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Surviving Depression (vishnu.tech)
479 points by vishnumohandas on May 20, 2020 | hide | past | favorite | 206 comments

It took me a long time after taking that leap of faith into therapy to learn that the most valuable part of psychotherapy is not information or advice but it is the therapist-client relationship itself. You need to internalize their advice and techniques (as OP managed to do on their own), and therapy is about creating a facilitative environment to alter that conception of self.

In therapy, you are unconditionally accepted with positive regard, which facilitates viewing yourself more clearly without the need to lean on self-defeating coping mechanisms, like self-pity or shifting blame. As social creatures we instinctively perform a lot of mirroring of others' mental state, so simply by being accepted we are able to try on what it is like to accept ourselves. It's leveraging an additional set of tools baked into us at a deep level to build self awareness and a more positive, realistic self model.

If you're struggling, I'd like to echo others and strongly recommend you reach out to a psychiatrist and psychologist if they are within reach for you. Take OP as an example that it is possible to change, but please explore all the resources available to you so that you can explore what works for you.

That being said, thank you to Vishnu for sharing some of your struggles and how you've managed to find ways to improve. It really helps to be talking publicly about these issues.

> In therapy, you are unconditionally accepted with positive regard

Oh, how I wish that were true. When I was 12, my brother was heavily into drugs, my sister was violent, and my parents were ending their loveless marriage. I wasn't handling it well.

My mother decided to put me in therapy. My therapist bullied me, literally shouting at me that I wasn't normal, suggesting I should skip out on school, and offering to "teach me how to masturbate". I hated going there, and told my mother (who had been granted custody), but she just said I hated it because he told me "hard truths" and "told it like it was".

It's been decades, and for all I know he's dead. I heard that he'd been fined for insurance fraud, but never lost his license.

I'm sure a competent therapist would have helped me. I did have problems adjusting, and I suspect (only suspect) that I'm "on the spectrum", as the kids say. But I was put in exactly the wrong place to deal with that.

Moral of the story: you have to vet therapists thoroughly before you entrust your psychological well-being to them.

For sure. The first talk therapist I went to was right after it father died. The receptionist warned me he was very old, which I did not find to be a problem in and of itself. I don't know if that is the reason he told me basically that I would get over it and not to worry too much. After two sessions, I stopped going. I went to psychiatrists for drugs still for many years, getting slightly better then much worse as most people in drugs do. It took almost fifteen years before I went back to a therapist (last year) and started taking her seriously. Talking to my drug dealing psychiatrists I did not take too seriously, except for one. She did both therapy and prescriptions. She got mad at me when I asked for a slight increase in my dose. That was the last time I took drug dealing psychiatrists seriously. I left her soon after and a year or two later tapered myself off the drugs and started recovering on my own.

In retrospect, I truly wish I had not gone to any therapist and definitely not to any psychiatrist. My normal drug dealer was much more helpful and much less harmful than any of them prior to the therapy I started last year. Psychiatry, especially, is a fucked up profession and when the two are combined and done by the same person, the conflict of interest prevents it from working. I will likely never see a psychiatrist again. Regular drug dealers have more scruples.

It’s hard to bring up that point without being misunderstood. While therapy can obviously be incredibly positive, like any discipline it suffers from a large proportion of mediocre practitioners, and a smaller but more dangerous proportion of harmful practitioners.

My personal experiences with mental health professionals (over several decades, in multiple countries) were unhelpful at best, and at worst they included things like recklessly prescribing medication (within 10 minutes of the first meeting), relying on outdated junk science, pushing for more appointments/making it very hard to end the patient relationship, etc.

Considering that many people who are likely to go to a therapist are likely to be in a vulnerable place to begin with (doubly so for children/teenagers), the recent wave of blind faith in therapy and the belief that “go see a mental healthy professional it can only make things better” is reckless.

I'm sorry you went through that, both the relationship with the therapist and your family's lack of support. I hope you, your siblings and your parents are doing better now, but either way this seems an important warning to note.

Also, they are trained and educated to recognize if this doesn't work. Speaking from experience there.

They'll try to gain trust, which is necessary. Actual licensed therapists have two things going in there. You can go and meet them in private. And they are legally forbidden from telling on you to anyone, unless you're violent or suicidal. They will throw years and years of studies away if they give away you secrets.

Beyond that, you'll be asked what you're struggling with. This can take a session or three. That's normal because it takes time to gain trust and open up. Though they'll gather data during these sessions, too. After all, you don't end up sitting in a therapists office because you're doing great.

And they do know a number of different behaviors that end up being problematic beyond a certain scale. But it can be refreshing to talk to someone just knowning your bug.

I knew I was writing too much by paragraph 2. But I'm submitting this anyway.

>unless you're violent or suicidal.

Yes, and if you are suicidal, police will throw you in a jail. Or worse - in a psychiatric hospital. And you are gonna be fired from work and will be even more miserable than before.

There is no help for men with depression. Even if you ask for it, you have to keep lying and downplaying your symptoms, so no one would think you are really depressed.

We don't throw anyone in jail for being suicidal. We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation. One of the first things you learn, even as a med student, is how to distinguish between "this person needs help" and "hide the sharp objects." That said, some patients are in the "hide the sharp objects" zone - and they get hospitalized to make sure they don't die.

You are creating an exaggerated worst-case scenario that, luckily, means you don't have to change or risk vulnerability or anything. Unluckily, your safe space sounds like a pit of shit. Depression will do that to you.

Please reach out to a professional & get help. You'll be shocked how much better you can feel in just a few months.

> "We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation."

Right, which still means that the patient has to very carefully manage what they say. If they are prone to exaggeration, colorful metaphors, or are feeling just absolutely miserable enough to say something they don't really mean out of pain or anger, they may spook the clinician into putting them into an "psychiatric hold" (e.g for California: https://en.wikipedia.org/wiki/5150_(involuntary_psychiatric_...) which can last 72 hours or more. Remember, just like half of developers are below average, so are half of clinicians and you won't know which is which until it's too late.

All of this is not to say that people suffering from mental illness shouldn't seek treatment. Just know what you're getting in to and how to get out of it if need be.

Exaggeration, colorful metaphor, and feeling miserable enough to say something are all different things, and aren't what we look for.

Except that last one, because that last one actually correlates with bad outcomes.

You're warning people to "know what you're getting into," but clearly have no idea what you're talking about. You may have experience with this, but clearly not from the clinician's side.

Let me give you a real example:

We look for /actionable/ ideation. You'd be amazed how many patients, expressing suicidal ideation, say something like "Oh, I'd just walk into the ocean and drown." Or, "I'd jump off a mountain and die" (living nowhere near a mountain). Etc. They express unrealistic or unachievable means of committing suicide that exhibit a pre-occupation with "dying", but not the process of death. Ceteris paribus, this is a reasonably low-risk person.

Other folks, far less, say something like "Oh, I'd take a gun and shoot myself. My dad has one in his closet." It's realistic, it's achievable, and he could do it in an impulsive moment - that person is a real risk.

(Caveat: these are obviously artificially constructed sentences to illustrate the variable under discussion. Please don't nitpick the exact wording/presentation in bad faith. Patients never spit out in one sentence "Oh, I'd take a gun and shoot myself, that one my dad has on his top shelf at home." )

Note that from the various speculation people have thrown out on this thread, not one has mentioned concrete achievability. Because, shockingly, people coming up with catastrophes about why they shouldn't seek help are really not the best sources of information about what care actually looks like.

I knew a guy who threw computer out of window, was threatening to jump out and was noisily destroying the place (he was not owner). This was triggered by his girlfriend running away (literally running away, he made just leaving impossible). Their friends called cops who came along with mental health professionals and took him to psychiatric hospital.

He found the whole thing massively unfair. See, according to his words, he did not really wanted to kill himself, merely show her how much he suffers and make her go back to him. According to him, she should go back due to threat, but everyone else should instantly see through it and be ok with it. He would tell anyone who would listen like the whole city is unfair and overreacts to every little thing.

So yeah, it can end up in jail or hospital from point of view of suicide threatening person. And sometimes there is good reason for it. In this case, it had also aspect of protection of everyone else in the building including his girlfriend.

Thank you for giving a real example. I appreciate that - it gives an opportunity to highlight a couple of aspects that people keep obliquely referring to.

1) This didn't end with him going to jail, right? Which is to say, the guy who was engaging in violent and destructive behavior was directed to medical care, rather than wrongly being deemed as case that was simply in need of punishment. That's a good outcome. Sick person breaks the law as a result of their ailment, gets identified as sick, and treated as sick rather than a criminal is kind of the ideal outcome, short of preventing their deterioration to begin with.

2) If he had gone to jail, it wouldn't have been because he went to a therapist and admitted to thoughts of self-harm. It would've been because of publicly engaging in acts of destruction.

"2" really is the part that leads to mentally ill people ending up in jail. My psych unit sees people with a history of jail time all the time - and it's almost inevitably due to possession of illicit drugs, loitering, petty theft, or snowballing offenses that they don't go to court for and handle like "responsible citizens." There's a real relationship between mental illness and jail, but it's not "we send people to jail for being depressed."

It's more like, "got a ticket, didn't go to court, ignored the follow-up letter from the county courthouse, ended up with a bench warrant, and if they weren't so depressed, probably would've just taken care of it all up front and never let it snowball." Or, "hated my meds, started self-medicating with weed and liquor, pissed off my housemates to the point that they called the cops, who found my weed stash." Etc.

1.) No, he did not ended in jail and was never charged as far as I know. I think it was more because nobody bothered. The story is however much longer, unfortunately for multiple people.

His girlfriend helped him to get out of hospital, because she felt sorry for him, but was less loving to him after (his words). Violence continued as they had to live together as the dorm did not allowed changing living arrangements mid year.

He was violent to next girlfriend too and harassed her after she escaped. He was homeless for a period of time.

2.) Absolutely correct.

I don't feel like I have had much or enough help from therapy or drugs and I've been on both of them on and off for more than 12 years now.

