just lived with it. I look back on those now as lost
years when I could have accomplished a lot, but instead sat around
accomplishing very little.

Some people resist medication because they're afraid it will make them not
feel anything at all. While this can certainly be the case for some
medications, there are enough of them that you can usually find one that
doesn't dampen your emotions completely.

In my experience, antidepressants tend to put a 'floor' under your happiness;
you don't fall down into the dark depths that are hard to escape from. You
also don't become unhappy quite as easily; I found a big improvement in my
ability to cope with external causes of stress and negativity.

------
mathgladiator
Hypomania can affect mood.

Hypothyroidism can also affect mood.

Exercise can affect mood.

You need to speak with your doctor about all three (or more since we are all
different), and you need to find out if you need medication to get you out of
the rut.

~~~
eavc
I don't understand the purpose of this comment, but it seems vaguely as though
it is to suggest that "depression" is not a sufficient name for his condition
and that its treatment through anti-depressants not a sufficient answer.

I appreciate and support efforts to get people to continue to investigate
their condition and to explore treatment options, but I bristle when it seems
to stem from a kind of prejudice against psychology and psychiatry as it
appears to here.

(As an aside: Hypomania is on the opposite end of the emotional disorder
spectrum from depression. Mentioning it here is akin to telling someone
complaining of constipation that they may want to speak with their doctor
about diarrhea.)

~~~
Alex3917
"I bristle when it seems to stem from a kind of prejudice against []
psychiatry as it appears to here."

Why? The majority, of the research used to approve the most popular
psychiatric drugs is outright fraudulent. And it's not like this is some
undocumented fringe claim, there are literally dozens of books about this; the
maker of the lexapro, drug the author is advocating, has racked up over 300
million dollars in fines this year alone for ethics violations related to the
science of the drug in question. If you don't have a prejudice against
psychiatry then you need to read more books.

~~~
eavc
Psychiatry is a branch of medicine based on the science of clinical
psychology.

The actions of a given pharmaceutical company hardly invalidate the discipline
as a whole.

Furthermore, a prejudice is never a good thing to have.

~~~
Alex3917
"The actions of a given pharmaceutical company hardly invalidate the
discipline as a whole."

It's not just one pharmaceutical company, it's the entire industry. The
pharmaceutical industry now tops not only the defense industry, but all other
industries in the total amount of fraud payments for actions against the
federal government under the False Claims Act.[1] And the psychiatric drugs
are, drug for drug, by far the worst offenders. And even for the drugs that
haven't racked up massive fines, their scientific support is somewhere between
terrible and non-existent.

[1] <http://www.citizen.org/hrg1924>

~~~
eavc
So you're telling me that psychotropic drugs have essentially zero scientific
support as treatment for psychopathology?

~~~
Alex3917
Yes, of course. Read Anatomy of an Epidemic, The Emperor's New Drugs, etc.

Robert Whitaker's blog is also really great, although you wouldn't necessarily
have all the information you'd need to read it unless you've already read the
book.

~~~
eavc
It's important not to throw the baby out with the bathwater. The enterprise of
psychology and its application is a worthwhile and fruitful one despite errant
ideas and applications in the past or in some of its member practitioners.

To even dispute the efficacy of some aspect of psychology requires the
practice of psychology.

I grant that there are dangerous abuses and manipulations of the approvals
process and public opinion, but it is also important to note that many
psychotropics have a place in the treatment of dysfunction.

I applaud that you are trying to spread the word about those abuses, but I
encourage you to measure what you say so as not to group the nostrums and
charlatans with the valid medications and practitioners of which many do
exist.

------
ja27
We're heading into the time of year that I've always struggled the most with
my chronic depression. I really have to force myself to get outside and get
sunlight, exercise, and eat better than usual. Those three things go a long
way. The short days and cold weather really make it hard.

~~~
iandanforth
Do you have a light box? Seasonal Affective Disorder has high co-morbidity
with depression and getting the right amount of the right wavelengths of light
at the right time has a surprisingly helpful effect. If you're into hacking in
physical space (aka making stuff) set up your bedroom so that you get very
bright light in the morning at a set time. Sunrise alarm clocks are crap so
ignore them and build the system yourself.

------
daeken
Thank you, Rob, for writing this. I figure I'll tell a short version of my
story (ok, I tried to make this short, but it didn't really work out well) as
well.

