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What to Do When a Loved One Is Severely Depressed (nytimes.com)
312 points by johnny313 on June 8, 2018 | hide | past | web | favorite | 217 comments

I feel like this should be left here:

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

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

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

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

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

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

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

[0] http://thehill.com/opinion/healthcare/375040-police-need-mor...

[1] https://www.theatlantic.com/national/archive/2014/12/police-...

[2] https://www.thedailybeast.com/unarmed-teen-killed-by-police-...

[3] https://www.mercurynews.com/2017/11/02/santa-clara-da-clears...

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

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

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

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

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

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

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

See, this is exactly what I am talking about.

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

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

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

We need to decouple the concepts of "assisted suicide in cases of terminal illness" (may not be assisted, may not be terminal) from other types of suicide.

The public health responses to you should be very different to the people who experience rapid onset despair.

As a person who lives in the US, this isn't something that I would generally think of if I were considering whether to tell someone that I was planning suicide. Reading your account however, maybe it's something I should be worried about.

There's a lot of issues with this in the US.

When I was a kid my oldest brother enrolled in some free counseling from a church. They had him fill out why he was going to counseling so he honestly wrote down that he had been having suicidal thoughts.

So this church freaked out and sent a pastor and someone else over to force him to promise not to kill himself.

Which as you can imagine was horrible and completely broke his trust in the system.

Also taught me to never ever be honest with people about serious things like suicide unless you've already know how they will react or you think you are a real danger to yourself.

Suicidal thoughts from time to time are fine. The issue is when you start to have real intent to carry them out. That's when you need help.

Telling anybody associated with the government that you're thinking about suicide instantly triggers a type of panic. I think it's very similar to the situation with drug overdoses, where calling for help can often get you into additional trouble. It's very likely, IMO, that there are people who have suicidal ideation but won't talk about it because they don't want to get committed, or worse. Then they don't get any help or advice and feel even more alone and do something that may have been preventable if they'd not been too scared about the consequences of openly talking about it.

It is important to take your mental health seriously before it reaches crisis points. By crisis, I mean where other people make choices for you as a result of your forfeit of authority in the situation.

There was a situation in Canada where police incident reports were shared with the U.S. border authorities under a law enforcement information sharing agreement, and a few people were denied entrance to the U.S. as a result of historic crisis encounters with police. Cops aren't bad, but institutions can be callous. Similarly, the record of a mental health crisis (or failing to disclose it) can have an impact on certain kinds of insurance, security clearances, (as above) travel, custody agreements, and by extension, jobs.

Learn to stay mentally healthy, and realize that it is an investment you make, often at the cost of other immediate things, which pays off as the result of sound decisions compounded over years.

100%. I think the physical “keep your body in shape” movement must be followed by a “keep your mental health/resilience in shape” movement in the coming years.

+1 be careful, even if they don't use violence they tend to go on conservative side and put your loved one in 72h hold and if it's late night or proper mental hospitals are full then they will end up spending those hours with crazy people they pick up on the street. It will be more traumatizing (especially for females since they will be surrounded by crazy males from the streets).

Yep. Back in my student / tutor days at university, I had a student with severe mental health problems. One afternoon, someone at his dorm called the police with the idea of helping him. He died of that day while being restrained by the officers who came to help.

Many officers don't receive sufficient training on how to deal with mental health crises, and sometimes the result of contact is bad.

Just saw on The Intercept:

> Police Broke Into Chelsea Manning’s Home with Guns Drawn — in a "Wellness Check"

She wasn't home. But the surveillance video is frightening. At least, it wasn't a SWAT team. But damn.


Suicide by cop is not uncommon. Even if you're not seriously suicidal, just severely depressed, I suspect that it can be tempting. In my experience, I'm too ineffectual when severely depressed enough to consider suicide. But faced with someone with a gun, all it takes is threatening them. I recall relatively recent video of a young woman who was killed after she charged a cop. At the entrance of a university parking garage.

I would be thinking really fucking carefully about posting this. If a loved one has a specific plan to commit suicide you need to take that really fucking seriously. Death by cop is so much smaller than suicide rate in the US.

As a person who has been badly affected by the police and the health system because of suicidal thoughts, I think you should think “fucking seriously” before you give advise to people with suicidal thoughts.

You may not like it, but the system utterly sucks and you can be easily, even casually, abused. In fact the likelihood is high this will happen. And the kicker? No one gives a damn if you do get abused, and if you die then your mental illness will be used against you for the reason that some cop killed you.

I thought the parent was taking it seriously, and I also think that part of taking that seriously is recognizing that someone who is that despondent might attempt suicide-by-cop.

I, for one, can count the number of times that talking to someone has helped my depression on 0 hands. That includes professionals.

I don't know how other people who've suffered depression most of their lives feel, but I can't stand this advice. It reeks of being the lowest effort possible by someone who has no understanding whatsoever of what they're talking about and prefers to just parrot something that sounds good to them. I'd honestly rather have people tell me they think I'm a weak pussy who should just suck it up, because at least their being open and honest about their lack of give-a-damn.

I think the best talk I had from a therapist in the early aughts went, "In general, the only things we know that help with depression are: exercise, some sunlight, a little social interaction, and self-care; bathing, brushing your teeth, etc. Medicine can help some but results are inconsistent, talk therapy is rarely helpful."

He spent two years just keeping me accountable on the little day to day things and while it didn't immediately cure my depression my quality of increased dramatically. The idea that something like keeping my room tidy would help with my depression sounded absolutely god damn insane at the time, "I want existence to end and you're telling me to make my bed?" ..but somehow those hundred small things mattered, life's pretty good these days.

