
Depression Part Two - westicle
http://hyperboleandahalf.blogspot.com.au/2013/05/depression-part-two.html
======
wisty
Quoting some guy off reddit
([http://www.reddit.com/r/TrueReddit/comments/1e08me/hyperbole...](http://www.reddit.com/r/TrueReddit/comments/1e08me/hyperbole_and_a_half_depression_part_two/c9vsiqa)):

>Depression is two beasts, gray anhedonia and black dysphoria.

> The gray beast smothers, drains, deadens and numbs; the black beast brings
> misery, anguish, self hatred and despair. They often work together, the gray
> sucking away every positive feeling and the black feeding everything
> negative. But sometimes one is dominant, and if the gray beast gets its
> teeth all the way into you, it takes away not just positive feelings but
> everything until you're just a walking shell so empty you can't even fully
> comprehend what you've lost.

> The converse, when the black beast has you, can be much like you describe -
> you can still feel a kind of dreadful, frenzied joy in short moments as you
> cling desperately to the edge of the sucking dark hole in yourself, trying
> to ignore the beast's whispers that any pleasure is a lie that will just
> make the coming pain more stark and inescapable and utterly deserved.

> They're liars, but they're good at it. Because they know you, because they
> are you. Pieces of you mind that should serve you and keep you stable and
> safe, but somehow grown and empowered out of all proportion. To live with
> them and not let them win shows a kind of strength that most people are
> sadly unable to recognize.

~~~
ChrisNorstrom
This is so accurate it's astonishing. Both the quote about Gray and Black and
the original post about the inability to feel. They're 100% on the spot.

I used to get a mix of both grey and black depression for years, I eventually
learned to just deal with it as it always goes away with time. I normalized to
it. Then I relized that I actually liked the grey anhedonia. It made me feel
free from forced emotions. I talked about it a few times on HN. I love being
depressed for a week or so ever other month. It always goes away but during
that time my thoughts & views feel so, authentic. I feel like I'm experiencing
the deep nothingness that is life, no hormones, no feelings, no hope. Just a
meaningless purposeless universe. It has a sort of depressive beauty to it. A
dark enlightenment. Pure logic. No emotion.

Some of the best song writers and poets wrote their best work when they were
depressed. It really allows you to reflect and think about things. As long as
the depression doesn't turn into misery or suicide, it can be a valuable tool
for creative people.

btw For me sunlight and exercise gets rid of depression within 2 days.

~~~
intended
I think the term you are looking for is depressive realism.

I forget the study (its been a while - please correct me if I am wrong), but
depressed people were checked for accuracy in their self assessment/
understanding their world/environment.

The thesis was that their thinking skewed them towards overly negative
assessments of their ability, chances, and position in life.

Turns out that several people had a more accurate understanding of their state
than the base line.

This fact actually bugged me for a while. If being depressed is more accurate
then isn't my mind being the most honest with me.

It was useful for me to think about it in these terms:

The issue with depressive realism is that it tells you a very prosaic truth -
that the world doesn't care. As you said: we already know that the universe
has no inherent meaning or purpose.

So why does it matter that base line people are more optimistic about their
chances? Or their aims? Why does it make a difference?

What matters fundamentally isn't the way the world is - Its a crummy place.

What matters to me is the world I can imagine and want to be _in_.

~~~
sigkill
[begin rant]

Your post sparked a thought. We've been hearing about 'cure' for depression.
From the point of depression, isn't the baseline a 'high'? Yet, we're told
right from childhood that drugs that put you on a high are not acceptable. Is
our brain not on a high naturally then, and could you classify depression as
the wearing out of the hormonal high? Just as one is able to make better
judgement at the base line if compared to being high, (as you say ->) people
are able to make better judgement at 'depressed' than normal. I don't even
know what I'm talking anymore, but I think we should stop seeing the
depression as a problem and start accepting it as a state of _not high/not
baseline_ , just as the baseline is accepted as a state of not high.

[end rant]

~~~
Millennium
The problem with what we call depression is not the depressive mode of
thought, per se. The problem is that this mode of thought gets out of control.

The depressive mode of thought is a tool, and an important one. The brutal
honesty of this way of thinking allows you to analyze situations more clearly,
and in so doing, it allows you to make better decisions. Being able to enter
this mode of thought was likely an important step in human evolution, and we
all do it from time to time, even those of us who are not "depressed".

But like most tools, the depressive mode of thought can be dangerous. That
same brutal honesty, applied to one's self, does not end well: our human
imperfections basically guarantee that such analysis will tear at the psyche
in ways that little else can.

It is said that we should not judge others because "you weren't there; you
don't know." But that doesn't work when you apply it to yourself, because you
were there; you do know. And so you analyze yourself, and your judgment
inevitably comes out wanting. The next question is obvious: what should you do
about that? Only there's usually not enough data to answer that question, so
an obvious intermediate step emerges: more analysis. And so the spiral
continues.

This makes the ability to leave the depressive mode of thought just as
important, from an evolutionary and health standpoint, as the ability to enter
it. Pick up the tool, use it as needed, and put it down again. What we call
"depression" is essentially what happens when you can't put it down.

You can probably see where I'm going with this. I think we're going about
treating depression the wrong way. We try to take the edge off the mode of
thought, when we should really be targeting the mechanisms that let people go
into and out of it. Those mechanisms, unfortunately, are poorly-understood
today.

There's also very likely to be an extremely delicate balance: you have to let
people out while also allowing them back in, lest some kind of
"antidepression" take hold where they can no longer pick up the tool. I don't
know what such a thing would be like; it's possible that we already know it,
but under another name that might or might not be linked to what we currently
call depression.

~~~
sigkill
It took a bit of courage to write this down so please bear with me.

Your post, I don't know why, has me in figurative tears. This feels like
someone 'gets' what's happening... and to think that I had no idea what I was
feeling for all this time was categorized as depression. I hate to say this
because it sounds fake and silly, but you know when people say it 'clicks' and
they feel like there's a sudden "light"? That's exactly how I felt after
reading your post. Don't ask me why, because I don't know.

~~~
seanp2k2
Totally agree. This was one of the most insightful things I've read on this
site in years.

EDIT: Hey, what if it's a natural cycle, like tons of other stuff? Normally,
it comes and goes, and the sickness is when it doesn't go. Not really a big
leap from your point, but something to think about.