From an early age, my parents (both in the mental health field) recognized
small symptoms of bipolar disorder in me -- periods of extreme energy and no
sleep followed by lulls where I wouldn't want to do anything. However, they
decided that the best course wasn't to do anything about it (or even tell me
they had these concerns), as they figured it was just me being a kid. For what
it's worth, I think they made the right choice.

I was 15 or so when I started seeing these symptoms for myself, and saw them
becoming more extreme. I would spend weeks programming furiously on The Next
Big Thing (TM), then fall into an equally low period, which usually lasted
about twice as long as the high. Originally in these low periods I just had
trouble focusing on anything, slept a lot, etc, but gradually I saw them
change into something very different. I became suicidal, and the smallest
thing would set me off. If I got into an argument with my parents, I would
just think "is all this worth it?" and start spiraling downward. My girlfriend
at the time is the only reason I made it through; she helped me realize that
this wasn't normal, and that I really should do something about it.

At 16, I told my mom that I wanted to see Dr. D (a friend of the family, and
probably the best psychiatrist in our small town). It came as no surprise to
me to be diagnosed with bipolar I with rapid cycling; it wasn't uncommon to
have extreme mood swings in between the longer periods, even happening several
times a day at their worst.

He then started me on various drugs. I don't recall the order or combinations,
but I was on -- at one point or another -- lithium, Lamictal, Abilify,
carbamazepine, Depakote, and others I can't remember now. None of the standard
mood stabilizers worked; I either felt completely numb or was sick as a dog.
Lithium in particular made me feel worse than I ever have in my life,
emotionally and physically. We tried a couple combinations to balance things
out, but in the end the mood stabilizers just weren't helping; in retrospect,
though, I wonder if they were and I just couldn't recognize it in myself.
Regardless, the next step was anti-psychotics; I wanted to be put on anti-
depressants, as the lows were what bothered me, but it was simply too risky --
if they were successful, they could well put me into mania that I couldn't
control.

The anti-psychotics made me feel nothing. I don't know how I can explain this
to someone who hasn't been there, but it's like your emotions just cease to
exist. In theory, they worked, but a complete lack of emotions and creativity
simply wasn't worth it. I was 17 by then, and I decided to stop taking all
meds. I moved to San Diego for my first job shortly thereafter.

I rode on an extreme high for the first few months I was there, working 18+
hour days. I was a 17 year old making more money than he should've been, and I
took advantage of it. Sex, drugs, and rock and roll really describes it well.
I went to shows, I met a girl (whom I took a cab to every weekend, an hour and
a half each way, then got engaged to a month after we started dating), drank a
lot, etc. In short, I did everything that someone in the throws of mania would
do. It took a while for this to catch up to me, but as always with bipolar, it
did. I crashed hard, and if it weren't for my fiancee at the time, there's no
way I could've made it through. I frequently thought about checking into a
hospital, but I thought I needed to push through. I'm not sure if I made the
right decision or not, still.

It took me a long time to really get myself in balance. The first step was to
recognize what state I was in -- this is _remarkably_ difficult. The next step
was to learn how to bring myself back to normal when I started getting low,
and I became quite good at it. Ignoring a few small fleeting thoughts, I
haven't been suicidal in about 4 years. Then I learned how to embrace the
manic side of it, and put it into my work without letting it go too far; I
don't know that I ever really got very good at this, as my first two months in
NYC have shown me lately.

A combination of a good support network (key for everyone, IMO, not just those
suffering from mental illnesses), knowing myself, and knowing when to say "no"
has been crucial in me largely stabilizing myself over the past few years.
It's not perfect by any means, but it's working better for me than anything
else has.

To close, I want to impress upon everyone the importance of getting help with
mental illness. This doesn't necessarily mean medication (it certainly didn't
in my case, even thought it was tried), but just knowing yourself is insanely
important. Too many people refuse to get help, and end up in far worse place.
I'm happy with my life as it stands, but it could easily have not gone this
way.

~~~
nakkiel
Sounds kind of familiar. I always read such write-ups with great respect and
some sort of fear as I know how easily and quickly it can become 'wrong', so
as to speak. Could you please be more specific with this though:

    
    
        The next step was to learn how to bring myself back to
        normal when I started getting low, and I became quite
        good at it.
    

I've been tying to do that myself with no success so far. Also, I seem to have
become different through years as the maniac phases are very short now and the
low phases are very long — but I've learnt not to take any decision during
those phases so I suppose I'm already on the safe side.

Thanks for sharing.