God damn brains are dumb.

I survived my deepest depression by showering and shaving every day. Then forcing myself to get dressed and go be with other people, even sitting in a coffee shop and feeling miserable, hiding it behind a smile and a book.

Being home, alone, unshaven, unclean, in an unkept house made me feel worse because of all the things I saw that needed to be done, and the isolation allowing me to think about that and only that.

A bit of tidying made my space feel better (less cramped) and a bit of tidying each day reduced the sense of burden compared to seeing the whole place as one big mess. Same for the self-care and other aspects.

Every undone thing is an extra stressor because it's an extra thing that you know needs to be done, but in a depressed state you do not feel able to do or that there is sufficient time to do (it seems overwhelming, even when in reality it's a small chore).

Being somewhat social (even as an introvert), being physically active and getting my sunlight, and maintaining a decently tidy home (I still suck at cleaning the shower often enough, and I never make my bed), have made an immense difference.

There's also the benefit of routine and ritual. That's part of what the showering and shaving did. I'm lying in bed and I haven't shaved yet, I need to shave, let's get up and shave. I have to do this, once it's done it's done and I can move on. Now I'm out of bed and I can maybe do something else or not, but the ritual helped force me out of bed and gave me even the chance to have a healthy day.

My suggestion is, instead of "making" the bed, pull the top sheet and covers down to the end and let the bed air out. It's easier and more healthy.

Your comment rings so true for me. I have had nearly the same experience with depression, talk therapy, and ritualistic self-care.

> (I still suck at cleaning the shower often enough, and I never make my bed)

I stopped using the top/flat sheet, which means "making the bed" is as simple as fluffing the pillows and shaking your duvet/comforter/quilt out over the bed. The flat sheet is responsible for probably 95% of the effort in making a bed. Coming home to a made bed is nice.

Bonus: when you buy sheets in the future, you can invest the top sheet savings into a comfier bedspread.

Keep in mind the flat sheet provides a barrier to protect your comforter from your gross body. Sheets are easier to wash than a comforter.

In much of the duvet-loving world (but not the US), you just use a duvet-cover on the comforter, and wash that as you would the top sheet.

You spend a third of your life in bed. Please splurge on all the comfiest sheets and blankets you can manage.

Excuse me if I stray out a little (I wholeheartedly agree with your comment) and ask you how is that your bed needs making. Are these things uncommon over there?


I hate making my bed so I can't be happier now :)

People need to change the sheets and pillow cases and duvet covers. When some people are depressed they find these habits harder to maintain. After a while they've become deconditioned, and they're still unmotivated, and it can be hard to get back into a routine.

Sadly I know. But you already needed to wash traditional bed dressing, actually one more sheet. The task of making the bed is much simpler with duvets, at least for me: I just take the thing with both hands, shake it a little and place it all over the bed. Compare that with placing correctly the upper sheet, the blanket and the covers. It's like ten seconds vs one or two minutes.

I was cynical about talking to people for the longest time. I figured I would forgo seeking the "cookie cutter" advice and went to see my priest -- expecting him to tell me "well you are weak in faith, pray more, say these prayers" etc.

He begins by telling me, "If I take this baseball bat, and smash your knee, would you come tell me, or would you go tell a doctor?"

I said, well obviously the doctor. He said "Ok, go and do likewise."

I went to counseling that week, which included temporary relief via SSRI's. I am still coping, but it is _worlds_ better than it was years ago.

Talking to people, especially that have the same philosophies, helps. If you haven't found the right people to talk to, keep looking. They are out there. It took me 4 tries, but glad I did. I live with a spouse that does not understand depression what so ever, so it is an absolute lifeline to be able to talk to an understanding professional.

> It took me 4 tries

In other words: less than 25% of them are right. About the same experience here.

My personal gripe: Most psychologists are feminists. If you explain them a problem you have, they’ll percieve it in a gynocentric way. They are in denial that men can be on the receiving end of a problem or injustice, so much that one of them posited to me that male and female suicide rates were the same. Which tells a lot about the state of science on men’s problems.

This can be true, but it's not necessarily always so.

Many years back, my partner was sexually assaulted, so I attended a few of her counseling sessions with the local Rape Crisis center as a support person. The female counselor commented that I was "very brave" to do that - something I found very odd.

Years later, my partner said that the sessions I didn't attend were little more than "man hating" and "man-blaming" for all of the world's wrongs.

I have also attended counseling, as I've recently started to understand the level of physical and psychological abuse that was inflicted upon me by my mother (and her boyfriend, as well as my stepfather) while I was growing up. My counselor was also female, yet not once did she belittle my suffering as less because of my gender. As I described a few events, I'd even hear her let out a gasp or draw a sharp breath, or a few words of concern.

It seems possible to me that you've come across individuals with their own concerns and agendas that lie outside the requirements of their jobs, but I couldn't write off an entire profession based on that.

I wish people would not down vote this. It's actually really common for people who identify as feminists to basically be hating on men. I wrote about something similar here (and I'm a woman, if that matters to anyone):


See if you can ask your family doctor if you can get a male psychologist then? Mine was quite lenient, at least, and talked me through the options, wanted my opinion, etc.

Men are feminists too, and often more eager and agressive feminists than female ones; as much as top MRAs are often women. Like any ideology, it is not a question of gender, surprisingly.

I, for one, can count the number of times that talking to someone has helped my depression on 0 hands. That includes professionals.

Yea I'm in agreement with this. No direct effort to "help" has been useful at all.