------
singular
This is a fantastic article which gets at a lot of what makes depression so
pernicious. It's actually nice to see it presented with cartoons - it could
easily come across as patronising/playing down the condition, but Allie does
it so well that it instead makes it somehow more approachable, more visceral,
and certainly a fantastic way of clarifying the nature of the condition to the
non-depressives in your life.

One thing she doesn't address (hopefully she simply didn't have to experience
it) is the dark side of other's reactions to it - the blame you receive for
'being lazy', or 'being so morose all the time', or the irritability it can
engender in you. Understandable if you hadn't explained to them your
condition, but I find people react this way even if you do - they simply can't
accept something bad like that happening without you somehow being
responsible, or they just don't believe you.

An even darker side to the disease is those, I don't want to say people, who
pick up on your condition, and see it as a weakness to exploit. That's
especially the case at work for the more bully-ish types - who better to pick
on than a depressive who feels like they're a worthless piece of shit already?

I think the more wonderful articles like this there are out there, the more we
can attack the stigma of this disease (and mental illness in general), and the
more unacceptable it will be for people to take advantage of it.

~~~
seanp2k2
I got excommunicated by my SO who I moved out to California with over being
"so negative all the time". That, combined with eliminating the small social
circle I had built here in the 6 months prior to that, wasn't the greatest
thing for my situation.

------
afreak
I don't speak much about my experience with depression but I avoid it namely
because it's hard to describe to people the emotions you feel as you "deal"
with it.

For about a decade I had noticed a behaviour in my mood and it caused a great
deal of grief for my friends, those I worked with, and most importantly
myself. It never really prevented me from holding down a job, but it very much
delayed me from achieving certain things in my life that I have only recently
started to attain. I blame my leaving post-secondary school early partly
because of the fact that I could not cope with the demands that it brought
upon me as well as the fact that I was losing a lot of interest in things that
I once had some level of passion for before.

It was never destructive to the point where I wanted to go and kill myself--
although there were fleeting moments where I questioned the validity of such
an action. However, it definitely brought me down a few notches and it was
only when I began to approach the issue seriously that I found myself on the
road to actually recovering. I had to let go of certain things to get to this
point and it was only by opening up to a select few people did I find myself
going down a path to better things.

Years of treatment and some self-exploration has brought a level of calm to my
life--I haven't seen a doctor about the issue in about three years now. I
avoided using it as a crutch in my relationships with people (even when I knew
it was probably a part of the tension), but I was less and less uncomfortable
telling people once I knew that it wasn't all in my head so to speak. With
that said, not everyone understands depression but I cannot condemn them for
it because it's a rather convoluted and complex thing to explain. Hell, I
don't even know what I am writing here to say the least.

Allie's statements definitely resonated with me and I'm glad to see her
writing again because her previous post about depression made me think about
how things were going mid-treatment. There is no real "cure" to depression but
I do think that there is a certain level of exploration that is needed to be
done to sort of make the whole issue less of a barrier to what you want to
accomplish. Even to this day I still have to struggle with certain aspects of
it, but I understand now after so many years of pain that it can be defeated
or at the very least put at bay.

~~~
aortega
>There is no real "cure" to depression

Not now, but there will be one. IMHO symptoms of depression don't seem as
something "psychological" or some trauma. They do not make any sense, and do
not help survival of the individual. They seem more like a malfunctioning
machine, some chemical missing in the brain. Smart people will figure it out
some day, and cure it like they did with many other diseases before.

EDIT: do not want to sound like a cheap self-help book, this is my opinion
from observing depressed people, and working with lots of malfunctioning
machines :)

~~~
noonespecial
The depressed brain isn't a machine that broke that just needs a replacement
part. The brain is a machine that in the course of its operation _changes the
way its made_. Depression is a dark anti-pattern in which the brain begins to
disassemble itself. What you think changes your brain and changes in your
brain affect what you think.

The only way to "fix" it is to build again what is lost. Can a drug help?
Sometimes, but building is long and hard. A depressed brain is like a house
thats been neglected for 20 years. It needs lengthy remodeling, not a new
paint job.

~~~
benjamincburns
> Depression is a dark anti-pattern in which the brain begins to disassemble
> itself.

I'd agree that it's an anti-pattern, but rather than the brain disassembling
itself I'd say the brain assumes a very stable, self-reinforcing thought model
which rewards negativity or anhedonism. I describe my experiences with
depression above, so I won't repeat them here, but I'm convinced that the only
"cure" is finding a way to disrupt this feedback loop. Like others suggest
sometimes it's drugs, sometimes it's traditional psychotherapy. Believe it or
not there's been a lot of recent success with shock therapy treatments for
various forms of deep depression - I'd assume because it disrupts this thought
model.

"What I cannot create I do not understand." -Feynman

Personally I think we won't fully understand depression and other "thought
model" problems until we have an accurate general model of thought processes
in the brain and the ability to manipulate them. In the mean time I think that
the tools we have are blunt instruments.

~~~
eli_gottlieb
The thing about the brain disassembling itself was meant literally. Cells
actually degrade and die during depression, and have to be grown back later as
you get better.

~~~
cma
Except anti-depressants can start working in ~2 weeks. SSRIs do something to
serotonin levels/receptor levels. If your brain is literally degrading itself,
that could just be a side effect of the lethargy, low stimulus, etc. that a
depressed person is subjected to. When someone takes MDMA, I don't think they
suddenly grow a bunch of connections; it just jacks up the level of serotonin
to an extreme degree.