~~~
dkarl
What daeken said. Improving my mood translates almost exactly into simply
acting like I would if I wasn't depressed. I don't try to pretend to be happy
or fake it (though I do use cognitive therapy techniques.) Instead, I just try
to do the same activities I would do if I wasn't depressed. I call someone on
the phone and ask them how they're doing instead of sitting and thinking about
myself. I make a healthy dinner instead of ordering pizza. I get some exercise
instead of lying on the couch. If I work, I release myself from self-criticism
(I'm so slow, I'm hopelessly stupid, I'm accomplishing nothing) and
concentrate on the work instead. If I watch a movie, I allow myself to enjoy
it instead of thinking the whole time about how much I suck and how I should
be doing something productive instead.

It's hard to do those things, of course. The essence of depression is
hopelessness. For me, it's hopelessness about myself, a deep conviction of my
own worthlessness and the impossibility of ever _not_ being ashamed of myself.
When you think that way, it's hard to see the point of making dinner or going
for a run. Long term, the biggest factor for me was to slowly learn to
disregard the reality of depression. By now I have a long enough perspective
on my life and my depression that I am better at seeing it as a temporary
illusion. I knew a girl who had persistent auditory hallucinations; she heard
voices constantly, angels and demons mostly. She knew they weren't real. At
least she said she knew, and she usually did, but when she didn't, it was a
problem. Coping with depression is a bit like that -- a constant effort to
disregard what your brain thinks it knows. So when I go out the door for a
run, or start cooking dinner, a big and very persuasive part of my brain is
convinced it's stupid and pointless, even while it's making me feel better. By
the time I'm done running or cooking, I'm completely aware -- with my whole
brain -- that it was worthwhile, and the fact that I've accomplished something
worthwhile in itself discredits the illusion. That doesn't completely dispel
the depression, not for long. Soon enough, the next activity I want to make
myself do still feels stupid and pointless. But it makes it easier to cope,
and it reduces the severity of the symptoms.

The older I get, the more consistently I manage to make myself do the things
that make me feel better. When I was younger, depression was overwhelming and
terrifying. Now it's mostly just miserable instead of scary. Especially now
that I know I can hold down a job through a bout of depression, and my friends
won't desert me, it's a lot less frightening.

~~~
joshklein
This describes my experience well, but I think it is worth pointing out that
what I (and I can only describe myself here because I don't want to assume you
are the same) have could be described as mild depression. What the OP
describes would be, I assume, described clinically as severe depression.

I have been able to "self medicate" like you with exercise, diet, rigorous
organizing and planning tools, and other ways of "ignoring" what my brain
tells me to do. When I was younger, I was briefly on medication and did not
like the side effects, and I have been lucky enough to be able to cope with
the tools I have at my disposal. I do not believe this is possible for people
with severe depression, and highly encourage them to seek professional help.

------
gentrysherrill
Really appreciate this article, as someone who has struggled with depression
extensively and (more or less) come out the better for it. People who are
experiencing the worst depression can mete out feel empty, desperate and alone
in a way that is almost indescribable to anyone who has not felt that way.
It's important for them to know that people care, are happy to speak with
them, and that those who have had similar experiences have, eventually, found
a happier and better existence.

------
samhay2u
Beutiful article. For what its worth, i think society is coming around to
mental illness. At least so in law enforcement. There are a whole brand new
range of policies and proceedures for recognizing and addressing the
signs,where as historacly they were much more abrasove and counter productive.
However, i believe most of mankinds 21 st century mental illness issues area
result of the industrial age where people are spending increasinly longer
amounts of there waking hours in the abscence of sunlight. A study conducted
by vanderbuilt university revealed that vitamin d3 was able to enhance the uv
saturation produced synthetically by uv box lights on a populous of patients
suffering from seasonal effectiveness disorder which is depression from lack
of exposer to sunlight. I have stated taking vit d3 and have noticed a
significant change in the dark montjs alone. You might want to ask your psyc
about it to see if he would let you take it alongside rhe lexapro

------
phren0logy
I'm a psychiatrist, an it is my great pleasure to treat people and see them
get better. I'm glad this was posted to increase awareness of the seriousness
of a Major Depression. It's a very misunderstood condition. Hope you continue
to feel better.

------
RiderOfGiraffes
This being Hacker News, my first thought was "Holy crap on a cracker - Andrew
Koenig is dead!?!". Then I discovered there is another Andrew Koenig of whom
I'd never heard, and it wasn't the author of Traps and Pitfalls who'd died.

Just thought I'd mention it.

------
Galilyou
Man, this is serious! My wife is on a challenging treatment, and one of its
side effects is depression. That opened my eye on a whole new meaning for the
word. Thank you!

------
veb
I've had some unfortunate things happen to me, in turn which gave me extreme
depression and PTSD. What I did was pretty simple... I did everything I could
do to have a good nights sleep. If that meant exercise, better food etc, I did
it.

Now it's manageable without any various medications, doctors etc and that
makes me feel pretty awesome.

P.S. The Beatles would always make me cry when I was on a low. Heh.

------
daimyoyo
I've been battling depression for years(binge and fasting cycles, not leaving
the house for days on end, sleeping 14-16hrs a day) and I'd like help but I'm
afraid the medication will affect my creativity. Do any creative people have
experience with what medicines to try and which if any to avoid? Thanks.