You know what would be helpful, is if people actually started being honest about how not together their own lives are. Forget depression, I just want the average person to actively acknowledge and vocalize that they don't have all the answers and haven't figured things out.

One of the biggest sources of anxiety for me is looking around and seeing all the people who "have their shit together" and thinking that I'm the only one over here drowning. Yet when you talk with them one on one, it's pretty clear they don't have any better handle on things than anyone else.

I suffer from clinical depression. Talking absolutely helped me, as did medication and cognitive behavioral therapy. But when suicide is on one’s mind, there is no time to make an appointment. Sometimes the act of talking it out with a third party can help give you the strength you need to seek a more effective treatment.

I’m sorry that talk therapy didn’t work for you. It has, however, shown to be effective at disarming suicidal thoughts long enough for other outcomes to seem attainable.

I was always a bit skeptical that just posting a phone number helps people, although it must have helped some people at least.

But besides that, what is there to do? Is depression even something that can be helped with?

Well there are short term coping mechanisms (talking, friendships, leisure, rest, work...); there are antidepressant drugs; and there’s finding a goal in life that transcends most problems on the way. I’ve been 12 years depressed since graduation, and things are piecing up together now, so I don’t know if psys were directly helpful, but at least they helped my wait until I found a greater goal.

This is the American attitude toward people and things we find distasteful. We seek to wash our hands of them, not fix or rehabilitate. We throw criminals in jail and forget about them, we hand off the mentally "ill" to clinicians and forget about them. The last thing we would do is help them ourselves, or see what in our society might be so damaging. Every person for themselves, autonomy and independence is the American way. Fundamentally we seek to reaffirm Puritanical attitudes of being born good or bad, and by emphasizing how "different" we are, how "specialists" must handle "those people" and not just friends who can listen, we create distance and make ourselves feel better. The opposite would be to humanize them, but that makes us extremely uncomfortable.

Suicide hotlines are pretty ineffective as far as suicide prevention goes.

You're getting downvoted, but I am not sure that's really fair.

I've been thinking this topic today. I happened to lose a (young) family member to suicide a couple days ago and, shit, that bothers me immensely.

Every time the subject of suicide comes up the first thing that is said is "call the hotline," however, in the last couple days, I have been questioning if suicide hotlines are evidence based. I have zero idea if the topic even has been studied, or even if it could be studied. I wonder if our resources can and should be better allocated. I wonder if people are calling suicide helplines instead of calling their doctor.

Or even people are saying it just because it makes them feel good. Because preventing suicide is actually hard and telling someone to call a phone number is easy.

I'm just pondering right now, I have no answers.

Personal story: I called a suicide hotline once and it was extremely unhelpful. It was the opposite of helpful, it actually made things worse.

The Fremont bridge in Portland had a sign with a # for suicide hotline, and it was the wrong number I believe for over a decade. Only when a road crew maintenance guy had to take it down for repairs did somebody check. It wasn't even in the news, I just happen to talk to one of the workers who told me.

This got me curious, so I looked a few things up on pubmed. Here's some articles that piqued my interest:

https://www.ncbi.nlm.nih.gov/pubmed/24086443 https://www.ncbi.nlm.nih.gov/pubmed/24163237 https://www.ncbi.nlm.nih.gov/pubmed/22320194

I’m sorry for your loss. The same thing happened in my family. It gets better with time.

It gets better with time. I am not convinced that this is the case.

I can’t promise that it’s the same for everyone. But for me, the pain faded. Thinking about it still brings up some emotions, but so much else has happened since then that the loss is nowhere near the forefront of my mind.

God, they are worse than unhelpful. In Australia, if you call Lifeline from a mobile, even if you don’t disclose who you are they are will still call the police on you. This happened to me, and I specifically called to talk myself down to a third party who I believed would listen, and I would not have to deal with the consequences of not dealing with uncaring and ill-equiped authorities who will take you to a psych facility (read: uncaring ED) at best, or shoot or maim you at worst.

No such luck.

When the media adds the number for Lifeline it’s just lazy and backside covering. Hell, for a long time the media were so badly informed aboutvsuicide they wouldn’t even report on it.

So yeah, suicide hotlines are not only ineffective, they can be positive detrimental to your health.

That's awful, but the US suicide hotline doesn't do that, one of the only places that won't call the cops on someone seeking help, unless they state that they are immediately killing themselves.


If you already mid attempt, and yet you are also calling a helpline, in that case there's nearly no reason to complain if the cops come.

Do you know of something more effective for the same cost?

Sadly, both statements are true -

Call Centers are not particularly effective. It's also true that there aren't widely available good options.

It's a difficult situation, and the tools to address it are inadequate.

Posting an anonymous comment on Reddit? I don't know, at this point anything is as effective as that. I'm just tired of seeing these hotline numbers shared across all forms of media as if they were the solution to everything. Real therapy, as far as I know, is the only effective solution. There's no low cost solution other than maybe trying to form deeper relationships with the people around you.

It sounds like you do not know much about the topic, but still felt compelled to contradict the most common suicide prevention advice in a public forum while offering no evidence.

Maybe not a great thing to do on a high-traffic website on the day of a high-profile suicide.

> not a great thing to do on a high-traffic website on the day of a high-profile suicide.

It's the only time people seem willing to discuss suicide. A week from now everyone will have forgotten that suicide is a real epidemic. I'd rather see people discuss real solutions instead be of endlessly repeating the same pointless things.

And I think people, including the person you responded to, would be open to that discussion if you had in any way supported your arguments with facts. If you want to propose "real solutions" provide some supporting evidence for why suicide hotlines do not provide good value for cost and what alternatives do.