Whenever in therapy it seems that I always try to argue against any advice given. Same online, so I guess any advice given to me I would try to oppose it, but I'm still telling about this and hoping for an answer or solution, because what else can I do. My mind only tries to find flaws in what the therapists say. I either say it out loud and keep saying it until I frustrate therapists or I keep it in my head and think those thoughts silently. I don't know how to just accept the advice. Same with social situations where I just keep silent, so I hate them too and try to avoid as much as possible in life. I either zone out or I try to find something wrong with what they are saying, but obviously not mentioning it. Maybe it's because I'm envious of their knowledge so I have to somehow find errors in them so I wouldn't feel bad about my lack of social performance/knowledge/wittiness. A lot of times maybe I purposely misunderstand rather than give benefit of the doubt in my mind, because possibly I really want them to be wrong. So all in all it occurs to me that not only am I less knowledgable than most people, I also have a terrible personality. Once again why I keep quiet, because showing it out would only sabotage my career, life etc.

And whenever I try to follow advice I have never had it work, I'm not sure if it's due to my own negative attitude regarding the advice, maybe I'm not following it properly or maybe it's just brain chemistry. But in a way where currently available anti-depressants won't affect it positively.

For instance, observing your thoughts from distance or trying to reframe them. Observing from distance - how long do I have to do that to make it work? It still doesn't kill the depression, frustration and anxiety. Reframing the thoughts has never worked since I don't ever believe the reframes and this always leads to existential crisis. If therapists suggests a reframe I will keep arguing it until it reaches "meaning of life" point again.

Another thing is sleep. I hate falling asleep. Even if I do it seems like I wake up too early. I feel like I have tried following all the low hanging fruit advice such as exercising every day, use melatonin, hot baths, whatever common tips I have found. I do running (6+ miles), go to gym every other day. I feel like I don't progress a lot, and I'm afraid because of my shitty sleep. If I take Ambien I will wake up in 4 hours, because that's how long it lasts, so it can't just be some shitty sleep hygiene either if I wake too early after falling asleep. I think I just feel disgusted about sleep and it seems that it affects any progress I'm trying to make as well. Probably affects my gym and running results, my cognitive performance - maybe that's a cop out since I'm not happy with my cognitive performance and blaming it on sleep allows me to believe that maybe I'm not cognitively as poor as I seem to perform currently and that I actually have potential.

I've never tried therapy but this looks familiar.

When I was trying and failing one more advise was too much. I had to step back, find peace with myself. It is hard. General idea is to get all the grief buried inside and release it. To find a path to unbury I sing. Without words. Like lullaby, moan, chant, whatever. It had to be sincere. Up to the point I would not not like accept that it is from me. Kind of meditation, clear state of mind like when running but it can sustain much longer - hours every day. In that state bad memories rise. Sometimes I groan, but generally search path to regret, to forgive myself and the cause of the problem. Walking and singing like there is a light at the end of the tunnel.

It is opposite from changing myself (reframe) - not manipulate inner world but trust it. I found it after started rollerskating, then dancing, then playing drums and harmonica. These skills and music especially build from inside.

And I believe this knowledge is ingrained in culture. I am not religious but I believe Church got it right. It teaches how to give peace of mind. Forgiveness, rituals, confession, community, singing, sacred place. Christian Gregorian Chants, Islam Quran Recitation, Afro Cuban Santeria.

Sleep. It is hard to sleep with alert state of mind. I had a luxury to take three years break from work. Getting back I had to accept needlessly stressed environment. Singing for hours after each working day. Ah, and who needs forgiveness the most is the body which is vessel for such pour soul.

Hope it helps

> Whenever in therapy it seems that I always try to argue against any advice given

You're not unique in that. There are a lot of patients that will fight against advice, tooth and nail. Sadly, we aren't very good at helping those people. That's part of why a lot of docs lead with meds and then therapy - the meds tend to get people into a position where they're more "oh, shit, I was thinking/feeling that?! That's not healthy!", so they're more open to what occurs in therapy.

But a decent therapist should focus on guiding your understanding, but eliciting "advice" from you to yourself, rather than providing their own. It's akin to motivational interviewing.

Have you tried a sleep study?

I don't have a miracle story, but I've read a number of others'. Many people's live are nearly immediately improved after a sleep study/breathing study is done.

I have, I snore a lot, so there's issues there, no apnoea, but this won't help with falling asleep - why I use Ambien. Although I'll try to get off it now.

And if I wake up I can't fall asleep again - unless I take more Ambien.

Have you tried trazodone?

> We don't throw anyone in jail for being suicidal. We don't throw people into psych hospitals unless they're at imminent risk of successfully committing suicide - we don't do admits just for suicidal ideation.

Who is this "we" you think you speak for? You may be right about what people are supposed to do, but people, even professional therapists aren't perfect. It all depends on the individual therapist, how they interpret what they've been taught, what you say to them, and how worried they are that if they don't do something you may commit suicide, and how that will look on them.

Some are very self centered just as everyone else, simply wanting more and more patients to earn a paycheck, so they will drudge up whatever they can to make you feel miserable, and get you hooked on psych drugs, all to try and get you to keep seeing them.

> Please reach out to a professional & get help. You'll be shocked how much better you can feel in just a few months.

I'd say don't do this. I've tried several therapists, one for over a year, and each session inevitably became a bout of very depressing intense navel staring.

I felt a lot better after getting away from all the self-help crap and developed interest in things outside of myself.

> Who is this "we" you think you speak for? You may be right about what people are supposed to do, but people, even professional therapists aren't perfect.

I can't argue about the variation in quality of practitioners. However, in every state I know of / have practiced / have worked in, involuntary holds get a lot of scrutiny. Docs are given the benefit of the doubt, it's true, but it's a far cry short of "better to cover my ass, let's admit." People are, in general, careful when they know they're going to be getting second-guessed. Additionally, admitting psych patients is generally a losing proposition for hospitals, monetarily. They're expensive, and tend to take up a lot of square footage. Docs are getting second-guessed by hospital admin, too.

As a sidenote: your average therapist is a social worker, not a physician, or even a psychologist. They don't admit anyone anywhere, and in most states can't do involuntary holds. Unless you're about to slit your wrists in front of them, the most they can do is make a suggestion, or call your psychiatrist and make a suggestion. If they do think you're an immediate risk to yourself, they call 911 ... who will take you to the hospital, where a psych will give his opinion.

> It all depends on the individual therapist, how they interpret what they've been taught, what you say to them, and how worried they are that if they don't do something you may commit suicide, and how that will look on them.

The proportion of depressed patients to inpatient psych beds is "a gazillion to one," in particular since funding for inpatient psych got gutted a couple decades ago. If you think the average psychiatrist, never mind the average therapist (not the same thing), can land every patient into a ward because "well, what if they mean it?"... I don't know what to tell you. Even the psychs I know that are trigger-happy are the kind that don't admit the vast majority of the time.

I admit that there's more trigger happiness in pediatrics. Kids, IME, are more likely to harm when they don't want to, to prove that they're Really In Pain. Their attempts are less likely to be "genuine", so to speak, so folks tend to be less confident of saying "Well, this doesn't really seem like someone that wants to die."

> Some are very self centered just as everyone else, simply wanting more and more patients to earn a paycheck, so they will drudge up whatever they can to make you feel miserable, and get you hooked on psych drugs, all to try and get you to keep seeing them.

Psychiatrists don't want to chat with you often. They will diagnose, prescribe, recommend a therapist, and see you once every 3 months once you stabilize. They don't want you to keep seeing them and, given that demand >> supply, couldn't care less if you stopped. Ideally you stop because you've gotten better, but either way, they'll fill that slot in their schedule pretty quickly.

Therapists - again, usually social workers - can't write prescriptions. Their livelihood does depend on you coming back every week. They will not addict you to anything and, if you were on meds, it wouldn't tie you to them.

Yes, they are likely to make you miserable. You're there to talk about shit that makes you miserable. If they're good, that goes double - many personality disorders are essentially "my developed pattern of dealing with things that make me feel bad is ultimately self-destructive." Addressing that involves changing "my developed pattern of dealing with things that make me feel bad." That's short-term highly aversive - that's your tool for avoiding feeling bad!

Bad therapists still navel gaze about things that make you feel bad, only without therapeutic benefit.

There's a shit-ton of bad therapists. That's more due to the fact that, like we're doing in other realms of medicine, we've decided the best way to address the shortage is to put it into the hands of woefully under- or un-trained people. Good therapists are, as a consequence, rare and comparatively very expensive (cost of a doctor's time for an hour, vs. the four simple drug visits he could have made instead vs. the cost of a social worker for an hour - yah, it's expensive).

Any reasonably mediocre therapist would have told you to "develop interests in things outside of (your)self". Therapy is like coaching: good therapy is figuring out what you need to focus on, and showing you how. You still have to go out and do the exercise.

Mate, if your message may have something to do with your username, I do hope things get better for you and I hope you find the resources you need for things to get better.

Even though this sounds exaggregated, this could be real for many people. Our socienty and systems are not designed to handle these kinds of problems properly. Why people face problems to survive after released from jail ? Didn't they pay dues?

Psychiatruyis not ultimate solution ( but it could be definately first step). We should focus more, on building healthy and happy socienty instead rich society. These values has to be cultivate in people.

“ There is no help for men with depression.“

this is emphatically not true, and it’s important - not easy - to recognize that that’s the kind of thought depression makes you think is true

I think it's true that men have way less to say about their problems than women, it can be amplified with depression but depending on the country you live in. it can be pretty hard to find help when you're a man. But I think the feeling is pretty general and the problem do exist.

Does that really happen? They jail you in the USA?

In Canada I've admitted suicidal plans on multiple occasions to doctors, psychologists, and once even the police. On two of these occasions I was sent to the psychiatric emergency room, but only for as long as it took to assess that I was no longer a harm to myself. The first time that took an afternoon, the second time it took a couple days. After that I went home, no repercussions.

In the US, in addition to feeling how you're feeling, you're likely to end up with thousands of dollars in new medical bills if we were to do what you did.

no, it does not

There absolutely is help- two of my bosses have gone through this and were able to give me first-hand advice as my son has been going through this over the last year as well. We learned about the different between a psychiatric hospital, a residential program, a partial hospitalization program, and therapy. Some hospitals are much better than others, which can give some the impression of hopelessness (some just seem to be holding places, others really have good programs).

I sincerely hope you reach out if you're having trouble or even just seem to feel hopeless, even while feeling content about that belief.