We don't understand them well and SSRIs don't work for everyone, but I don't
think your cell-death theory is an open and shut case at all.

~~~
eli_gottlieb
The cell death is a feedback loop. I've taken lithium carbonate when I got
depressed. The fact is that however much you may be fighting the depression on
your own, the chemical aid will _not_ "cure" you, nor "make you happy and
right", but it _is_ an immense aid to breaking the neurochemical feedback
loops and thus to letting you run your own brain again.

------
tomasien
My best friend was non-suicidally depressed for 2 years, and I just did not
believe him. I thought he was just having trouble getting over an ex for some
reason, because him being depressed didn't make sense.

The thing that finally convinced me, and ONLY in retrospect, was hearing the
full story about him and our best girlfriend during that time. This girl is,
pardon my objectification, an 11/10 in every way. Everyone we know is in love
with her, and with good reason. It turns out, for a large portion of the time
my friend was depressed, she tried really, really hard to date and/or have sex
with him, and he repeatedly turned her down every time. He'd been attracted
to, and probably in love with, her since I can remember and still is, making
hearing that this went on for YEARS shocking to me. But both sides confirm: it
happened.

It turns out, her wanting him made him feel like she was playing a joke. "How
could she possibly want to have sex with me, or like me in any way? Here's the
answer: she doesn't. She's playing a joke on me, and I don't fucking care for
it" he says was his inner-monologue at the time.

We still look back and just marvel about that time, because it was so
bizarrely different the reality we've lived in all the other days of our
lives.

------
jerf
On a completely different topic, this is a great demonstration of the
usefulness of RSS. I subscribed to this blog yea verily a long time ago, and
it's been silent for a long time. But this popped right up in my feed last
night like it was never gone. Sure, _this_ post ended up on HN, but in general
it's great for that sort of thing.

~~~
qu4z-2
Fairly likely the poster got it via RSS, so we're all reading it through RSS
indirectly.

------
firefoxman1
So what is it called if you have every single one of these symptoms, _except_
actually being depressed? I find myself not caring at all about what others
have to say, how they feel, etc. and you can imagine the hurdles that imposes
on someone who has to make a legitimate-feeling human connection to sell a
product. Social interactions are a game to me (that I've gotten quite good at)
but none of it feels real.

I haven't felt that need to be dead as described, but definitely concluded
that death would be neither good nor bad...and what's the point in waiting,
right? Isn't it all the same?

And the "everything is hopeless bullshit" attitude i've had many times. I've
just concluded that, perhaps...everything IS pointless. But we can enjoy it
nonetheless. Enjoy the pointlessness, since it's all we CAN do.

Anyway, is there a name for this besides selfish asshole syndrome? Anyone else
like this?

~~~
nostrademons
Do you not feel emotions, or do you not feel empathy?

The former is called alexithymia. It literally means "no words for emotions",
and is experienced as an inability to identify emotional states in oneself. A
person may still _experience_ emotions and act on them, but they're unaware of
which emotion they're feeling at any given time - for example, they may snap
at or say something nasty to a close acquaintance, but be unaware that they
were angry or that their words would be hurtful to the other person.
Alexithymia isn't a disorder in itself, but it's a symptom that can indicate
other disorders. Common causes include dismissive/avoidant attachment
disorder, autism spectrum disorders, avoidant or schizoid personality
disorders, or sometimes PTSD and emotional trauma.

Lack of empathy means an inability to put yourself in someone else's shoes and
imagine someone else's perspective. It's actually divided into two categories:
a deficiency in emotional empathy means an inability to understand others'
emotional states (and is closely related to alexithymia, as you usually can't
identify emotions in others if you can't identify them in yourself) and is
commonly associated with sociopathy, schizophrenia, and narcissism; while
cognitive empathy is your ability to imagine yourself in another's shoes and
take on their perspective given their differing information, and is frequently
deficient with autism spectrum disorders, bipolar disorder, or borderline
personality disorder.

~~~
StavrosK
> It literally means "no words for emotions"

It actually means "repelling emotions". Alexi- comes from αλέξω, not α- and
λέξη.

------
greatergoodguy
I'm really impressed by how well this conveyed such a difficult concept.
Depression can be so foreign to those that have not experienced it, and the
first step to helping people is understanding them.

~~~
knowtheory
The comment threads about this post are definitely an exercise in irony.

She touches on, but doesn't get into the fact that she can still pick up on
all social cues, and still feels obligated to respond to the imposition that
others put on her to feel better and be happy despite the fact that she's
unable.

And it's the fact that it's not possible for the depressed person to fulfill
the social interaction that non-depressed people want (e.g. non-depressed
person wants depressed person to cheer up, depressed person knows they can't
cheer up) that causes the depressed person to avoid the non-depressed person
and their unfeasible demands.

Part 1 touches on not giving a fuck about how interacting with others goes
down a bit more: [http://hyperboleandahalf.blogspot.com/2011/10/adventures-
in-...](http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-
depression.html)

~~~
tetha
This sounds consistent with what I am understanding so far.

To my current understanding, it is necessary to distinguish between a state of
mind and a current mood. Certain states of mind just don't support certain
moods. Furthermore, for certain states of mind it's hard to get into and hard
to get out of.

As a silly example, note my daily life. If I sleep in hard, I'm just not in a
productive state of mind and I don't get out of that state of mind all day.
The result is that I just don't do much that entire day. On the other hand, if
I set my alarm clock to 6 in the morning, I get all my chores done to 10 and
pull a full workday on hobby projects without breaking a sweat. The "zone" of
programmers also appears to be such a state of mind which just doesn't support
social interactions well.

Depression appears to be similar to this. It's a state of mind that's hard to
get out of (or hard to cover up even) and that just doesn't support cheerful
and happy moods. From there, our usual stress avoidance mechanisms kick in,
for example by avoiding overly cheerful or happy people and things don't
improve much.

------
shoe
Okay, I'm not really sure what to ask, maybe this will make sense?

I completely agree that life doesn't carry any _inherent_ meaning and I
frequently finding myself faking emotions and mostly just reacting in the way
others react in social situations. It's like existential-introversion-apathy.
I have so many ideas, and things I want to learn and do, yet I'm too content
in apathy to act on many of them. I'm in a good job, but when it comes to my
personal life I mostly have a blank stare to respond with.

Really, I haven't felt like I've been living for myself for a long time. If it
weren't for my girlfriend and my family and knowing that they would be
completely broken if I wasn't here, I'm not sure I would still be here.

I guess this sounds worrisome, but I've felt like this for the past 6 years
and have managed so far. It got worse after college, but now I feel like I'm
at a lower equilibrium.

I've thought about doing something about this, but I really have no idea. I
mostly feel _guilty_ that I even have this "problem". Are these feelings and
thinking patterns really a problem? What can be done about them, if anything?
I'm a young 20s working male in America. That's a hell of a good dice roll in
the global humanity game which is why I feel guilty even writing and talking
about this.