Cognitive Behavior Therapy is scientifically proven to work. Basically any CBT book on amazon on the subject, look for best sellers, read reviews - $3.99 plus $1.99 shipping is your cost. Another book, The Power of Now I personally recommend. Everything else you need is in the KJV.


Has self-directed CBT actually been studied?

Yes, most of the books start off listing the studies and the results. I seem to remember the best seller one, Feeling Good, actually goes into the history and discovery, including the actual tests and results incrementally, although I don't have my copy immediately available. When I say scientifically proven, I mean it. If it doesn't work, the researchers would honestly like to learn about your situation and why it didn't work.

You didn't answer the question. Were these studies done on people who were self directed? "here's the book, have fun, we'll follow up in a year."

As far as I understand most people receiving CBT who have been studied have received it in a professional setting with weekly meetings.

Yes, I did. CBT is done self directed. In a professional setting with somebody is possible, but it is more like giving you homework. I have never been to a group or "professional" In the studies (I believe to be in Feeling Good but it could have been in a dozen other books I read) they split up groups an gave CBT training to one and the other one was a control. However, getting to that study there were a series of other studies of ideas (which had to be changed because of the results) that lead up to CBT. I seem to remember the author talking about going to conferences and how they changed their ideas as they broke down what the models.

Then yes, there was actually a study of the book Feeling Good (kind of meta), and told to read it with a checkup every 6 weeks just like you guessed it in the quote. There are other CBT books that are smaller and to the point, more tactical approach to learning the methods (I think one is called Learning CBT) of Feeling Good. The second half of Feeling Good goes into drugs, which at the time was written no long term studies had been done or possible. From my personal research, these drugs do not work and cause more damage then good. I have found that through suffering and depression, and then working my way out of it, I believe I am better off then just taking a drug. I feel they are supressing some kind of natural force that is needed to build character, but for some people they are needed as a "backstop" to get out of a hole. On another note, depression has grown several folds since the introduction of antidepressants. I do not even consider that there is actually a thing as a drug that can do what they claim, but that's my personal belief.

King James Version.

Sure but they make people feel good about themselves when they post them. Much like "liking" a Facebook post as a form of activism.

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

Star Trek V!

Sybok: Let us explore it together. Each man hides a secret pain. It must be exposed and reckoned with. It must be dragged from the darkness and forced into the light. Share your pain. Share your pain with me, and gain strength from the sharing.

Sometimes the pain is a secret even from the person harboring it. IMO this is the basis for some PDs.

I never really believed in Freudian stuff until my first wife. Her subconscious was a monster.

That's part of the stigma. Some of the concepts and models sound goofy (crazy) to those who haven't experienced it. Freud though... I'm not impressed with him in the slightest.

No stigma here. Just don't know how to get a person who thinks everyone is crazy but her, help.

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

There's another good quote I've heard: “Be kind, for everyone you meet is fighting a hard battle” (https://en.wikipedia.org/wiki/Ian_Maclaren) I have heard it with " you know nothing about" at the end.

UK: 116 123

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

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

FWIW, this is a common paradigm taught by instructors of meditation. That is, thoughts in general are transient and not something to necessarily identify as "me" nor to assign undue importance. Notice thoughts come and go and return to the breath.

I am not qualified to suggest that meditation is beneficial specifically for depression, but I think there is sufficient evidence to advise the practice in general.

This is a great tactic for ridding yourself of any unwanted thoughts. Learn to see them as "other" or a "mindvirus", not part of you. Learning to identify myself with the aspects of myself that I like has helped me in nearly every facet of my life.

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

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

I found meditation practice immensely helpful in my struggle with depression. I learned that the present moment is the only moment, and I can let the thoughts pass through me and come out the other side.

I thought it was pretty hippie-dippy stuff when I started, but I was desperate enough to give it a good honest try, and damned if it didn't help more than talk therapy and everything else.

I look at it like my brain is lying to me. "Hey, you want to die" ... "No I don't brain, you're full of shit."

Somehow related, when you have a problem or a decision to make, thinking about you in the third person apparently helps.

Whenever I have anxious thoughts or worries, I imagine my friend having them instead, and me giving them advice. That advice tends to be a lot less self-critical and more helpful.

"Remember, people do recover from depression"

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

Depression fucks with your interpretation of reality, the distortion seems impossible to 1) not be true, 2) restored.

It's indeed possible to get near normal, but it's very hard to convey to someone in such pains.

Rationality also goes out of the window when emotion storms strike. Even though I knew that the previous day I was alright, if the next I go down, it's not always enough to help me go through the bad times.

ps: also give pills a chance, they might not work, but it might lessen your load tremendously and avoid further damage.

The depressed are hard to convince because they are depressed. The friends and family of the depressed are hard to convince because they are ignorant.

Recovery is just another step in the process.

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

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

It scars you

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

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

I haven't forgotten what it's like to know that dying is better than any other available option, and yet undoable.

We equate openly suicidal people to attention seekers because they talk about it without doing it. Facing that disbelief was one of the things that scarred me the most.

The research seems to show that most people who don't take SSRIs recover from a bout of depression in about two years. If you take SSRIs then you partially recover after a few weeks, but the underlying problem doesn't resolve.


This was true to my experience. The anti-depressants were successful in numbing the pain and they arguably did their job (they kept me going in the absence of the support I really needed). The several years of psychotherapy and development of some very warm and loving friendships that then followed has allowed much deeper change to happen.

The importance of connection and trust, at least from my experience, cannot be stressed enough.