I agree that it's a risk, a very real one. That's why choosing your words carefully is paramount and not talking about certain things or downplaying them essential. I trust my therapist only up to the point where that trust might bump up against the law. If it's something that happened fifteen years ago, I'll admit I felt apathetic and almost like not wanting to go on. If it's recent, it'll just be skipped over. I think it can still be helpful, but I'm not going to risk my current life for the possibility of something ever so slightly better.

Your comment is very sad, are you okay?

I hope you find peace through your means and I want you to know that people care about you.

hey man, listen to the other posters. therapy can change your life. I hope you're okay dude

Also: they might rat you out to the machine by proxy based on what drugs they proscribe or other conditions they apply if they feel you "abuse" drugs, which means a different thing to every shrink, and you don't get to know until it's too late. Get yourself a nice "drug abuser" flag in your file because you like weed or MDMA, and maybe you can't get real pain-killers later when you fuck your back up.

> And they are legally forbidden from telling on you to anyone, unless you're violent or suicidal.

OT fun fact about Germany:

While doctors (including psychologists and psychiatrists) are legally forbidden from disclosing what they learn in therapy, other patients in a group therapy setting aren't, and are even required to testify about what you said in therapy.



That's why I would never agree to a group session here.

It was the subject of a petition to the Bundestag some years back, but the Bundestag didn't see any reason to act.

> I knew I was writing too much by paragraph 2. But I'm submitting this anyway.

I don't know why you say this. I found your whole comment informative.

> And they are legally forbidden from telling on you to anyone, unless you're violent or suicidal.

That last is a reason a lot of people end up wanting to visit them. It's a privacy catch-22.

There are also several things (being a pilot among them) that such a "private" session also may result in you being formally and permanently disqualified from.

The privacy laws really need to be strengthened.

> In therapy, you are unconditionally accepted with positive regard, which facilitates viewing yourself more clearly

You have described effectively the opposite of modern society, where there's a thirst to find faults in one another. Whether it some bias, political opinion, attitude, etc. It's a national past time to judge the virtue of another person's character. The less understanding and reflection on self, the more vicious the judgement.

Maybe if we begin spending less time virtue signally to one another and more time being alone with our own thoughts...

In therapy, you are unconditionally accepted with positive regard, which facilitates viewing yourself more clearly without the need to lean on self-defeating coping mechanisms, like self-pity or shifting blame. As social creatures we instinctively perform a lot of mirroring of others' mental state, so simply by being accepted we are able to try on what it is like to accept ourselves.

This is the most succinct description of a positive human relationship I've ever read. It does lack a feedback mechanism for correcting destructive behaviour however.

A danger one can fall into with therapists, is that therapists have a self-interest in you coming back and/or giving a positive referral. If the therapist has that self interest in the back of their mind, they can avoid pushing you out of your comfort zone and/or enabling unhelpful patterns in order to get along.

Absence of pushback is something beautiful/rich people often experience - because others see them as a valuable asset, they optimize for maintaining the relationship, even if the person is being self destructive in the process. This is why drugs are such a problem among them - it is costly to tell them they have a problem and so beneficial to benefit from their weakness in your favor until the wheels come off.

"therapists have a self-interest in you coming back"

Just a single data point counter to this:

I had a therapist with whom I had a good relationship and who I'd seen for a long time who suggested that I find another therapist because we weren't making progress. I was reluctant to do so and we continued for a few more months when once again they suggested I find another therapist for the same reason, at which point I did leave and sought out another therapist (who was completely unrelated to this one, so there was no referral or kickback).

If the therapist was motivated purely by self-interest they could have easily not have pushed me away, twice, and continued to have me as a loyal client. Instead they asked me to go see another therapist, for my own good.

So, yeah, some therapists actually care. You have to find the right one, of course.

At least in SF any therapist worth their salt usually has a waiting list. Demand for services far outstrips supply. Even if they didn't care, they really have no vested interest in you coming back because there is a line of twenty people right behind you waiting to get in.

This is true of any profession.

LeBron has a waiting list of teams that'd love to have him. What about the bench players that make up >50% of the NBA? Does the demand for them far outstrip supply?

Chances are, you're not seeing the LeBron of therapy, you're far more likely to be seeing that bench player who is worried he's going to get cut.

> A danger one can fall into with therapists, is that therapists have a self-interest in you coming back and/or giving a positive referral. If the therapist has that self interest in the back of their mind, they can avoid pushing you out of your comfort zone and/or enabling unhelpful patterns in order to get along.

This is an example of a pattern I see everywhere now that I look for it. I think of it as the junk food metaphor. There are many products/people/experiences/ideas/relationships that make you feel good right now but later leave you feeling even worse than before. Every time I eat McDonald's, halfway through that double quarter-pounder with cheese I find myself thinking "This is so fucking amazing. Why don't I eat this everyday?" Ten minutes later, when my stomach feels like I took a punch to it, I remember the answer. McDonald's is good to me, but not good for me.

I think a lot of therapists are like that too. They are unconditionally kind and you get an hour to talk about nothing but yourself. You can walk out feeling amazing. But did you leave with any tools? Did you get any closer to solving the mental problems that hold you back? Often, the answer is no.

I'm lucky that the therapist I found strikes a very good balance of being short-term good and long-term good. When I'm really struggling and in a rough spot, he focuses the session on easing my pain right now. But when I come in and things are going OK, he says, "OK, now is a good time to try to work on some of those deeper problems." Then he'll ask a series of probing questions that turn over dark patches of my psyche I've been afraid to look under.

I leave those sessions with sweaty hands feeling like I got a root canal and a math test at the same time. Those sessions aren't good to me. But over the next couple of weeks, I start to feel like an abcess has been drained. Those sessions are good for me.

These days, a big part of life for me is finding the right balance between short-term and long-term benefits. I've erred too far in both directions and ended up miserable, but there does seem to be a sweet spot somewhere in the middle.

As someone who has survived some really bad episodes of depression, a lot of the content of this resonates with me and seems like useful advice. I think "My inability to find anything relatable made things worse." is very true, there is very little out there of people sharing their recovery stories, so props to author for writing this!

That being said, the dismissive use of 'Happy Pills' is a bit problematic IMO, for some that is the most effective way to heal depression (not just "numbing your senses"). Though of course, over the long term fixing external issues in your life that lead to depression is of course sensible.

Self-plug warning, I recently wrote a post titled "Things Everyone Should Know About Depression" which conveys some of my own experience and a lot of facts about it: https://www.andreykurenkov.com/writing/life/things-everyone-...

I’m sorry if I sounded dismissive. I guess it was because my experiences with psychiatrists were painful and frustrating.

I completely understand and agree that medication could be a viable solution for someone else.

More important than viable, for some people it actually is vital. It is a very, very important note. For some people, psychiatric support is not a pill to alleviate some pain, it is more like a pacemaker: it's the difference between life and death.

It can be the difference between a completely clogged brain coupled with suicide attempts (where no amount of tentative discussions with specialists resonates, if the person even has the energy to get out of bed at all), and having the energy to learn and use the therapeutic tools for well-being.

I'm glad to see that CBT has been an interesting tool for you by the way, and there's a lot of growth around CBT, DBT, and trauma-informed care, that is fantastic for the improvement of mental health nowadays.

Yep, this is me with venlafaxine. I appreciate that medication is not a panacea, but it really gets my blood up when people act like meds never work for anyone. It's just patently false.

No worries, of course different peoples' experience vary - but there is a lot of stigma about even trying them as is, so maybe best to give a caveat that it is worth trying for some.

Perhaps then also with the caveat that the potential harmful effects can completely fuck you up, let alone the withdrawal that many experience; not looking for a debate or argument, however certain classes of medications have a bad rep for valid reasons and people should be cautious because of many variables.

Medicating will be painful and frustrating for most people, the only thing that differs is whether they will eventually help or not. Sadly, the road to find a working medication that has minimally inhibiting side effects is painful enough that it isn't worth it for many people. Therapy becomes a bit more viable, especially since it's more of a positive process.

It didn't come across as dismissive to me and I've tried a similar variety of those meds. Some people experience serious side effects and the tradeoff is not worth it. I'd rather be depressed than a sexless zombie who can't function at work.

It did not sound dismissive, it was dismissive.

The phrasing is inaccurate and likely to put people off treatment that may save their lives.

> That being said, the dismissive use of 'Happy Pills' is a bit problematic IMO, for some that is the most effective way to heal depression

100% agree. For some of us, a low dosage SSRI is all it takes to unclog the brain and start the healing process.

I started suffering severe depression when my (now ex-) wife asked for a divorce, about 3.5 years ago. Therapist/psychiatrist also have told me there is a lot of grief mixed in. The fact that my 20 year old kid won't talk to me makes it worse.

Nonetheless, it has gradually gotten better. I don't think the medications have been very effective, but time to internalize different ways of thinking about my life have helped. They're slow, though. It takes a long time to change.

Another thing I sometimes do, somewhat akin to what is described in the article, is just close my eyes and be, for a bit. I would call it meditation but there really isn't much thinking -- just feeling what I feel. Accepting where I am, as best I can.

I really identify with the 'I’m better now. It’s hard to call myself “happy” (what is happiness anyway?)'. I don't think I'm happy (I have memories of what that felt like), but at least I'm not desperate every moment.

I've spent an insane number of hours wondering why being alive is a good thing. Still not sure I have an answer.

Can very much relate. And especially when you're simply trying to get through hell, there's a lot to be said for finding a sympathetic therapist/etc to just help you get through it.

My tips: Be kind to yourself. Try to do things when you can--action is a universal anti-depressant. Try not to pointlessly ruminate--it's generally depressing. If things get really bad, and you have no other ideas, get drunk. (Not great, but far better than an ill-considered suicide.)

As for why being alive is a good thing, not sure I have that answer either. But really, we'll all be dead very soon, so I figure there's little need to rush things.

Bonus: For meaning, (1) something to do, (2) someone to love, and (3) something to look forward to. And (2) could be a pet, if you're sick of people.

>If things get really bad, and you have no other ideas, get drunk. (Not great, but far better than an ill-considered suicide.)

A large proportion of suicides involve drugs and/or alcohol. This might work from you but I don't think you should necessarily suggest it to someone else who may be feeling suicidal.

Admittedly, I have my own coping strategy for feeling suicidal that I would 100% never recommend to anyone else...