I don't know, is this a broken way of thinking?

~~~
gordaco
> Really, I haven't felt like I've been living for myself for a long time. If
> it weren't for my girlfriend and my family and knowing that they would be
> completely broken if I wasn't here, I'm not sure I would still be here.

This hits home. I've been there for about 14 or 15 years. Not so long ago I
realized that this was a form of implicit emotional blackmail, which is a very
hard situation, because, while it certainly works indistinguishably from
standard emotional blackmail, it's not done knowingly or maliciously. I've
ended up feeling like I don't own my life... again, not a good situation to be
in.

------
peterwwillis
[http://3.bp.blogspot.com/-drS0smfRtIo/UWtKWq-
cwyI/AAAAAAAAI-...](http://3.bp.blogspot.com/-drS0smfRtIo/UWtKWq-
cwyI/AAAAAAAAI-0/7NofDAulZ3Q/s640/ADTWO32.png)

I can remember being a kid and telling my mother _"I don't want to kill
myself, I just don't want to live, because I see no point."_

That's when they started putting me on medications. four years and 20
different pills later and I finally convinced them to stop doping me with
random chemicals, and I started to feel better. I haven't been on any meds
since. I currently love my life very much.

~~~
johnward
I've been dealing with the exact feeling for over 15 years. I don't see any
hope.

~~~
peterwwillis
Well i'll share a little bit of what might have helped me. Maybe it'll give
you some ideas.

First was my acceptance of a lack of a point to life. At first, for a long
time, it made me sad that there was no point. Then I kind of stopped caring...
I got to that point where she's just walking through the desert, in denial
that nothing matters, just trying to ignore that life is meaningless and keep
going for no reason.

Over a long period of time, I would occasionally discover something which was
mildly interesting, and it kind of inched the curtain of nothingness up a bit
and I could see some light. (In retrospect, I wish someone had carried me
around and exposed me to the endless array of amazing curious weird pretty fun
things in the world)

Relationships were impossible. Most of the time I would be wandering through
life and waiting for something to happen. I probably should have talked to
some experts who could have explained that my behavior was tailored to prevent
me from changing my attitude, but that's hindsight for ya.

The second thing happened recently. Through an amazingly intelligent,
unyieldingly positive, buddhist-like fun person, I discovered that the brain
is actually as stupid as the dog Ms. Hyperbole has. But it is possible to
train your stupid dog brain to be happier, to be more confident, to believe in
things.

It seems impossible, but it's a real thing. I'm still not sure what books or
people to refer to help you with this, but google around for PMA, mindfulness,
and benevolence. The general idea is that if you tell yourself you are good
happy things, and that there are good happy things in the world that can make
you more good and happy, it just sort of... happens.

Oh, and find a community of people that like the same things you do who are
really positive and fun to hang around. Good role models can help. When you
feel things again you can begin to stand on your own and engage the things in
life you have discovered that are worth while. Then, keep discovering new
things.

Even if you're faking it, be positive. Fake it until you become it, as that
lady in that TED talk said. And seek out experts. Even if you consider
yourself broken, remember that all broken things can be fixed and made to work
again. You're not born a brain mechanic, so you need to find some of them and
learn how to do basic maintenance until you get it running again.

~~~
johnward
Well I'm past the point of not wanting to live now, but I still really don't
feel much. I feel good when I work out. I can't think about myself without
feeling like a failure. Most days I try to start out thinking about positive
things I have in life, but then I get to work and those all go away. My wife
doesn't think I love her. I do but I just don't get any feeling in general.
She caught the grill on fire and everyone else is panicing and I'm just like
"whatever" put it out.

------
_m_a_u_r_i_c_e_
Problem is: its just a malfunction of the brain. If somebody has bad eyes you
don't request that the person just should make an extra effort to see better
and think it is the persons own fault if the amateur 'advise' doesn't help.
You give him glasses. If a brain function is affected we are still in the
state of hocuspocus, making patients and families suffer more then needed,
even make them feel guilty about it. Maybe we just may not have the knowledge
for a correct medication, until then the "healthy" people should learn to
respect and really listen and take the depressive person serious.Its just a
malfunction. It is as it is.

~~~
iSnow
Point is, the eye is a (relatively) straight-forward vision machine. The lens
is not the right shape? Wear glasses and the system enters an improved stable
state.

The brain a continously changing feedback machine. It changes its very
physical architecture by what you hear, see and think. Trying to correct it
via lobotomy or medication has not really worked out that great and there is
reason to suspect it will not work out great in the future.

Ironically, substances that indeed improve mood and well-being in depressed
people (especially MDMA, but also LSD, Psilocybin, Heroin ) are dangerous,
addictive and verboten. They essentially brute force some of the subsystems in
the brain (like pleasure/reward) and I believe every substance that does this
is going to be addictive.

~~~
seunosewa
> substances that indeed improve mood and well-being in depressed people
> (especially MDMA, but also LSD, Psilocybin, Heroin) ... I believe every
> substance that does this is going to be addictive.

Dude, you're misinforming people. There are indeed substances that help
depressed people. They are called anti-depressants. The illegal drugs you
listed above are not anti-depressants, and therefore you have no rational
reason to believe that anti-depressants must have similar properties. Real
anti-depressants are generally neither dangerous nor addictive. Please don't
misinform people about this.

~~~
peterwwillis
"Real" anti-depressants have been found to _cause_ suicide, and are part of
why the suicide rate has been increasing in recent years. There are thousands
of articles about this, starting over 10 years ago.

However, it's obvious neither of you are qualified to talk about addiction, so
both of you should either provide sources or shut up about it.

Some of these articles talk about the potential suicide risk created by
antidepressants:

[http://www.washingtonpost.com/wp-
dyn/content/article/2006/12...](http://www.washingtonpost.com/wp-
dyn/content/article/2006/12/13/AR2006121300452.html)

[http://www.nytimes.com/2005/02/18/national/18depress.html?_r...](http://www.nytimes.com/2005/02/18/national/18depress.html?_r=0)

[http://www.huffingtonpost.com/dr-peter-
breggin/antidepressan...](http://www.huffingtonpost.com/dr-peter-
breggin/antidepressants-cause-sui_b_218465.html)

These articles talk about what we know about antidepressants and their risks:

<http://www.helpguide.org/mental/medications_depression.htm>

<http://www.drugwatch.com/ssri/suicide/>

This person rails against the first few articles, but also acknowledges the
risks:

[http://freethoughtblogs.com/ashleymiller/2013/01/18/antidepr...](http://freethoughtblogs.com/ashleymiller/2013/01/18/antidepressants-
and-suicide-the-rant/)

Some Google Scholar searches:

[https://scholar.google.com/scholar?q=antidepressant+cause+su...](https://scholar.google.com/scholar?q=antidepressant+cause+suicide+study)

~~~
LaGrange
What _causes_ suicide is that at the point where depression lifts _a bit_ ,
you suddenly are able to take action, but not necessarily any happier. In
fact, did you not that part about "hate" in the OP? That's when people kill
themselves. It happens with medication, it happens with CBT, it is an
essential inherent risk of depression therapy — the first few months are
_dangerous_.

~~~
peterwwillis
I mostly caught the part where the guy I replied to was making ridiculous
statements about both antidepressants and how there is somehow a "logic" which
dictates that illegal substances can't treat depression.