That link doesn't seem to show me any research, just a pop-science book for sale?

The files are inside the computer.

I'm assuming you've read the book, and so actually have some idea of what this 'research' it probably refers to is. If it doesn't exist outside of the book, you may have been tricked.

So true. Our minds don't just influence how we see the world around us - they create the subjective realities which we all inhabit. If you keep telling yourself 'there is no way I can do X', it becomes reality.

Empirical evidence has indeed proven that there are many cases of depression which are rooted in chemical imbalances or physical abnormalities and can't be cured by shifting one's thinking patterns. But that represents a portion, not a rule or even a majority of cases.

It's frustrating and saddening to try and help someone when they deeply believe that they can't be helped.

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

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

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

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

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

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

What you just wrote had me wondering if my wife was posting to HN because I'm sure she too is also at the end of her rope dealing with my anxiety and depression. If your person is anything like me please resume the loving and know that in all likelihood you're not being intentionally wronged. We just aren't dealing with the black dog as well as we'd like or wish we could.

If there are no children or other complications, I would not hesitate to leave. The relationship could be part of why the depression persists, and I don't mean that in a "it's your fault" kind of way. Some people just mix like oil and water.

It is possible to leave in a nice way. My divorce followed telling him "I'm tired of hurting you. I'm tired of being hurt. I think we both really gave it our best. If we could do this dance, we would have figured it out by now. I want a divorce." He breathed a sigh of relief and agreed. We both cooperated in making it amicable and not a disaster for any involved party.

Leaving doesn't have to be a case of abandonment or rejection. It can be a case of gently setting both parties free.

Thank you so much. I’m gonna need this way of explaining things very soon, it’s been eating me up inside.

Act in love, no matter how you feel.

That takes emotional energy and strength. You have to find that somewhere other than out of that relationship.

That's how you send yourself to therapy. How long do you put up the act for?

Have you considered going to a therapist yourself?

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


I highly recommend watching it to better understand the disease.

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

That's a great video, but I think it's from 2011. I recently came across another video from 2016 which is a bit more technical and sheds some light on the results of recent research. People interested should definitely give it a watch - https://www.youtube.com/watch?v=BZbunmaU-60

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

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

It seems so tone-deaf. More accurate is:

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

If only you had continued reading one more sentence!

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

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

We need a civilian-life equivalent of Rangers from the burner community.

> Rangers act as non-confrontational community mediators, providers of reliable information, facilitators of public safety, and navigators of the edge of chaos.

And/or, train police in these techniques. More empathy and patience, less judgement.

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

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

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


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

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

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

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

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

* http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-...

* http://hyperboleandahalf.blogspot.com/2013/05/depression-par...

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

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

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

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

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

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

Sadly yes.

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

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

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

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

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

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

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

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

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

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

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

The discussion is largely rooted in anecdata and can be interpreted multiple ways due to the relatively low number of lethal events: https://www.washingtonpost.com/news/wonk/wp/2016/07/13/why-a...

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

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

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

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

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

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

It's dependent upon which officer is dispatched. Some, perhaps many, especially those who are more experienced and intelligent, and have been trained in mental health crisis intervention, will be helpful. Others who are inexperienced or not trained will just want to handcuff the person and throw them in an ambulance by any means necessary.

Most cops will want to help a suicidal person. The ones who handle it badly make the headlines and the viral internet stories.

The other problem is that "the system" is not really set up to help people who are suicidal to the point that the police are called. They will be sent to the psych ward at the nearest public hospital for evaluation, where they will be seen by overworked staff who know nothing about the person's history. Especially if they have no means to pay, they will be discharged as soon as possible and there will be little followup.

> I honestly don't have any numbers to backup my feelings...

Then you don't know what's true and you should want to find out. Otherwise you risk spreading very harmful anti-intellectual and anti-science misinformation.

> And even if statistically the police aren't that likely to hurt someone, the frequency that it's happening and the growing resentment on both "sides" can make it so that many people will want to attempt other solutions before involving police.

Consider that you might be contributing to this very problem. You're spreading a meme here that you don't even seem to believe is backed by data because of your feelings on the topic. Now multiply this attitude by millions of people and you've got an entirely self-inflicted societal problem.

Humans developed scientific tools precisely to overcome our biases and emotions. Leaving them behind in the name of feelings is the path towards chaos.

But the feelings are just a symptom, they aren't the problem.

You can throw out stats that say it's not likely, but that won't cause me to really worry any less when I need to decide if I call the police on a loved one, or if I call the neighbor.

I honestly wish I didn't bring up the "hurt or killed" aspect of this, as that is always the thing that ends up devolving into internet fights. Worries of ending up with large medical bills from police interaction, or being charged with a small crime and losing your job, friends, house, etc... are much more worrisome in my opinion.

Regardless of how based in reality these feelings are, the police need to handle it. The solution isn't pulling out stats and saying "this isn't really an issue", because it clearly doesn't work.

Health insurance reform is so badly needed in this country, and the police need to work with the communities, they need to build trust, they need to show the community that they aren't dangerous, they need to show that they won't jump at any opportunity to charge someone with a crime.

I fully understand that asking police to go more lenient on arrests and charges when on a wellness call will end up with some possibly very bad people "getting away with it", and that asking police to put their guns down and even possibly disarm themselves in some situations will lead to officers getting injured or killed. But the arms race of everyone distrusting everyone else is going to end up with a much larger amount of harm in the long run.


My ex attempted suicide. I came home from work and found him. I called an ambulance, naturally. The cops came.

While the ambulance was taking him away (to the opposite hospital they said they were going), the cops questioned me. The male was rather nice in mannerisms, but the female...