I'd recommend to identify computer games that are good for you and your mental state and play them when things are not so great.

You can be someone else for a while, with solvable problems and their own emotions. Competitive shooters are probably not so great, but light-hearted adventure games can be, or calm simulation games (Stardew Valley is well-known for its meditative effects for example).

Having been way too close to that, I suspect that most of the drugs/alcohol didn't cause the suicides, but rather were taken after the decision had been made, to make the passing easier. That's pretty grim, and there's probably no way to know.

At least for me, being lit makes me happier for a while.

In any case, staying drunk isn't a long-term plan, for sure.

I don't know about depression, as I do not suffer from it, but I do know getting drunk during a PTSD episode is a sure fire path to suicide. PTSD suffers actually have a higher suicide rate than depression and alcohol pours flames on the fire if someone with PTSD uses alcohol as a way to try and numb the episode.

Huh. Well, probably conditions differ, and we're all unique. Definitely each of us needs to be their own scientist. Good luck.

>I've spent an insane number of hours wondering why being alive is a good thing. Still not sure I have an answer.

Reminds me of this passage from Catch-22. One of the characters is saying he revels in terrible situations that last forever, because it makes life seem longer that way.


"Well, maybe it is true," Clevinger conceded unwillingly in a subdued tone. "Maybe a long life does have to be filled with many unpleasant conditions if it's to seem long. But in that event, who wants one?"

"I do," Dunbar told him.

"Why?" Clevinger asked.

"What else is there?"

I'd argue he never experienced anything that terrible. I can totally relate to wondering whether even another hour was doable, and no, being alive just for the sake of being alive in those moments is not worth it. I guess I've always been hopeful even in the worst of times that things will get better (they always do) and that's the only thing that makes those stretches workable.

> I've spent an insane number of hours wondering why being alive is a good thing. Still not sure I have an answer.

You're not alone, the existentialist/nihilist position is that there is no good answer to this question, and life is intrinsically meaningless. This strain of thought has been around for more than 100 years and no one's come up with a really solid counter-argument.

A couple things to consider;

- A meaningless life is normally assumed to be a negative and depressing thing. But why is that? Some people have argued for "positive nihilism," the view that a lack of meaning is freeing. From reading about both sides I eventually came to the conclusion that assigning a positive or negative value to the intrinsic meaninglessness of life is artificial. Both sides are just coming from their own head space with a bunch of stuff they've made up, and projecting. Life's fundamental properties simply exist. The human condition is neither positive nor negative, it just is.

- Even if there's no "good" or intrinsic reason to live, some people manage to cope anyway and enjoy happy, interesting lives. The list of strategies humanity has developed for coping with the abyss is as long as history. Existentialism, absurdism and religion are all radically different philosophies for coping. More practically, everyday tactics for coping range from things as simple as getting more sunlight and exercise, to meditation and (some) social relationships, to many many types of drugs and therapies. There is a long list of coping mechanisms to explore for the sake of curiosity if for no other reason.

- Finally if you choose death, there's no undo button. I think there are too many taboos around suicide (unless you're already dying, at which point some elements of society seem to grant you permission to make a decision which was none of their business anyway). However it can certainly be said that once you cross this line, you lose access to all the other things you might have wanted to do. If it turns out you were wrong, too bad, you'll never know. In this sense suicide is the greatest act of hubris possible, it is the belief that you've arrived at a final conclusion, and in our vast and unknowable universe, this type of belief is almost always incorrect. The only certainty is uncertainty, and with suicide you have eliminated it.

> I would call it meditation but there really isn't much thinking -- just feeling what I feel. Accepting where I am, as best I can.

I would very much call that meditation.

Yeah, it seems to be a common misconception that meditation is forcing yourself not to think.

FTA: > I set aside hours each day to do nothing. In some sense, this was meditation. Except, I did not force myself to not think. I wanted to get comfortable with the voice in my head. I would sit, lie down or walk while paying attention to my body (the heartbeat, the breath, the funny noises my stomach made), and the physical world outside (there were so many beautiful things to trip on).

The author (and the top level comment) thought they weren't meditating, when in reality they discovered mindfulness meditation :)

One way to understand meditation is to just give yourself the time & space to experience & become bored with your repetitive thoughts. You don't stop thinking - you just become bored with it and settle down. It's immensely healing once you've experienced it.

The feeling of solace does not have to carry any spiritual meaning.

It appears that the commenter has found both meanings of "You against Your Body".

Meditation doesn't have to carry any spiritual meaning either.

I agree.

Having (or finding) a natural state of solace without having to think about it is relaxation at its finest.

“ Another thing I sometimes do, somewhat akin to what is described in the article, is just close my eyes and be, for a bit. I would call it meditation but there really isn't much thinking -- just feeling what I feel. Accepting where I am, as best I can.”

Essentially, you’re doing shamatha meditation.


Another beneficial practice is loving-kindness meditation.


Meditation helps cut through the flurry of thoughts in our heads and return us to our basic experience of living in the present moment. We spend so much of our time living in the past (remembering or regretting), or the future (planning), or in fantasies or distressing scenarios that we create in our minds. It’s good to simply be in our bodies where we are in the present moment from time to time.

I was severely depressed for a couple of years, and moderately depressed for many years before that. What helped me were: a good psychiatrist who was a good therapist, meditation, an anti-depressant prescription, abstaining from drinking alcohol (for 4 years now), and leaving a problematic relationship. I’m still somewhat prone to anxiety, but I generally have more self-awareness.

One other thing I can think of which helps is to try to get off of the “me program”. Directing our compassion and focus to others puts our own troubles into perspective.

Good luck. Everyone has their own journey.

For those suffering from depression, anxiety, stress please consider meeting with a psychiatrist and psychologist.

Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine). All the pushing through and search for answers, triggers, or source of problems won't solve this.

Secondly, cognitive behavioral therapy (CBT) can work well for analyzing the 'why' you feel and/or behave the way you do. It provides perspective, insight, and tools for helping cope with problems (control/mitigate or potentially eliminate).

Both of these are tools that can dramatically improve your life. I've been there and still am. Seek the support you deserve. Tomorrow will bring a better future.

> Some brains are neurologically misconfigured

This is almost always symptomatic. There's a fair amount of research on dopamine depletion. Addiction, including but not limited to drug use (e.g. high-fat-high-sugar food, pornography) can show deceases in receptors. Vitamin D3 deficiency can pose a problem. Sedentary behavior. etc.

I'd recommend CBT principles to anyone, research shows they're as effective as prozac. The point is many changes can be implemented before resigning to perpetual medication.

I'd be cautious of the claim that CBT is 'as effective as Prozac', or another chemical solution, in general. A cursory glance at the Wikipedia Criticisms section for CBT points out at least several concerns with the existing research[0]. Anecdotally, a family member of mine went through a complete round of CBT, for a mental health disorder, and they said that it seemed mostly just like standard therapy, and perhaps increases mindfulness a bit, but definitely felt it could not hold a candle to standard treatment. I should point out that they followed the protocol quite rigidly, and embraced the therapy with an open mind.

No doubt CBT has varying effectiveness between individuals. Somewhat tangentially, I find this[1] article cited in the Wikipedia page[0] to be an interesting read; a meta-analysis of ~70 studies, showing a seeming decrease in effectiveness of CBT over 30 years.

[0] https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy#C...

[1] https://www.semanticscholar.org/paper/The-effects-of-cogniti...

A single study is listed as being challenged. Have others:

From 2010 - "In this 36-week study, partial and nonresponders to placebo, and responders and partial responders to Prozac, CBT, and combination treatments in the 12-week trial were openly treated (TADS Team, 2007). As in Phase 1, Prozac and combination groups received additional encouragement and contact (medication management). Despite this, all treatment conditions converged by 30 weeks and remained so by Week 36, with significantly more suicidal ideation in the Prozac-alone group. The percentage of suicidal events for those on Prozac, whether in combined or alone groups, was nearly 12%, double the 6% in the CBT group. Despite the convergence of efficacy and continued risks, TADS is often cited as evidence that combining psychotherapy and medication produce superior results (e.g., NIMH, n.d.)." -- https://www.researchgate.net/profile/Dickson_Adom/post/What_...

"Collectively, the findings detailed inA.C. Butler et al. / Clinical Psychology Review 26 (2006) 17–3127 this review suggest that CT is highly effective for adult unipolar depression, adolescent unipolar depression,generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, PTSD, and childhooddepressive and anxiety disorders. The comparison-weighted grand mean effect size for these disorders when compared to no-treatment, wait list, or placebo controls is 0.95 (SD=0.08). CBT is associated with large improvements in symptoms for bulimia nervosa, and the associated effect sizes (M=1.27, SD=0.11) are significantly larger than those that have been found for pharmacotherapy. CBT also has shown promising results as adjunct to pharmacotherapy in the treatment of schizophrenia." -- https://www.get.gg/docs/Empirical-Status-of-CBT.pdf

Prozac yields a risk of side effects, and ceasing use brings a strong risk of relapse. Comparatively CBT offers a lasting solution.

Do you have any sources suggesting pornography leads to the reduction of your dopamine receptors?

Directly, less so. I imagine it will come because other addictive behaviors have been linked to dopamine depletion.

"Another metabolic parameter strongly supporting a neurobiological basis for natural addiction is found in studies examining dopamine receptor depletion. Wang et al., demonstrated dopamine (D2) receptor downgrading with obesity similar to that seen in drug addiction, and the levels correlated with BMI.[31] An animal study recently published by Johnson and Kenny found that rats exposed to “palatable, energy-dense food develop a profound state of reward hyposensitivity and compulsive-like eating. The maladaptive behavioral responses in obese rats probably arise from diet-induced deficits in striatal D2R signaling. Overconsumption of drugs of abuse similarly decreases striatal D2 receptor density, induces a profound state of reward hypofunction, and triggers the emergence of compulsive-like drug taking behaviors. " -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115160/

How can be almost always symptomatic but at the same time run in some many members of the same family? When you go to see a psichiatrist one of the first questions the ask is if there's history of mental illness in the family.