~~~
seunosewa
What I said was that it is completely illogical to say that because you think
heroin can fight depression and its also addictive and destructive, that
therefore real anti-depressants must also be addictive and destructive. You
cannot infer the properties of anti-depressants from the properties of a bunch
of illegal drugs that you (a lay person) consider to have anti-depressant
properties.

~~~
LaGrange
Actually, while not really addictive, virtually all anti-depressant/anti-
anxiety drugs turned out to be habit forming, to pharma corps dismay and
nobodies surprise.

~~~
qu4z-2
> to pharma corps dismay and nobodies surprise.

Wow. In my head that was the most sarcasm-dripping "dismay" I've read this
week.

------
3rd3
I can‘t decide whether I would be any happier if we lived in a less corrupt
would, in a society that has meaningful jobs for everyone and if our
governments would care more about our future, education and less about
religion. But I believe that most of my depression arises from there.

~~~
mikecane
Maybe "circumstantial existential depression" is an unrecognized area. I agree
with you.

------
leothekim
I read this and was a little surprised that this wasn't an exploration into
his own depression, but more the experience of it and how frustrating and
isolating it felt to explain it to others.

An important thing to understand about depression is that, for most (certainly
not all) people, it's the outcome of having anger and a retaliatory impulse
turned _inward_. Exploring what you may be angry at can be helpful in
reengaging with your life. It is not the path to happiness, but engaging with
your anger is certainly a way to make you feel more alive and present in your
life.

EDIT: In expressing my surprise about not reading about an exploration in
depression, I forgot to mention that I'm glad the author found a forum to
speak out about his frustration and isolation while feeling depressed.

~~~
svachalek
It's a "she" by the way. Allie Brosh. Her blog was incredibly popular a few
years ago before she went mostly silent but for an ominous entry about
depression. Anyone who's new to her writing should definitely go through the
back catalog from brighter, funnier times.

E.G.: <http://hyperboleandahalf.blogspot.com/2010/07/dog.html>

------
xijuan
Depression is different for everyone. My depression is quite different from
the one described in the article. My depression is usually mixed with anxiety
and is triggered by a stressful life event. To me depression is like falling
into the sea of sadness. I feel an immense amount of sadness partly because
that the stressful event has a reason to make me sad. Along with the sadness
is the feeling of disappointment for myself and for others. But sadness is the
most prominent feeling. My depression could get a lot better very quickly if
the stressful event reaches some sort of satisfactory resolution. But if it
doesn't, I would just feel sad,sad, sad ,and eventually escalating to feeling
hopelessness...then wishing I could be dead...

~~~
krcz
There is possibility it's not depression (at least not in scientific
understanding of term), but some different kind of animal, like Generalized
Anxiety Disorder (<http://en.wikipedia.org/wiki/Generalized_anxiety_disorder>
).

------
JohnLBevan
A common theme amongst depressed folk is that they see everyone around them
being positive and feel subhuman because their experience doesn't match up;
them trying to aspire to the brand their friends present and not realising (at
least not accepting at a subconscious level) that there may be a lot of
negative stuff their friends are hiding from them. To "cure" this, one idea
would be to create an anti-social network - somewhere where you present the
worst possible image of yourself, a place to relieve yourself of the burdens
you'd never pollute your positive image / good vibe feed presented on your
Facebook stream. As well as giving people a place to open up to that side of
themselves you'd see your friends being honest about their downsides so
wouldn't have such a high bar to compete with, helping you to feel more human.
People enjoy self-detrimental comedians for this reason (amongst others), so
the idea has some validity. It would be interesting to see how this played out
in reality. . .

~~~
seanp2k2
Some of the funniest comedians are ridiculously sad/pessimistic people.

I've thought about doing stand-up on many occasions.

------
samwilliams
You are clearly very talented, this is a truly excellent post. It made me
understand an extremely complex subject better, as well as making me laugh.
Well done!

Some people find the idea of positively affecting many peoples lives
encouraging. If you happen to be one of those people, congratulations -
mission accomplished. The tens (hundreds?) of thousands of people that will
read your post today will have enriched lives and will likely treat those that
they meet who have depression in a more appropriate way. If 100k read your
post and interact with 5 depressed people over their life span you have
positively affected 500,000 people. I am willing to bet that this is more than
most people will ever meet.

Once again, you are clearly talented and have acheived something great here. I
will stop gushing now, as I hope not to be a dead fish taunter!

------
jpdoctor
I've lived more of my life on the other side (the side of light) compared to
Allie. Perhaps that's why one of her segments screamed out at me above the
rest.

> but I somehow managed to convince myself that everything was still under my
> control right up until I noticed myself wishing that nothing loved me _so I
> wouldn't feel obligated to keep existing._

So as an old guy (GOML) who's had a couple of good friends suicide: If you
have a friend that might be having some trouble? Err on the side of butting-
in, in the kindest way possible. If it turns out that nothing was really wrong
and you feel embarrassed, you will feel nowhere near as bad as if you did
nothing and something was actually wrong.