She told me it was my fault and berated me for my messy house. I was accused of hiding a meth lab (My house was messy, but it wasn't that bad. Seriously). They asked to search the house. I said no. Seriously, at that point I wanted to go to the hospital. I think if I we were a different race, I wouldn't have been able to opt out of the search.

I still hate that female cop.

This was my experience as well.

I hope you and your ex are doing well now.

Thank you, and I*m sorry you have had to experience something simlar.

I'm personally doing well. A good amount of time has passed since then (15-16 years), so lots of positive life changes and healing and stuff.

Not so sure about the ex, in part because I lost contact with him some years ago and in part because his suicide attempt was caused by major mental illness. He was on disability last I knew and I was pretty sure he still suffers. But it also wasn't a situation I could stay in. His mental illness kept me there longer than I might have done otherwise, honestly.

I hope everyone involved in your situtation has fared well.

Definitely true. I've had a student call for this sort of ideation, after taking prescribed medicine, identified himself as black so they could tell who he was when they arrived, but didn't ask for a 'crisis prevention team'.

Somewhere between the 911 Dispatcher and the police that showed up, the only salient points communicated were "black man" and "drugs" and they rolled up on him as if he was a drug dealer. Very easily could have gone another way.

It also varies according to the particular police department, the particular officer(s) involved, and whether they got up on the wrong side of the bed that day. Generally it's not worth the risk and it's recommended not to call police for "wellness checks".

This is one example, but the article has advice from several experienced people. https://theintercept.com/2018/06/05/chelsea-manning-video-tw...

I don't see why you're getting downvoted.

How many people here would have said the same thing a few years ago before the issue became more mainstream?

Interactions depend just as much on the cop(s) in question (and the bad interactions seem to depend more on the cop) as the person but the statement from the article is basically true at face value. It's always been true. That said, NYT wouldn't have said this a few years back because it wasn't a fashionable issue for folks in ivory towers acknowledged (or at least not enough of them for NYT to feel comfortable mentioning it casually) and NYT obviously does not want to rock the boat too hard among that crowd. Now that it is acceptable I can't say I mind seeing it stated so bluntly.

It's never a good idea to involve law enforcement in anything, if you can avoid it. It's such a wildcard what will end up happening.

That is a warning for people who live in the US, and are not moderately wealthy caucasians. Sadly yes it is bitterly true.

Anyone can be affected by this, which is why police brutality should be an everyone issue, but statistically speaking you are correct.

(There are many other, more dangerous places in the world where you shouldn't call cops for things like this, but probably everyone there knows why, so you don't have to caution the statistically unlikely subset not to do this.)

It's a warning for everyone. Caucasians have plenty of bad interactions with police, especially surrounding mental health. Also, depression is increasing fastest in white men.

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

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

2) Make a checklist of essential tasks and get into a habit of doing those things no matter what. Some examples: shower, brush teeth, floss, use mouthwash, clip nails, walk 10k steps, do dishes, make bed etc. Check them off. It doesn't matter what's on the list, but it is important to check off 100% of the items each day. Put every small task you can think of on this list and you'll feel good when you check each of them off.

3) Take a good multivitamin + vitamin D

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why are you discussing a cold or antibiotics with a therapist anyway? They can't prescribe drugs.

Because I had a cold and she noticed and told me to call my doctor to get antibiotics.

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

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

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

I'm not sure if it's as simple as lack of existential threats, but I'd agree that it is important to have a purpose in life, and a daily routine, and research backs this up.

It's also important to rule out any life stressors that could be causing the depression, such as an unrewarding/stressful job, or living somewhere that you don't want to be.

It's an interesting way of looking things. Depression is as complex as the brain which produces it, however. This may be a part of it, but there are many pieces in that puzzle.

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

I teared up because it is so true.

Give it a try if someone you love has depression.

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

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

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

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

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

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

I agree that in general that is the right approach.

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

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

I am too. I have an incurable medical condition. I am pro right to die.

But there is a third option and that is you work on finding ways to improve quality of life. That's what I do for myself.

I suspect a lot of depression is biologically based and it should be treated first as a medical condition, not a mental health issue. A very large portion of my mental health stuff is a side effect of medical stuff.

I don't know how to popularize that approach.

I wish you every success in your search and a high quality of life. May you forget your challenges when you want to and recognize them when you want to.

This seems a bizarrely simplistic (or incomplete) statement.

It needs at least an adjective in front of "agony". I don't expect you're suggesting euthanizing someone with acute appendicitis or a severe cluster headache.

For the purposes of constructive discussion I don't mind qualifying "agony" with "enduring", so to limit scope to those with chronic, untreatable depression. But the original statement is an honest representation of my thoughts.

ETA: At the same time, it's important to recognize that suicides inflict dramatically more pain on those left behind than other causes of death.

OK, so enduring (which includes constant/unwavering?) and untreatable. I haven't been able to find how many sufferers of depression that includes.

If it's close to or actually zero, then maybe it's a strawman.

It's not zero. The numbers are pretty big:


Treatment-resistance is relatively common in cases of Major Depressive Disorder. Rates of total remission following antidepressant treatment are only 50.4%. In cases of depression treated by a primary-care physician, 32% of patients partially responded to treatment and 45% did not respond at all.

I'm not advocating withholding help from any of them. It's more of a philosophical quandary.

If you believe (as I do) that the universe is indifferent to human suffering, that life has no greater purpose beyond this one life, and that minimizing human suffering is worthwhile; then the idea of forcing someone to live a life of pain bothers me. And at the same time, the idea of a suicide increasing the suffering of those left behind also bothers me.