That's still not causation. A history of depression doesn't mean these members all had inherent brain misconfigurations. The brain's chemistry is not static in the first place. There could be afflictions, deficiencies, environmental conditions or cognitive biases spanning generations that could lead to these issues. Everything we experience is expressed as a chemical reaction in your brain, whether you're happy or sad. No one looks at an ecstatic person's brain and assumes they're wired to be ecstatic. Grief and depression can run long.

By virtue of the success rate of therapies such as CBT and others, the evidence for inherent "bad" brains runs thin.

> Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine). All the pushing through and search for answers, triggers, or source of problems won't solve this.

Do you have proof of any of this or are you just regurgitating the bullshit you've been fed? I've been searching for years and all I can find is that this hypothesis is bullshit without any evidence behind it whatsoever. Even psychiatrists and neurologists know it's bullshit. It doesn't help anyone to pretend like this is true and it can be harmful. Encouraging people to take drugs based on what is essentially a fantasy is likely a huge part of the problem. If I'm wrong, I'd like to see the proof I've been trying to find now for over a decade.

You can show via SPECT brainscans that the over- or underactivity in certain parts of the brain correlates strongly with psychological symptoms. For example you can show that people suffering from ADD have a lowered activity in their prefrontal cortex. Or that people with an overactive deep limbic system suffer from depression. Check out Dr Daniel Amen's work. He did over 83000 brainscans.


edit: added count and link to video

That's a far cry from demonstrating that specific neurotransmitter imbalances are the cause of depression.

True. It seems depression is created and sustained through distorted thoughts. Check out David Burns' "Feeling Good".

What proof specifically would you like to see?

Proof that "Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine)" and that this is the cause of depression.

No I read that, I meant, what type of experiment that proves that statement would you like to see. Because I feel like if I point out some research you would find something weird about them just to dismiss them, so I'm asking beforehand what kind of setup or study would like to see.

One that demonstrates that serotonin/dopamine is actually the cause of depression and that taking drugs affects those neurotransmitters and relieves depression. If we're going to say to someone that you are depressed because of a chemical imbalance, you must first prove that is actually the cause. Then you must prove that the medicine affects that neurotransmitter and relieves the disease. This hand wavy "chemical imbalance" idea is barely a hypothesis. Prove it. Measure serotonin in a live brain and demonstrate the causation with depression. Demonstrate that the level is truly imbalanced compared to a non depressed person. Show that changing the level relieves depression.

Instead, we don't even know how depression drugs work and last I checked, measuring neurotransmitter levels in a live brain was impossible. That would be ok as science doesn't know everything, but then we need to stop with the idiotic "chemical imbalance" lie.

So according to that logic, we should also stop with the lies for the current medications we use for schizophrenia or epilepsy or Alzheimer's disease because we don't know for sure the cause and we can't prove it? Even when we see many people getting effective treatments from these drugs?

there exists conditions like adhd where some brains are wired differently from birth

So you say but provide no proof. Also, that's very different than saying it's caused by a lack of/too much serotonin, dopamine, or some other neurotransmitter or receptors without a shred of proof, as the parent claims. The reality is, there is no proof of anything like that causing depression, anxiety, or other mental health issues. How would we know if such things cause disease when we can't even measure them in a live person? The whole chemical imbalance idea is bullshit to sell drugs to patients. I'd love to be proven wrong but no one has any evidence to do so. Even professional psychiatrists know that the idea is bullshit. But it does sell a lot of drugs whose efficacy is questionable at best. So the facade lives on and people continue to parrot this harmful bullshit.

This. I had great results from working with a cognitive-behavioral psychologist. She helped me see patterns in my life that I had never even suspected were there before. I'm skeptical that I could have gotten the same results by reading a couple books on CBT on my own. The exercises were valuable, but so was the outside perspective, and I don't think either would have worked as well without the other.

> Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it.

Bullshit pure bullshit. This has never been shown and its disgusting that its re-iterated by people purported to be well-meaning.

A problem with the emphasis on CBT over the past couple of decades is that it cannot work for a fair percentage of chronically depressed people because it emphasizes challenging negative thoughts on the assumption that they are untrue.

The problem is, what if you have depressing thoughts that are totally rooted in reality? CBT doesn't have a very good answer for that.

There are other strategies and models. IPT. Psycho-dynamic. ACT (which does address the gap I refer to above).

So, a patient may well have to shop different practitioners, clinics, and models to find one that addresses your needs. After all, the response to a bad haircut is to find a different stylist, not to give up on haircuts forever.

Out of pocket costs can get excessive. If price is a major factor, consider university teaching clinics, which can often provide talk therapy (generally with student therapists, and quality/interest can vary a lot) on a sliding scale based on ability to pay. In SV, for example, there is the Gronowski clinic staffed from Palo Alto University).

“ The problem is, what if you have depressing thoughts that are totally rooted in reality?”

I thought the point of CBT was to avoid making negative assumptions or falling into thinking traps. For example, “I’m on the street and hungry. I’ll probably be like this for the rest of my life.” This is a thinking trap - thinking that bad situations will last indefinitely. Instead, we can think, “I’m on the street and hungry, but I’m alive, and I can probably turn things around.”

just to throw my hat in, I've found CBT difficult to put into practice. a vicious cycle formed as I increasingly blamed myself for not working hard enough to help myself and buckled under the pressure of completing exercises.

psychodynamic approaches and group therapy had much more palpable impact, as the missing piece I think was seeing and relating to others. not being alone and talking through issues made a world of difference compared to applying what felt like mechanical exercises of CBT.

CBT definitely won't work for everyone, but this seems like something a good therapist could help someone work through. Self blaming like that is one of the cognitive distortions that CBT should be able to help root out.

I realize that it very likely just wasn't the type of therapy that works for you, just throwing out the alternative perspective for anyone reading this and considering CBT.

for sure! i feel a lot more capable of applying the self reflective tools of CBT at this point in time. but it really felt like CBT was consistently suggested to me at a point in time when i just wasn't ready. and it took some (difficult) time to understand that there's nothing wrong with me for not being receptive to it.

> vicious cycle formed as I increasingly blamed myself for not working hard enough to help

Something that took me way too long to understand. Beating yourself up for feeling bad makes it twice as bad. A counter argument is negative emotional stress is motivational. My argument is negative emotional stress is one of the crummier types of motivation.

> My argument is negative emotional stress is one of the crummier types of motivation

i agree. i am jealous of people who find empowerment in struggle this way but insistence on CBT just made me feel more alone. now that I do not feel so hopeless about being able to affect change, i am more able to reach for self-help tools, but i'd argue that it could be dangerous to have it be suggested as the first line of help for someone that's already holed up in self-destructive tools, especially if they lack self awareness.

>Some brains are neurologically misconfigured and prone to chemical depletion or lack receptors for it (ex: serotonin or dopamine).

Readers: please be aware at best the science on this statement is hypothetical, at worst it's a marketing slogan designed to sell someone drugs for the rest of their life.

IME, it's best to start with the psychologist. They can determine whether talk therapy will be enough to correct the chemical imbalance without drugs. If necessary, they can refer you to the psychiatrist, who can give you the medication, but doesn't want to talk.

They can also work in tandem. You might be more receptive to therapy and analyzing your feelings when you don't feel like the world is ending. IMO, there's a threshold where antidepressants are necessary. When I lose interest in everything I care about, I don't feel like cooking, everything seems boring, and I have no energy (anhedonia), that's my threshold.

I've been leery of CBT because it seems like it's too focused on how the patient thinks about their situation and not on actually creating a situation that's worth living.

It seems like for many people the issue isn't so much that they are sad or in pain so much as it is that their life lacks any sort of meaning or direction. The problem isn't so much the presence of something bad as it is the lack of something good.

In your experience does CBT engage with those sorts of issues?

My journey (it has been a long and arduous one, multiple therapists, multiple psych's, more drugs than you can imagine) has recently taken me down the path of psychoanalysis and deep exploration of my childhood. It has been eye-opening and transformative to say the least.

I would urge anyone who may have had a traumatic childhood to dig into that more. This book has been a fantastic resource: https://www.amazon.com/gp/product/B00C4BA4I6

Psychoanalysis has changed my life for the better. I'm a much more thoughtful, compassionate, and understanding person (with myself and others) than I was when I started. For all the bad rep Freud/analysis gets, theres something deeply right about it, and I think many many people could benefit from it if only they could find their way to giving it an earnest and extended try.

I don’t know if I recall this correctly, but doesn’t the author write with a religious undertone? Would this be effective for a non-religious person?

I haven't noticed a religious undertone. I grew up in a religious family but I am, currently, not a very religious person. The author was raised in a Catholic family though, so there are sometimes anecdotes or experiences that are related to religion and clergy.

Personally I find the writing to be concise, to the point, and very scientific. I read 30% of the book last night because I could not stop. I am like a dried out sponge and this is the water I have been looking for.

I'm looking for advice. I have been suffering for the last several years.

The root cause of the problem is still there and cannot realistically go away easily [1]. I'm consulting with psychologists and was taking medicine (held currently by the lock down). It has not helped to read literature myself [2] as it only says sadness and depression are likely given the circumstances.

Among the good things: I have a good job [3], have several friends who are supportive, am trying hobbies like music. I'm generally exercising also, slowed by lock down.

[1] I've been in an abusive and sexless marriage for over a decade, living separately now. Spouse has filed a false violence case against me, the matter is in the courts and proceeding at its own pace. And there's more.

[2] E.g., Maslow's hierarchy of needs (https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs)

[3] My performance is below my standards due to low motivation and negative impact of stress on memory. I am barely able to do anything myself, however, I'm doing great in guiding and mentoring others which is an important part of my role. It has helped to let them know of my personal situation and everybody is supportive.

> I've been in an abusive and sexless marriage for over a decade, living separately now

This is a substantial thread to pull. Do not discount the impact of this on your life and your wellbeing.

My email is in my profile if you would like someone to talk to.

Thanks a lot for the helping hand!

I highly recommend you listen to these lecture series. I cannot overstate the profound effect they had on my life, by giving me the tools I needed to turn my depression around and give me a sense of balance and control in my life.



Thanks. I'll look at these.

I had a complicated family situation that made it impossible for me to have any sort of peace of mind.

You have to get out of that, first.

You said it yourself. You named that as the root cause.

If it won't realistically go away easily, you have to make it go away the hard way, whatever that is.