------
bitwize
I realized that this was done by the "Clean All the Things" girl, and I feel
for her so hard, in so many ways.

~~~
benatkin
The alot person too. It sucks a lot.

------
BoredAstronaut
What gets me about this description is how it's all about having indirect
feelings for things in your mind. The imagination is a pretty late-stage
evolved trait. I often think it's amazing that we have emotional responses to
ideas in the first place. Seriously: they are ideas! Why should people have
feelings for ideas? It's kind of bizarre.

People should have emotional responses to real things. And I've often wondered
why we don't treat depression with more realness. Trying to treat it with
"positivism" is just more of the same thing that aggravates the depression:
disconnection from real things. Positive attitudes are invariably supposed to
be evoked for, once again, ideas.

Sunlight and exercise are two things that were mentioned as real things that
can help re-connect people to physical reality (instead of ideas). Another
important one is fundamental to human emotional and social health: affection.
Simple physical touch from someone you trust and who will suspend judgement.
Hugs. Hand holding. Sitting on the couch together. No expectations. No
demands. Just freedom to be.

It seemed from the article/comics that some (maybe a lot) of the person's
unhappiness was coming from the discomfort and pain of not living up to
expectations imposed on them by others about their attitudes. Just being
detached is not itself that horrible (and maybe it's less weird than being
emotionally attached to imaginary things). But being made to feel/believe that
you are a bad person, a defective person, a source of pain to others, that
leads to a real kind of pain. Other peoples' facial expressions and tone of
voice affects us on a much deeper level than conceptual imagination.

Like many mammals, some birds and other kinds of animals, humans are deeply
wired to respond to the sounds and images of other humans expressing positive
and negative responses to us. Those are the first place to go to work on
immediate sensory treatment for depression. Because these social signals are
so ancient, we can even get treatment from non-humans. Cats and dogs make
people feel better. It's even been shown in studies that seniors in retirement
homes feel better when they are given time with pets.

I'm not saying this is a guaranteed solution, but it hasn't been mentioned in
this discussion, and it's very important. The way we socialize is inadequate
to our biological needs.

~~~
rmrfrmrf
You don't treat major depression with "realness" because the brain has the
ultimate control of sensation and perception. Physical sensation doesn't make
a difference in those cases. Light therapy is used for seasonal depression
(seasonal affective disorder), but it does not necessarily work for those with
major depression.

Your suggestion about 'physical touch' is funny because I think it perfectly
shows how people misinterpret what depression is. Imagine touching your spouse
one day and realizing that the endorphin and oxytocin release is no longer
there. All you feel is warm flesh. Suddenly, the natural moisture of the skin
becomes apparent. Has skin always felt like this? It's kind of gross. My
discomfort becomes apparent, and now suddenly I'm trying to make a face like I
_enjoyed_ that hug. THAT is what depression does. You have all of the
sensation with none of the reward pathway. And, much like someone who has lost
one of their basic senses, the brain tries to overcompensate through
heightened sensations (like feeling the moisture of someone's skin), which
causes discomfort and anxiety.

Imagine smelling a flower and _not_ having that temporary, brain-clearing,
'ahhhhh....' moment. This is what depression does to you.

~~~
seanp2k2
This post makes me feel like I've never had depression, because I always
enjoyed hugs...just not as much sometimes. I think that it's a gradient more
than a "yes/no" type thing, and I haven't experienced that badly (thank FSM).

------
tiltomatic
Thank you for this. It looks like all the 'depression is an invented
conspiracy' folks have already weighed in, so this may be futile, but: you're
entitled to your own opinions but not your own facts. Specifically: depression
is a brain disease influenced by environment, but ~1/3 of the risk is
inherited. [1] While antidepressants don't work a lot better than placebos,
this is because placebos work well. This does not mean treatments don't work
(and the widely-cited studies that argue otherwise have major flaws). [2, 3]
Treatments (not just meds) save lives - and sadly, one of the consequences of
scaring folks away from treatment is more suicide. [4]

[1] <http://www.ncbi.nlm.nih.gov/pubmed/22783273> [2,3]
<http://www.ncbi.nlm.nih.gov/pubmed/20800012>,
<http://www.ncbi.nlm.nih.gov/pubmed/22136980> [4]
<http://www.ncbi.nlm.nih.gov/pubmed/17728420>

------
misnome
This really, really matched up well with my experience of depression, which I
lost almost two years to, and am only now recovering from.

------
pushkargaikwad
Well most likely this comment won't be seen by many but still I thought to add
my views on what I think can be one way to control depression, specially short
term once which we all must have gone through.

1\. Most likely life is outpacing "your" speed so lower the speed of life. You
don't have to do N things, do N/2 things. It is OK to take breaks and not do
anything for few days.

2\. Most of the time, depression comes because of disappointment. It is good
time to tell yourself that Life is unfair and move on.

3\. Do not judge yourself too much, failures are fine. Everyone fails, it is
just that they don't talk about it. Despite your failures, most likely, you
are still doing better than majority of the people in the world.

4\. Talk to people, most of the time, you just want someone around you to talk
and may be take care of.

5\. Learn new things and Find new hobbies, it often helps cheering you up.

6\. Avoid depressing thoughts as they suck you in never ending spiral. Again,
talk to people, learn new things and find new hobbies to avoid this loop.

~~~
dolphenstein
Couldn't think of anything worse than having to talk to people when in the
middle of a bout. I'm sure it'd be helpful, just that it ain't gonna happen.

------
eatitraw
1) How to know if you are depressed:
[https://dl.dropboxusercontent.com/s/ao1aqb9vinfcwt2/Burns_De...](https://dl.dropboxusercontent.com/s/ao1aqb9vinfcwt2/Burns_Depression_Checklist.pdf)
(there are a number of other questionnaires, but I like this one)

2) How to deal with depression: book by Dr. David Burns "Feeling good" --
really good book, you should try applying methods of dealing with depression
described in it. Available on kindle(but even if you don't have a device, you
can read in your browser): <http://amzn.com/B009UW5X4C>

3) How to deal with depression if 2 doesn't quite worked out: find a good
psychotherapist. I would recommend cognitive-behavioural therapy, but I may be
biased, because I love Burns' books. Anyway, CBT or not, you should find a
therapist if you struggle with depression.

~~~
claudius
While likely a good start, I don’t know if this checklist (the dropbox link)
is fully sensible – if I put a 4 in ‘Criticizing yourself or blaming others’,
another 3 or 4 in ‘Loss of interest in sex’ and maybe a 2 in ‘Worrying about
your health’, I am already labelled ‘unhappy’ or even ‘mildly depressed’,
whereas all three are – IMHO – perfectly acceptable things to be found in any
somewhat perfectionist, health-conscious person who finds entertainment in
their work.