It's probably impossible to avoid this degenerating into a religious debate, but those are my thoughts.

> It's not zero. The numbers are pretty big

Woah.. treatment resistance is nowhere near the same as being untreatable. It's an alarmingly huge leap to make, especially since the definition kicks in after only two anti-depressants have failed.

> minimizing human suffering is worthwhile;

I agree..

> then the idea of forcing someone to live a life of pain bothers me

But I still take issue with the seeming over-simplicity of this statement, as well as your original comment, because it (dangerously, in my opinion) brings the notion of euthanasia/suicide [1] into the dicussion merely because of some pain.

If someone's life is going to be, essentially, nothing but pain, then, OK, I agree it's inhumane to force that someone to live, but that just hasn't been established.

Meanwhile, philisophically, I'm uncomfortable with not pursuing all the other avenues of pain relief before resorting to death.

[1] Assisted, unassisted, whatever.. I'm not categorically opposed, by any means.


That's both an uncharitable reading and out of context. Like the original commenter, I'm feeling free to take some liberties with my language.

However, to clarify, the threshold I was suggesting was of severe, unrelenting pain, as I alluded to in my previous comment. That's hardly impossible.

> like the abortion debate

This reference unnecessarily draw contentiousness into the discussion, contrary to the guidelines.

> no common ground

Demonstrably not the case, since I agree with rectang regarding suffering in general, and, I believe, regarding the right to die with dignity in the face of unavoidable suffering. I merely disagree with the nuance (or lack thereof) as applied to the situation of depression.

Ironically, had that woman lived in a country which forces people to live, the result would have been, as she put it, "a grusome and lonely death".

Fortunately, that speculation has little merit, not just because it's a sample size of 1 (aka anecdata) but, more importantly, because it was made by the depression sufferer herself.

Also, characterizing a country that doesn't support physician-assisted suicide as one which forces people to live strikes me as a non-sequitur. Merely decriminalizing suicide is enough to remove any "force".

This is why I, again, object to your glossing over the details when speaking on this issue. The details matter, especially if you're not just trying to gratuitously stir up emotion or controversy.

Depression can be effectively treated. It is not the same as terminal illnesses that are often covered by right to die laws.

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

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

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

not "knowing more about how depression works".

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

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


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

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

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

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

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

One of the first points from the article:

"Don’t try to cheer him up or offer advice

... it could backfire by reinforcing his sense that you just don’t get it, said Megan Devine, a psychotherapist and the author of “It’s O.K. That You’re Not O.K.”

“Your job as a support person is not to cheer people up. It’s to acknowledge that it sucks right now, and their pain exists,” she said."

My parents also read a bunch of books on depression and tried to teach me about it to help me.

It was the last thing I wanted to do. I didn't have any energy to learn anything, I was having enough trouble trying to hold myself together as much as possible every day. Whenever someone tries to help someone who's depressed, I guess they don't get it because most of the time, the depressed person is probably barely keeping it together, and asking them for anything more is not going to work.

Gosh, an 8 hour video series telling you that you're broken? I can't imagine why he wouldn't want to subject himself to that.

It's probably way more important that you watch and understand it than him.

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

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

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

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

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

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

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

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

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

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

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

A few interesting things to note on this topic:

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

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

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

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

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

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

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

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

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

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

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

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

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

I wish this were the case, but "vacation for the mind" is not a good description for the hospitalizations I've been a party to (and have had to work to get people out of). Hospitalization is better than physical harm and is an appropriate response to an acute crisis, but our acute mental health care system in the US is very problematic.

I think it's important to be clear that there are interventions that work that precede crisis hospitalizations, and that even if hospitalization is the right call, you can improve the experience by getting people connected with a good doctor first. The belief --- not irrational --- that there's no available intervention other than psychiatric lock up is a part of the problem for some people.

Partial hospitalization would be way preferable, but that generally requires more engagement on the part of the depressed than "show up and say you're gonna kill yourself."

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

and also they are really expensive, similar to trips to the emergency room.

What if you need the help? If you're severely depressed or hallucinating, by definition you can't care for yourself.

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


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


I strongly disagree.

Without getting too far into anecdotes, I’ve personally seen multiple people reach out to hospitals for help, and all of them were in a worse condition for it - Both by their own account of the events, and from my outside perspective.

While you might be right in an ideal world, real experiences don’t live up to that standard.

Did you read this at all?

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

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

I'm sorry, but have you ever been to one? I have. It is an arcane movie-like entrapment.

So I check myself out. Great, they petition me. Now I spend the next Monday locked in the same holding cells they put the accused in before they appear before the court.

The hearing itself seemed like a total formality. Doped up on medications, without internet or phone to contact people, no 'real' legal representation, it was basically all for show. They did my case and five others in less than 5 minutes total.

The end result? A possible court order giving them permission to keep you locked up longer than was legally able beforehand.

It's not even worth attempting. You end up with less rights than you started with.

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

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

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

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

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

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

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

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

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


I've lawyered up to get people out, more than once. Please be more civil.

I think we have very different definitions of control.

To me, having control over when I leave is being able to walk out of the building at any time. Full autonomy. Having to petition some entity is the antithesis of control from my point of view.

You don't petition anyone. Unless you were committed or attempted suicide, you get to sign yourself out. I've seen it happen.

I have seen it NOT happen.

It's policy. Request to leave. Petition the court. It's seriously standard practice and par for the course.

I mean, they literally can tie you down.