If it's just a matter of waiting for court cases to resolve, I think you can already start putting the past behind you and moving forward. But I'm assuming in my answer here that there is more to it.

Thanks for the help and advice even if it's just reconfirming the understanding.

There's more to it indeed as you guessed.

I too suffer with depression and have been now for the better part of a decade. I, for similar reasons, have also chosen to live instead of die. My depression began to get worse a few years ago and I decided to do something about it this year. So far I have tried therapy and I quit for.. yet again.. similar reasons. I have not tried medications because I have an addictive personality and will no doubt become dependent on them.

What has helped me the most so far believe it or not is quitting smoking. Not so much because smoking was a trigger, but because it's shown me that I am capable of going toe to toe with myself. Exercise also seems to be helping me. Although, I will admit I have begun to drink quite often, every night in fact, and I am working on that.

I will give some of your suggestions a try.

antidepressants do cause physical dependency in basically everyone who takes them -- you have to taper off slowly. but they are not addictive in a psychological sense. they don't get you high or make you feel good in the moment.

i took them for a while and never felt any urge or desire for them -- it was something i had to constantly remind myself to do. indeed, i would frequently forget to take them -- this is not something that usually happens with addictive substances!

my point is, there are many reasons to take or not to take antidepressants, but there is almost no risk of addictive behavior like might happen with anti-anxiety drugs like xanax or stimulants like adderall.

If anything, I find that I am more often tempted to try and go off of them when I shouldn't or at too quick of a pace without tapering since the side effects of most anti-depressants are not pleasant.

Most people need to try a few antidepressants to find one which really works for them and which they can take with relatively few side effects.

I had Sertraline 150mg previously and found that rather than helping me it caused a significant increase in my suicidal ideation.

I now take Mirtazapine 45mg instead and the suicidal ideation has gone away entirely, of course I have other side effects (the Mirtazapine makes me drowsy and has caused me start snoring!)

If you're reading this and your not getting a good response from your current medication, talk to your GP about changing to something else. Sertraline didn't work for me, but very well could for you, etc.

> it's shown me that I am capable of going toe to toe with myself.

I can relate a lot to this.

Of all the things I did, documenting thoughts (along with solutions to problems as and when they popped up) helped the most. Updating this document during every bad trip made the future ones shorter.

Thanks for sharing.

Also, PSA: Get tested for any sleep disorders and hormone issues. Affects every aspect of your health and is massively under-diagnosed (80-90%)

I'd say psilocybin (magic mushrooms). It doesn't cure depression by itself, it just punches you in the face and shows your reality and then you can decide if you want to change something, everything or nothing. It's cheap, it's natural (not that it makes it good, but it's nice that nature provides and it's accessible), it's been proven very safe for the majority of the people (not to be taken with antidepressants or if suffering serious mental issues such as schizophrenia) and it's been used for ages for many purposes and science has been considering it as a very valid treatment for depression for some time now and I can vouch for it.

There are places in the world where this is legal, and you can do it with doctors if so you wish. I didn't go through the official medical route since like many other people, I wasn't entirely convinced that taking pills covering the problem (if anything, I don't buy the "chemical imbalance" theory - I do believe there's one, but that's just the end of the chain and not the cause) combined with several years of therapies was going to be a good idea in my specific case.

Luckily HN is a quite open community and this has been discussed several times so please use the search to read more about it. The book "How to Change Your Mind" by Michael Pollan is a must read if you want to convince yourself and give it a try. I can also recommend r/microdosing and r/psychonauts.

Please do a lot of research before you decide to take this route as the process can be tough but then if you happen to be very deep into depression it's worth looking into.

I think this is becoming popular advice in HN and adjacent communities. I don't agree or disagree, and absolutely loved Pollan's book, but having a psychedelic experience can be a very different thing for someone in doldrums vs. serious clinical or chronic depression. Having dealt with both and invested a huge amount of effort into escaping and avoiding the latter category at all costs, I think there's not a lot of actionable advice that applies to a person in that state, other than try to take care of yourself and hold on for dear life.

That being said, I've pursued this in the past and didn't really know heads from tails about where to get these substances or how to know they were safe, how to properly measure dosage etc. And I still don't. But I did learn that it is actually pretty easy to grow your own psylocibin mushrooms. I have had some interesting experiences with them, a novel break from ordinary life and mind. But in my experience, not a novel break from or treatment for depression; I would be ambivalent about having those experiences, especially a powerful one, in the midst of very dire emotional states.

If you are going to go the psychedelic route, I highly encourage you to do post session integration work with a therapist. I have been dealing with depression for most of my adult life (I'm 51). Psilocybin is a really wonderful medicine, and you may well find breakthroughs on your own, however, having somebody to help you unpack the volume of material that can arise while sifting through the chaff for the wheat, is very helpful. Psychedelics accelerate and amplify the therapeutic process. By taking the ego out of the way, they enable a LOT of material to arise. My first psychedelic experience was almost two years ago with MM and it was beautiful. It didn't move the needle a ton, however. I've gone on to do a guided MDMA session which was really amazing, as well as a 12 day ayahuasca and mescaline retreat in Ecuador. Everything has been improved by the post-trip integration work I've done with either my therapist or in small group integration sessions (check Meetup for relevant interest groups in your area). If you do trip on your own, pay very special attention to (mind)set and setting; they are key. Having a trip sitter is also a good idea, at least until you are a little familiar with the terrain. And dancesafe.org sells test kits to help you test for purity and safety.

is there a legal way to do this for yourself or a family member? and could dancesafe be a honeypot?

It depends on where in the world you live. In the US, MAPS.org are currently conducting Phase III trials on MDMA for PTSD, primarily using veterans as subjects, I believe. Johns Hopkins (I think) is doing trials with Psilocybin. No idea about Dancesafe. ANY website could be a honeypot. There's nothing illegal about buying Fentanyl test strips and reagents.

Thank you. Is there a way we can help accelerate the reclassification of MDMA or Psilocybin?

You can support maps.org. They have been doing outstanding work in this space for 30+ years. Write or call your congresscritter?

Depression and anxiety are diseases of the ego. When you dissolve your ego, such afflictions melt away.

Nope, not always. I had a bad psychedelic trip with complete ego loss, and it gave me a boatload of issues that I still haven't completely recovered from. I'm more afraid of death then I was before, and I've been dealing with a higher level of generalized anxiety as well. Psychedelics and ego loss aren't always a panacea.

Are they? I thought they’d be more of a wrong interpretation of the reality, wrong as in unecessarily negative; or a chemical imbalance or a bad situation in life, or suppressed emotions, or lack of agency or... there could be so many reasons. It doesn’t help that too many things are fit under the label of depression either.

And a reason for a higher prevalence of depression in the western hemisphere is in my opinion how we choose to live our lives.

I dont doubt that there are cases of depression being caused by an unhealthy ego, but that’s not always the case.

You mean personality disorders? I think they are something else.

I feel compelled to ask this though: As a famous story goes, anyone naïve self-diagnosing might incorrectly conclude to have been inflicted by multiple disparate diseases.

I haven't been able to figure out what could to tell me conclusively if someone (I or anyone else) is clinically depressed at all. I mean, is feeling of sadness depression? Sadness depends so much on what's happening at any given point in time, and some days are more sad than happy and vice versa. Sometimes, there's sadness associated with a context (may be showing up at work evokes sadness due to recent failures in professional life, say), but coming home to your kid doesn't, or may be it's the reverse, and may be you are suddenly, unpromptedly are reminded of an incident or a regret that sadness comes gushing in... Is this depression, or normal emotional response to persistent stress? I guess, what I'm trying to say is, reading up on depression makes me feel like I may be depressed, but then how can anyone know for sure that they aren't misinterpreting or misattributing the symptoms?

In my case, I was moderately depressed for many years. It took being severely depressed for me to do something about it. My suggestion is don’t wait for that. If you think you may be depressed, you’re probably depressed. Make it a priority to address that.

Life is difficult. We don’t need to be happy, but we need to be able to be content with what we have and where we are.

I feel like directing our compassion and our focus outwards to others helps put our own troubles into perspective. But, we also need to care for ourselves.

Depression is really a large group of diseases/conditions just like cancer with a broad range of different forms, except we haven't yet developed any way of conclusively delineating the different forms like we do with leukemia, melanoma, lymphoma, lung cancer, etc. Just like most adults develop some form of cancer - in the form of benign tumors - most adults will experience some form of depression as they age, mostly as short bouts of general sadness. A small but significant fraction, however, will develop forms of depression that are the equivalent of 'metastatic' cancer that are far more serious and threatening. When people talk about "clinical depression," they usually mean the latter group that have qualitatively more serious symptoms like suicidal ideation and extended periods of depression which lead to ongoing negative consequences like trouble forming and maintaining relationships and jobs, sleeping far more than normal, etc.

Well think of this. When you are sad, do you feel like killing yourself is an option to stop that feeling?

This isn’t necessary for depression. I was severely depressed, and I never seriously considered taking my own life. I did sometimes feel like it would be OK if I ceased to exist.

I didn't say seriously considered. I'm talking about what it's known as suicidal ideation. You can be sad and down for weeks because you got rejected from your favorite company but I would be surprised if some suicidal thought pop into your head because of this. For people that are depressed is not rare at all. Even people with anxiety disorders have them often.

If you're ever looking for a CS partner I'm down to play. I'll race you to the bottom of the scoreboard haha.


This is almost a full day after your post and I don't really have anything to add, but I wanted to thank you for writing this post. It was honest and heartfelt.

I think the worst part of modernity is the over-promise of happiness and a good life through the constant bombardment of marketing. We grow up believing that we're supposed to be always happy and when we're not, we're told that the problem is us.

I have a young daughter and I will always try to keep her grounded about the harships of life and make her see beauty in the struggle for improvement and selflesness. Life is hard, but hard things are worth tackling. There's beauty in the struggle if you seek it. I think it's easier if you know when to zoom in on the day-to-day and when to pan out on the past decade and hope for the next one. Switch between them regularly.

Regarding the point on writing—I've been struggling with depression for some time so I built a writing tool which helps me to refocus every day. It has helped me immensely in the past few months, so maybe some of you will find it useful:


You can install the app as a PWA and it works offline ootb, there is NO tracking/analytics, etc... I don't even know how many people are using it.