~~~
fbuilesv
Speaking from personal experience, worrying about creativity is the least of
your problems when talking about depression. In my own case, I'd spend 4-6
months without doing anything at all besides sleeping. No side-projects, no
programming, no guitar, nada; sleep, watch TV and sleep some more. Once I
started taking medications I started programming again, going out, exercising
a bit. Once you get to the point where depression is stopping you from doing
anything, creativity is worthless (since you're not creating anything).

I haven't found any serious consequence of taking the meds (Zoloft, Elavil and
Remeron) w/r/t my creativity. I can still do the same things I used to do
before, while mantaining the same level of quality. I've also found that it
helps me push myself harder, which is pretty good.

------
pella
<http://www.curetogether.com/depression/treatments/pmi/>

[http://www.curetogether.com/depression/ig/treatment-
effectiv...](http://www.curetogether.com/depression/ig/treatment-
effectiveness-vs-popularity)

~~~
pella
"What works for depression (and what doesn't)."

<http://bluepages.anu.edu.au/treatments/what_works/>

~~~
eavc
St. John's Wort is as effective as anti-depressants?

I'm skeptical of this page and encourage others to be as well.

~~~
JoshCole
[http://www.informationisbeautiful.net/play/snake-oil-
supplem...](http://www.informationisbeautiful.net/play/snake-oil-supplements/)

This data visualization suggests that saying that St. John's Wort isn't really
snake oil.

------
eavc
I am so pleased to find that this is a simple personal testimony about the
value of professional treatment and support.

I was expecting to find a folksy anecdote or some "hack," and I was pleasantly
surprised.

------
Alex3917
"[Lexapro] addressed some chemical issues in my brain"

Citation needed. Sorry, just because you have depression that doesn't give you
a free pass to make stuff up.

------
noname123
Why do people keep treating depression as a medical condition? You are
depressed because your life sucks. Fix it or accept it. <eom>

~~~
zackattack
This guy is being unfairly downvoted. A not insignificant number of cases of
depression are rooted in not cultivating proper emotional awareness, and then
ignoring the body's emotional signals. But people are unwilling and, frankly,
unable to take responsibility for their emotional life so this attitude is an
unpopular one. Also worth pointing out is that it's unrealistic to expect that
everyone can be happy, some unhappiness is essential to social stability.

~~~
eavc
I downvoted you for the same reason I downvoted the other guy.

You are speaking in vague generalities, with authority, on matters about which
you are apparently ignorant. Moreover, your propagating this misinformation is
detrimental to attitudes about depression, both for those who might be
afflicted and the public as a whole.

Depression is a serious problem which should be addressed through science,
credible education, and consultation with professionals.

The comment you are defending is utterly asinine. Persistent depression is far
more likely to be the result of cognitive-behavioral factors and/or
physiological factors rooted in genetics than it is to be the result of bad
life circumstances aside from some negative extremes.

Furthermore, you grant that people are "unable to take responsibility for
their emotional life" and yet somehow also support the patent contradiction to
that idea in suggesting that "fix it or accept it" is acceptable advice.

Your final line (in addition to conflating freedom from depression with "being
happy") belies a kind of moralistic thinking about mental health. Would you
say that broken legs are essential to social stability? Or ulcers?

~~~
zackattack
You make an excellent point. I should have distinguished between severe
depression and dysthymia. I do not know much about severe depression but I
have plenty of knowledge about dysthymia. Many people casually conflate the
two and I made that fundamental error in my post. My apologies.

~~~
eavc
I appreciate that. I honestly don't care about winning arguments or looking
smart on this point. I just wanted to get out my critique of your post for
people to read after yours so they can see another angle.

Warm regards.