This is the kind of horror story I was preaching against. They don't do such things unless you become violent. This is not one flew over the Cuckoo's Nest.

I have to argue from personal experience and my own eyes that lesser offences can be harshly punished and everything that is legal or in the rulebook is not constantly followed. Of course this will depend on location but you're talking in absolutes.


" Of the 35,000 or more suicides per year in the United States, about 1800 (6%) are inpatient suicides. It is estimated that a psychiatric nurse will experience a completed suicide every 2½ years on average."

The quality of life, if you will, varies enormously in psychiatric hospitals. It may be extremely conducive to treatment and recovery in one and just this side of Bedlam in another.

source: Personal experience helping member of wife's family who was hospitalized for disabling chronic refractory depression and intense suicidal ideation. This was about two years ago.

One institution (in San Mateo County) was great, the other (in Santa Clara County) was awful. She was very lucky in being transferred to the better facility after two days in the awful one.

It's not clear she'd have survived a more extended stay at the first. Slightly over a week in the second helped her enough to go back home and live safely.

This is good advice: go to the nicest hospital you can.

> After that you're 'legally' crazy (whatever the fuck that means)!

In Australia, what it means is that you are involuntarily held in a psych ward, you have no right to leave and you don’t get a say in your own treatment. That includes no choice in your medication.

I'm from New York City and I've had the pleasure of being in 3 different psychiatric wards from adolescent to adult.

If you have never been in a psych ward and never met crazy people, you will now be surrounded by crazy people and you will also be considered a crazy person.

While crazy might be offensive, the people in these wards need serious help and most of them are people you do not want to be around. And you definitely do not want to be locked for days with them either. If you have never experienced this, it will be traumatizing especially if you come from a sheltered environment. If you're suicidal, you were a threat only to yourself. Some of these people in the ward are there because they can be threats to others. That means you will probably see someone be knocked down by nurses and tranquilized. You will hear people yelling, singing, talking to themselves, doing destabilizing things. You will literally be in a horror movie.

You will lose most of your clothes and your belongings. Your first day you will probably be in a hospital gown. You won't be allowed to have shoelaces or even pens or pencils until they determine you're not a risk.

You have to listen to everything an authority tells you to do and comply. You need to eat even if the food is bad when it's meal time. You need to make sure you do everything right so you can leave as soon as possible. Don't want to do some bullshit music, meditation, or arts therapy? Not cooperating. Not socializing. Negative marks. You need to take the medication they give you, even if you don't want to.

If you had the great misfortune to be admitted to the hospital on a weekend, you might be screwed until business hours so they can get the medical records they need or when the regular doctors are back.

Want to make a phone call or use the computer? Last one I was at you were limited to less than 15 minutes, there were only 2 phones, and they were always being used.

Can't sleep at night because you're sharing a room with someone else or just anxiety ridden because you're in an uncomfortable psych ward? Negative marks or ask the nurse for benadryl.

I was grateful to be in a safe place and get the help I needed but every psych ward I've been to has not been a pleasant place because I was stuck there for almost a week without much freedom surrounded by crazy people. That's why most people never ever want to go back to a psych ward even if they're suicidal. It can be that bad.

I knew how to follow the rules and get out as fast as possible but some people don't or can't. They're not good at following the rules. Some of the people I met in these wards had been there for 2 weeks, 4, or even longer. It was really sad and even more depressing. Children whose families abandoned them. Adults who didn't have anywhere to go.

I have direct personal experience to know that Everyone gets better in the hospital. is absolutely false.

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

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

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

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


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

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


That doesn't counter it, though.

It could be true that "the wiring in the brain that makes people creative" increases the risk of depression while also being true that there are other things that increase it too.

Your comment also implies that whatever that wiring is, doctors don't have it, and I don't know if that is an assumption we should make.

The suicide rate in doctors is not higher than the general population.

Suicide is common. There are lots of doctors. Some doctors die by suicide.


> The frequency of suicide in different occupational groups was examined, and rates of suicide were calculated by sex and age group for these categories. Persons working in the farming, fishing, and forestry group had the highest rate of suicide overall (84.5 per 100,000 population) and among males (90.5); the highest rates of suicide among females occurred among those working in protective service occupations (14.1). Overall, the lowest rate of suicide (7.5) was found in the education, training, and library occupational group.

There's a theory that creatives are much more sensitive (which is why they are so good at their work) and thus more vulnerable to crazy highs and lows.

One book on the subject is, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.

The attribute you are looking for actually has a formal psychometric measure: neuroticism.

Slight nitpick, but Heath Ledger died of an accidental overdose [0].

0. https://en.m.wikipedia.org/wiki/Heath_Ledger

Accidental is rather bold. I'm sure Ledger was aware he was playing with fire. I've taken hard drugs for chronic pain -- and the threshold of difference between pain relief, sedation, and ultimately death- it is a stark dosing and feeling difference, not easily overlooked. I'd garner 90% of overdoses from clean drugs (not fentanyl swap/cut with other things), 90% are people who have an existing death wish. The risk is like penance, self whipping or cutting or whatnot. It is almost cathartic because they think the result is binary; either death or numbness. But we all know that there are medical midpoints like brain death or organ failure..etc.. Depressed people tend to be catastrophic, taking complex odds and possibilities and projecting them onto a binary, almost altruistic pair of contrasting outcomes. Its sad..I only know this because I suffer the same way..just not with drug abuse anymore.

Well there was no indication he was depressed or wanted to die, just very wound up and unable to sleep. Certainly combining multiple drugs is asking for problems as many people have found out the hard way.

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

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

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

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

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

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

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

Fuck depression.

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