~~~
eatitraw
So you _actually_ can put 0s in all other questions and 4s in these two and 2
in another one? In my opinion, such a person would be either misinterpreting
the questions, incorrectly stating(misjudging) answers, or actually having
other signs of depression. There is a chance though that such a person may
exist though.

Take "Worrying about your health", I think "worrying" here means "being
anxious". So while normal health-conscious person cares about her/his
health(eats well, sleeps well, takes necessary prescribed medications, etc),
she/he isn't anxious about it. In contrast, depressed person may worry about
her or his health without taking any actual steps to improve the situation.

Or take "Criticizing yourself or blaming yourself"(note second yourself, this
question in kindle book is different, maybe I need to prepare correct pdf). If
you spend your whole week under pressure of self-criticism, thinking about
every mistake you made and every imperfection your work have, however small or
large, then this is definitely 4. "Somewhat perfectionistic" is 1 in my book.
4 is "Extremely perfectionistic".

Or "Loss of interest in sex"? Why would an exteme loss of sex drive happen to
a normal person?

~~~
claudius
My point is that it is _very_ easy to misinterpret these questions and/or the
scale 1-4. ‘Criticising yourself’ is to me an absolutely normal action, and
this whole quantify-yourself-and-your-actions idea is basically about
_criticising_ and improving yourself.

Similarly for ‘worrying’ – does it mean ‘anxious’ or merely ‘concerned’? Taken
to an extreme, I worry about my health when crossing the road. ‘Loss of
interest in work _or_ other activities’ also matches nearly everyone, given
that people will lose interest in specific activities over time.

Certainly, such a questionnaire with a standardised interpretation _and_ scale
will be helpful, but you will need a professional to do such an assessment. To
me, it looks as if it will over-diagnose people as unhappy/depressed.

Loss of sex drive is also something that can happen for a multitude of reasons
– satisfaction found in work, for example, or other sources of stress.

~~~
eatitraw
I don't know about this questionnaire(and I don't have enough time to check
right now), but similar ones are quite reliable tools for self-assessment.
They are _designed_ to be used without presence of mental health professional,
and they work. Most of your criticism is valid though, and scores may be
distorted, but I am quite skeptical that this effects leads to many false
positives.

Also, I am not saying that criticising yourself is not normal, I'm saying that
spending all time criticising and blaming is not normal.

By the way, if your score actually more than 10, try other tools, Beck
Depression Inventory for example. And try reading the book, you may find it
useful even if you aren't clinically depressed. BTW, there is a chapter on
perfectionism(which is quite common attitude in depressed individuals).

~~~
claudius
I am quite happy actually and somewhat busy with other work, so I’ll pass on
the books, nevertheless thank you.

But I guess it is valid to ‘over-diagnose’ here, i.e. err on the side of
caution, so it might even make sense to put in things that make sure anyone
not absolutely fitting the standard ‘happy’ bill might be compelled to seek
professional attention.

------
navs
I don't talk much about my depression. It's terribly difficult trying to talk
about feeling nothing. Allie is a wonderfully smart person that perfectly
illustrated some of those feelings I've, for years, been unable to articulate.

------
breakupapp
OMG love this post. "Fish are always deadest before dawn!"

------
richardlblair
I want to thank you for taking the time to write this all up. This is really
well written, the images are amazing, and you explain it all so well.

It can be hard for people to understand depression; to understand that there
is nothing really to understand. Like you said, how do you explain nothing? It
is so far beyond comprehension...

Finally, I'm so glad you are feeling better. Every time I see corn I'm going
to think of you and your story.

Thanks again.

------
Estragon

      > My fish are dead.
    

Everyone's fish are dead, but they keep going by pretending that they're still
alive. The trick is to learn that the pretense isn't crucial to the
fabrication of positive feelings. You can fabricate them out of nothing but
memories of playing with your plastic horse as a child, if that's all you've
got.

------
squozzer
The piece was intriguing. And while I can't prove it, non-existence is
probably overrated.

------
bwb
Such a great post, sent to quite a few people and thanks for posting it here!

~~~
westicle
No problems. Lots of other great content on her blog too, but this is the
first update in a couple of years I think.

I figure knowing more about depression (or sharing someone else's experience
of it) might be interesting and/or useful to other hners.

------
shameerc
One thing that I've learned from my life is, never explain yourself to others
when you start feeling depressed. Others may not completely understand you
when its connected to your emotions.

------
wellboy
I never thought I could be depressed in any way, but I came to see that hole
you were talking about a bit. I think the problem is that when being in
depression, one is too much in your head and similar to startups if one can't
bounce off their "ideas" from something, they ou commit "idea-incest" and they
start getting weird thoughts that are detached to reality. You don't want that
and I think as you said, it takes that certain corn to pull you out of that
sticky pool of your entangled thoughts. :)

~~~
seanp2k2
...and this is why you should be doing some basic usability testing and
proving out your product to small market samples. You can do this IRL too by
doing things such as:

\- Going to the bar \- Grubwithus \- Going dancing \- Hiking a popular trail

etc :)

------
mikecane
Beautiful post. Wish I'd had it decades ago. "Wait for the corn" will become a
mantra.

------
khitchdee
Great cartoons!

~~~
netnichols
You should really check out her back catalog. The following is one of my
favorites:

[http://hyperboleandahalf.blogspot.com/2010/04/alot-is-
better...](http://hyperboleandahalf.blogspot.com/2010/04/alot-is-better-than-
you-at-everything.html)

~~~
neilk
I recently discovered <http://reddit.com/r/alot> .

------
ebbv
I've dealt with depression as long as I can remember, even when I was a little
kid. I feel like I have only gotten pretty good at dealing with it as an
adult. Here's my approach which may or may not work for anyone else:

1) I recognize that depression, self pity and all that are a waste of time and
ultimately stupid. It's not hard to keep in mind that rationally I have it
really good. This alone doesn't fix anything but for me it's important to not
fall into the romanticism of depression as if it's deep and meaningful or
"more real" than being happy. It isn't. It's bullshit.

2) I realize that these feelings are just a phase, and that I will get through
them and the best thing for me is to "ride them out." I look at them like the
emotional equivalent of spraining my ankle or something like that. A non-fatal
injury which will heal and get better. The best thing to do is to let it heal
and do what I can to aid that process.

3) I help myself get through the depression by focusing on things I enjoy. I
try to make arrangements to hang out with friends or family who I enjoy being
around. I listen to music that helps me when I'm feeling shitty (in my case
this is usually metal or industrial music.) I seek out other entertainment I
enjoy; comedy, video games, etc.

4) Foremost in my mind I keep the fact that there is no afterlife. If I do
something stupid like suicide, there's just nothing. But if I stick through
whatever I'm going through, I can experience more things that make me happy. I
can see my nieces and nephew grow up. I can have some cookies. etc.

Best of luck to anyone else who has this issue. Find what works for you and do
it. Stick around. Life can be great and there's nothing else.