More context: https://sonnet.io/posts/ulysses/

One of the easiest and most effective things I've ever done was start taking DL-Phenylalanine. I'm not a doctor and you should definitely not take medical advice from random people on the internet, but if you struggle with depression, do yourself a big favor and look into it.

I wanted to ask you more about this but the email link in your profile is not working. My email is also in my profile.

Interesting, I hope scr.im is just temporarily down and not permanently offline. My email is freedomben at proton mail dot com

I really believe physical activity helps regulate your metabolism, and can really reduce depression.

There are theories about gut bacteria being involved in regulating the brain. There are no species on earth who experienced a sedentary lifestyle.

To be honest I don't really like exercise. But it's all about avoiding atrophy, at all cost.

My country recommends walking for at least 30min per day.

I'm not saying jogging and pushups cured me, but it does help.

As someone who struggles with this on and off, probably more on than off but I dont like to admit that, I find gratitude to be the one thing that makes a huge difference in my life. It fits in nicely and deeply with my religion as well so there's that.

Externally though people think I'm a very happy person. Internally I know its just easy for me to forget or push away the dark thoughts for periods of time, but when I let them surface, they can cause a lot of sadness.

The thing about me is that I am a very logical person. I recognize and find it very easy to deal with the fact that depression is by and large a chemical imbalance. So I often find it very easy to label my current sadness as something caused by lack or excess of chemicals in my brain and that helps me cope a lot with things as well.

I've found depressed people tend to be told a lot to excercise and dont consider it as a solution, but again for me I find it fairly easy to co-relate the low points in my life with a lack of excercise and fresh air. So this tends to again help me push myself out of my low moods.

As a non-religious person, all this resonates very much with me. The gratidtude bit is something that is relatively easy, and surprisingly effective at making you feel more connected with the world. Try writing down the thing you're thankful for, or even actually thinking people. I bet you'll be surprised at mood the lift you get.

Agreed. I've noticed that sometimes I get a huge boost of happiness by simply smiling and giving a greeting to strangers passing by who seem to be having a tough time...

Seeing the huge smile on their face when they see a random stranger greet them brings me to the verge of tears.

The life of this world can be tough on people. Every little bit helps.

Many coping methodologies have been described here, and the role of religion and spirituality has been scientifically studied to (in the general case) help with depression [1]

While I can advocate for the Christian worldview, religions and spirituality in general have advocated for 'giving up control or acknowledging the lack of control' as one primary tool. The religions differ on who to give control to, who is in control, etc.

However one approaches it, if one is able to find purpose in something larger than himself ( or fake it till you get there), it keeps you moving one day at a time.

When one is at the end of his rope, the belief that there is a more powerful person in control and watching for you, it brings immense relief. Now, this is the belief that one must get ( and this is where the community around him is best positioned to help)

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426191/

> Many coping methodologies have been described here, and the role of religion and spirituality has been scientifically studied to (in the general case) help with depression [1]

That's what "therapy" ultimately is. It's a religion. Instead of going to church once a week, you see a therapist one or more times a week.

Look at the top comment advocating for therapy. It's filled with religious allusions - "taking that leap of faith into therapy", "and therapy is about creating a facilitative environment to alter that conception of self", "In therapy, you are unconditionally accepted with positive regard,", etc.

Everything in the top comment is familiar to anyone who was raised a christian. Therapists just took the place of confidants like priests, pastors, etc as christianity/religion decline. The way the "converted" talk about therapy is eerily similar to those who find faith or are born again. But whatever your "faith", there is no doubt that "faith" helps alleviate depression. Whether there is a real neurological reason or whether it is a placebo effect or entirely something else is TBD.

Therapy isn't religion. There's an analogy there, but it only goes so far.

A good therapist is not going to ask you to buy into an ideology/doctrine that requires faith in the religious sense.

The word "faith" in "taking a leap of faith" does not actually have the same meaning as the word "faith" in "religious faith." It's an analogy. To say it in programmer lingo, the word "faith" has been overloaded.

> I can advocate for the Christian worldview

I realize it's off topic, but hopefully that's OK---I think we might be able to have an interesting conversation on this.

How can you believe in Christianity when there is no direct evidence for it? I have been struggling to understand this for a long time.

I was raised as a Christian but had to give it up as I matured and couldn't find evidence for it.

I think there is a real lack of honest discussion around this (or maybe I haven't looked in the right places).

this is a very fair question, that I too, raised as a Christian did struggle with, and then found reasons to have the opposite reaction that you did - the evidence is there- all around us, and this explanation of faith might explain it? https://www.rzim.org/read/a-slice-of-infinity/faith-trust-an...

Consider looking at other resources about RZIM, whose goal is to 'make the thinker believe and the believer think'.

That article uses a lot of fluff language to say that, for the author, faith is based on believing accounts of the resurrection.

In other words, taking peoples' word for it.

Definitely not a novel idea (not that it needs to be).

I think this may be one of the more interesting and less common arguments for Christianity.

Is that your position?

My faith is based on both evidence(as in accounts of the resurrection, among, many many others) as also based on personal experience (both tangible and otherwise)

C.S Lewis is a great writer from the turn of the century, whose books you might consider.

Do you know that there is a lot more proof in the biblical accounts than in many other historical events - https://www.theguardian.com/world/2017/apr/14/what-is-the-hi...


My personal take?

There is enough evidence in the physical world - that if you look, can make you a believer at best, or a doubting agnostic at worst.

It is however the personal experiences that solidify the faith.


Depending on where you are in life, some events (current) might hit a nerve. For me, it was a persecution that made question the social fabric, and yet in the midst of it, were some crazy guys - who were willing to martyr themselves? Why? - that search led me to rediscover Christ, though a Christian myself.

It took a while, but I would also say, it is not we who seek God, in our case, it is God who relentlessly pursues us.

When you say a "doubting agnostic," I guess you mean "agnostic but doubting it, i.e., maybe there is a God."

a) I really like the Narnia books. I tried once to read one of C.S. Lewis's apologetics books (can't remember which now), but gave up very quickly, because the writing style seemed highly disingenuous. I didn't sense much potential in his work to have a strong, rational argument that someone not already committed to faith would accept. Maybe I should try again, more carefully. Is he the best apologist you can recommend, or is there someone else?

b) What is the evidence in the physical world that you are talking about? I take it that this is in addition to "word of mouth" across the centuries. I'm not aware of any such (additional) evidence. I think Jesus was a historical person---there is enough evidence for that. But that doesn't prove the religious claims. Undoubtedly you would agree that there have been many false prophets (e.g., Zoroastrian prophets, to try to pick something not likely to offend or be controversial).

c) Would the evidence you point to be enough to convince you to believe in Christianity, or is "personal experience" necessary to bridge the gap? If it's the latter, what kind of personal experience is it?

In the interest of full disclosure, I just want to understand what makes religious people believe what they do. I'm not even remotely open to accepting religion, myself.

>Is he the best apologist you can recommend, or is there someone else?

Take your pick from here. https://en.wikipedia.org/wiki/Christian_apologetics

Some come more heavily from science like Francis Collins, some from theology like Sproul, from philosophy like Craig, pick your poison.

the one thing you need to do however, is to give the benefit of the doubt - because it really comes down to splitting of hairs. Once you are able to grasp their arguments and its basis, then you can see if you agree with it.


the bible itself is a set of writings over the ages - with its dates proven as a fact. Within it, we see historical events that were foretold come to pass.

Maybe you might want to look at the bible from a fresh perspective ( from a Hebrew lens ) - [1] would give you a deeper understanding of the history, culture, reasons behind some of what appears to be crazy etc. At the very least, you will leave with a deeper understanding of that culture etc.


the next question you might have is 'why do I need to trust this literature' It has to be divinely inspired. Written at a time when the worldview did not know the ends of the earth and people believed that one would fall off, the bible stated ( in Isaiah ) that the earth is a circle; people thought it allegorical till they found out it was; just 1 example.


About the Hebrew language itself -- it too was not man-made. One example, in hebrew, the words that are variants of the same letters have related meanings -- so the words for 'ear' and 'balance' were almost the same and no one had a clue why -- till they found out last century, that balance is tied to the ear. ( i am just giving you small examples ). There are tons such out there waiting to be studied.


> I just want to understand what makes religious people believe what they do. I'm not even remotely open to accepting religion

Just be careful as you may get more than you bargain for! I myself, was on a quest towards getting more rooted in atheism that I started studying books and debates, and then found about apologetics ( I was not exposed since i was born a christian and lived a nominal christian life). I turned out to experience the faith and now I am in a dialogue with you.

In the interest of full disclosure, I would love for you to accept Christ but am humbled and also comforted that it is not me who can do it, it is only you with God's leading. I share my experiences hoping that something on my journey can help you in yours. This journey has made me live life with a purpose and am much joyful than before ( even though I have lost some things along the way)


[1] https://torahclass.com/teacher/author/tom-bradford/old-testa...

I get what you are saying about the Bible containing information that couldn't have been known at the time it was written, as a hypothetical way to prove that it was divinely inspired. I'm not convinced, but I think it's an interesting argument. Well, it's an argument, let's say that.

Do you know if there's a good source that collects all of these types of claims in one place?

Would you drop your faith if you stopped being convinced that this kind of thing was good evidence?

When I was a teenager I believed in the Bible codes [1], which is a similar idea. But I eventually had to admit that I didn't have good evidence to support that argument.

[1] https://en.wikipedia.org/wiki/Bible_code

I got a response from "freekisanders" that can only be seen with "showdead" turned on.

I am reposting here because he made a legitimate comment and it should be seen by people.

Freekisanders---if you see this, you need to make a new HN account.

Mods---please un-dead this guy, he seems benevolent.

Here is his comment:

Reading this thread with interest (even though it is off-topic).

I'm also a Christian. What convinced me (among other things) is historical and scientific accuracy.

As said, there is enough prove for the historical existence of persons like Jesus and David.

And many biblical events and dates can be confirmed through archaeology.

As to scientific claims, a good collection of articles would be: https://www.jw.org/en/bible-teachings/science/

One that fits your question: https://www.jw.org/en/library/magazines/watchtower-no1-2018-...

Thank you for your reply, and for telling me I died. Haven't posted a comment in a long time, and unfortunately I can't see that I'm dead :) Made a new account as suggested.