~~~
rmrfrmrf
1) > _romanticism of depression_

Saying shit like this makes me think you don't get it. You know what's even
stupider than self pity? Being alive.

2) Why ride them out when you can end them right now?

3) When you're depressed, you don't 'enjoy' anything.

4) > _there's just nothing._

Perfect. Where do I sign up?

Not trying to downplay your experience or anything, but your assessment of
what depression _is_ sounds an awful lot like what people who aren't depressed
_think_ depression is.

~~~
iliis
Not necessarily. Emotions are curios things and the part about riding them out
helped me a lot. You can't end them right now. If you try to stop em or
suppress em you'll only achieve the opposite. It's a bit like trying not to
laugh when you are already laughing your heart out.

I think the better solution is to live trough them. You don't have to accept
the feelings as something good but thinking of them as a sort of temporary
injury that will heal if you let it works. If you catch a flu you take a few
days of rest and it will be gone. You don't force it to end by walking around
and 'being strong'. And it's even more so with things going on in your head.

Number 3 is something I can only do as a sort of preventative measure.

~~~
saraid216
> You can't end them right now.

I think you missed the subtext of suicide there.

------
cLeEOGPw
I always thought that uncontrollable emotions are weakness, so I was
constantly putting a layer of rationale over my emotions from the very young
age. Now I am not sure if I can't feel strong emotions any more, or nothing
emotional ever happens to me. I am a little afraid of the first one because I
was not very sad even after my grandfather died (closest of the family members
I have lost so far).

------
dschiptsov
"Everything that could be lifted by a CBT is caused by ignorance."

I'm fully aware of dopamine-based theory of depression, but for some
mysterious (for the theorists) reasons there are much less dopamine volatility
in the East.))

------
kruhft
Answering the headline: no, eventually everything isn't hopeless bullshit.
There's still a lot of hopless bullshit, but eventually you'll find something
(or if you're lucky, a few things) that makes all the hopeless bullshit worth
putting up with.

That's why people find suicide so sad. Almost nothing can't be overcome with
time and suicide cuts that time short. You learn this as you overcome things
by not giving up.

This process is called 'growing up'.

~~~
GuiA
>This process is called 'growing up'.

How condescending and uncalled for. Many great men and women committed
suicide; it has nothing to do with "growing up" (or variations thereof)

~~~
claudius
I’d say many great people never grew up either – but that definitely depends
on your definition of ‘growing up’. If you define it as reaching intellectual
and more importantly emotional stability and maturity, then I can see how you
could think of overcoming depressions or other psychological disorders as
‘growing up’.

~~~
GuiA
"growing up" is a subjective thing and has no unified definition.

That being said, conflating lack of intellectual/emotional stability and
maturity with depression is terribly short sighted and shows a lack of
understanding of what depression is.

I'd encourage you to educate yourself beyond the mainstream view of depression
(= "oh but only goth teenagers or losers get depressed") before making such
claims publicly.

------
ak39
Wow, what a beautifully written and illustrated piece.

However, I gave up counting the number of times I read about life being
"meaningless". The author is more likely suffering from an existential crisis
than actually being clincially depressed. He/she is searching for meaning. To
feel. Reading some mid 20th century French philosophy might help here.

Clinical depression? Boy, that's another ball game altogether. That type of
shyte won't result in a beautifully animated and elegantly worded blog. :-/

~~~
GuiA
I'm clinically depressed, and have been for pretty much all of my adult life.
It's much stronger at some times than others. A recent "peak" is when I had a
panic attack in downtown San Francisco at a concert last Friday night that
lasted 2 hours or so and rendered me unable to function in a room full of
people and loud noises. It was awful.

I've heard arguments similar to yours many times. I've tried mid-20th century
French philosophy, and do appreciate it. But it doesn't help.

Depression manifests itself differently in different people. There isn't a
"correct" form of depression. Telling people that "you're not depressed,
you're X, do Y and all will be OK" doesn't help _at all_.

You probably mean well, but making those sort of comments do everything but
what you think they do.

~~~
ak39
I do not intend to downplay the anxiety and the emotional pain of the
experience either you or the the OP had. I empathise completely. I myself have
gone and continue to go through such "crises" regularly. I feel just as much.

My point was: it's ironic that the author talks about the lack of interest in
the aesthetic of "life" and the general disinterest in the veritable
cornucopia of little toy horse plays around us when he/she did EXACTLY that by
writing a lovely, beautiful and well-crafted blog. (I am not being sarcastic.)

Doesn't anyone see the beauty and irony in that? Does clinical depression
create such works of art? If so, we should celebrate it as a gift!

~~~
StevenRayOrr
You seem earnest, so I am going to try not to be frustrated, but depression is
not a gift that results in creative genius. People who manage to struggle
through it and create art are doing it _despite_ their disease and not because
of it. The romanticism that is attached to the suffering artist is incredibly
frustrating and, I think, dangerous. It leads people to believe that it is
okay or worthwhile or noble to let this illness rule over you. We don't
celebrate cancer or dementia or schizophrenia as "gifts". Sometimes people
suffering from those illnesses are able to create beautiful works, but we
don't romanticize their diseases because of it. Why would/should we do that
with depression?

~~~
Jasber
I agree with almost everything you said, except for this:

> People who manage to struggle through it and create art are doing it despite
> their disease and not because of it.

While depression can hurt creativity––bi-polar disorder and schizophrenia can
actually help it[1].

The discussion has mainly been around depression, but I think the "suffering
artist" label can apply to a range of disorders.

[1] <http://en.wikipedia.org/wiki/Creativity_and_mental_illness>