Reading this thread with interest (even though it is off-topic).

I'm also a Christian. What convinced me (among other things) is historical and scientific accuracy.

As said, there is enough prove for the historical existence of persons like Jesus and David.

And many biblical events and dates can be confirmed through archaeology.

As to scientific claims, a good collection of articles would be: https://www.jw.org/en/bible-teachings/science/

One that fits your question: https://www.jw.org/en/library/magazines/watchtower-no1-2018-...

I wonder how often people try the very basic, organic (if you will) things before resorting to chemicals that mess with their brain. I mean - reasonable diet, enough sleep, exercise.

A major part of it seems to be a vicious cycle.

I once went to a Sarah McLachlan concert, and you know, her music can get a li'l "blue". Back in the day I went to a LOT of concerts, being a 20-something guy in NYC. That crowd straight up shocked me. Most seemed morbidly overweight, and many hauled literally buckets of junk food to their seats. I actually left early because the whole scene started bumming me out.

And I would imagine these are the people who would not even try changing their lifestyle and just ask their doctor to make them happy. It's all very sad.

>reasonable diet, enough sleep, exercise

For many victims this is already too difficult to achieve. The use of pills and therapy are the jump start they need to then use these basic steps to improve their lives organically.

To be frank it is abundantly clear that you do not know the first thing about depression. It saps motivation first to such an extent that the reason SSRIs are a suicide risk is because they wanted to kill themselves before but didn't have the motivation to actually carry out desires.

Saying to "just" make lifestyle changes is like asking why paraplegics just don't start crawling until they can walk and deriding them as lazy because their legs are atrophied.

I do not live in a country with extreme lockdown. Neither have I been economically affected by this. But my coping mechanism for depression was hitting the gym. Not just the excercises themselves but the entire ritual. The moment I feel the smell of the place, places I go to atleast 3, I get a sense of calm and focus. I really tried my best with a rudimentary home gym and tried some running when it was possible due to weather. It took me years to build up the gym strategy. It took a day to break it down. After a few weeks in lockdown without my ritual I felt the old blackness creeping back. The complete lack of human interaction other than the synthetic zoom sessions that do nothing for me. I dont feel any human connection over zoom. And I wonder if all the articles of the fun zoom hen parties arent just satire. Like when priests were trying to make jesus cool during my teen years. Lockdown has lifted a bit and I have started to meet people in person again. Always distanced. I imagine this is what lepers felt. Everone goes out of their way to stay safe. Being close might make you sick. I and you are hosts for the viral plague. Out to cause our fellow human beings with unneccesary suffering with our pesky needs to see other human faces. See a strangers frown or smile. 2 days ago I went to the mall for some food and just get, once completely norma, take away coffee. I met an old collegue and she broke all protocol and just spontaniosly hugged me. I started to sob. Unctrollably. I think the last time someone touched me was march. Or maybe late february. I have a therapist. Losing access to her did not bother me all that much. I have no financial issues or physical ailments. I have spent these past few months sobbing, randomly. Pulling myself out of bed, wondering if its tuesday or saturday. Wondering why I could not just die in my sleep so I dont have to face another day of being an absolutely useless piece of space that no one cares about. That hug broke something awful and my poor chocked collegue may never know what an incredible gesture that completely normal sentiment was for me. I no longer feel like a disgusting host for viral pestilence. The gym opens in a week. And if it closes down again. At least this time I know what to expect and can prepare.

  But my coping mechanism for depression was hitting the gym
Gyms are subject to the strictest lockdown terms here in CA. Mine in SV closed 10 weeks ago.

I read this after another sleepless night and it made me cry.

I have had "go back to therapist" on my todo list for too long. Reading it has reminded me of my plan to get things back on track. Thank you very much for writing this.

That's really it, isn't it? No one "lives" with depression, we "survive" with it. Depression is little more than getting used to worsening conditions and treating yourself poorly. "Living" stops when that pattern of behavior starts, because attempts to live are shut down by rumination and defeatism. Then introspection starts and you can see the basic issues but can't reason your way out of them, nor draw on the discipline that has been washed away because of them to put in the consistent work to better oneself.

I recommend this talk about depression and software developers: https://www.youtube.com/watch?v=yFIa-Mc2KSk

There are newer versions of this talk, but I think this one has the most powerful storytelling.

Somewhat related: "The Depression Thing" by Zach Holman (https://zachholman.com/posts/the-depression-thing).

Setting aside time to do nothing. Man, I haven't "done nothing" in far too long.

I have a dedicated day toward reading, which is kinda close. But just relaxing for a bit sounds so nice.

I read others asking for possible advice on where they can go/what they can do for help, and beyond the standard psychologist/psychiatrist, and typical resources linked from others, I'd like to share my experience.

Had depression most of my life, going from irritable depression to standard melancholy depression. Seen a handful of psychologists, and wished they worked. As mentioned in the article, it takes an enormous amount of time to get someone else 'up to speed' on you, your history, your proclivities, and your hypothesizes. I did it a few times, but had mixed experiences. Still think psychologists are a very good resource, its just takes time to find a good one.

During treatment, I tried a multitude of the standard anti-depressants, which merely masked the symptoms for myself. For others, these options work much better.

After being frustrated from my last therapist, I decided to dive into the research, and self-experiment. After 5 or so years, the following has helped immensely. I still have my lows, but they feel normal, and expected:

* Exercise: My constant irritation against those that just wanted to help, made it hard to let them in. So my anger and resentment was turned to weight lifting, and focusing on muscle building. I tend to overthink, so this was a good way to still continue to analyze, but also tire me out into a meditative-like state. The key for me was not to just go through the motions of the workout (though some days that's all I did), but to feed into that primal urge for aggression, put on intense workout music (mine was heavy rock), and exert as much energy into defeating my sets as possible. I agreed to do 10 reps for this last set? F-that, I'm doing 12. Nope 14. (within reason)

* Food: If you've read my past comments, you'll know I eat carnivore. This isn't to proselytize the diet, though it has had the largest positive impact on my emotional well being compared to anything else. Rather, its to point out that diet plays a key role. If you're eating something that's inflammatory to your gut, your emotional state may be the victim. This isn't the case for all instances of depression, but the research is mounting [0][1] Though these resources contradict my attitude towards many (not all) plants, the point is find what diet is right for you, even to at least eliminate that possibility. For me, if I stray into a problematic food, I am intensely depressed for at least a day or more, reminding me of what I worked to 'cure'.

* Time to yourself: As others have pointed out, meditation is great. So is yoga (especially hot yoga, if you like a challenge). Start slow, but what I've found for myself is that as my self-discipline increases, my confidence and mood do as well. From normal yoga, to 80 degree, to 95 degree, the challenge and (enjoyable) 'pain' in the moment, leads to a euphoric bliss of calmness after.

* Sun: Vitamin D deficiency is shown to have many issues related to depression, immune health and others. Depending on where you live, and how much melanin you have, you may need more than you think. Spend time outdoors during sunny periods (without sunscreen) for a time that's appropriate (you'll have to test yourself to find your optimal amount). Ask your doctor for vitamin D tests on a regular basis, so you have data to test your hypothesis.

* Socializing: Introvert or extrovert, some communication (whether in person or over the web) is generally seen as a positive thing for many. At times I didn't want to interact with anyone, as I would just hate my own existence, and their happiness as well. So in times like those I'd join forums or play games with people online. Something to get out of your own head. Or immerse yourself in a book, 'socializing' with the characters.

Hope this helps someone, I understand all too well the deep, endless darkness that is depression. It's always lurking around the corner, and sometimes I forget how bad it is, until I slip up. But there is a way out, it just has to be your way.

[0] https://www.health.harvard.edu/blog/diet-and-depression-2018... [1] https://www.health.harvard.edu/mind-and-mood/food-and-mood-i...

> For me, if I stray into a problematic food, I am intensely depressed for at least a day or more, reminding me of what I worked to 'cure'.

Out of curiosity, do you believe there's a possibility of this effect being mostly (or purely) psychological? I understand that there's a robust and growing body of research linking nutrition, inflammation, gut health, and mental health, but they seem to be either over long timeframes or meta-analysis of other studies. When I read people's reviews of how keto/carnivore/low-carb/vegan impacted their mental health, I'm always wary of statements that link a one or two-time ingestion of a certain food type with a complete relapse of symptoms, although maybe I haven't been properly paying attention to my own body.

I agree the research isn’t there to the same rigor as other fields. Thus I too don’t like to rely too heavily on it. My experience is N=1, anecdotal, but the subjective difference is astonishing. And although correlation != causation, it can imply it.

It took a few months of eating consistently to see results, and taking detailed logs daily with subjective rating system made it as close to “scientific” for myself, to review change over time.

Alas that isn’t true science, and I’m not sure how we can truly test nutrition, ethically. Studies in other animals have similar effects as epidemiological studies: they point to variables we should casually test.

This is such an uplifting article. It's great to see someone recognizing their own healing and thinking about how they made it all work.

> I set aside hours each day to do nothing. In some sense, this was meditation. Except, I did not force myself to not think.

In fact this is exactly what many styles of meditation practice are! You're not "not thinking," you're being self-aware of your thoughts and learning to guide them where you want them. I say this not to be pedantic but to correct some notions of what meditation usually tries to achieve: more self-awareness and control, which you can use to help guide your own sense of self and healing. (At least this is the conclusion I've come to after using one of the well-known apps that I actually really like.)

I still suffer from light depression and moderate ADHD, but meditation has been just as effective for me as therapy and medication for both of these (although I'm sure medication and therapy are making the mediation easier and more effective).

It looks like words I would write. I guess there are people out there who got the very same problem, with very same thought process. And it's fortunate that seems it works for him. I would try.

I've been living with depression and anxiety for so long that it is my state of normal. I find cover from my feelings by working 12 hours a day and focusing as much as I can. When I lose focus is when depression resurfaces. I finally invested in my mental health in the last year, seeing a therapist and practicing CBT. This has been a breakthrough year for me, emotionally. I am thinking about quitting my work and working on something entrepreneurial related to mental health. I've found that the most important part of self-therapy is practicing what is learned, developing new mental habits that trigger as countermeasures to cognitive distortions.

I feel like I'm a survivor of a emotional holocaust where people see an emaciated mind and don't understand the cause.

Just make like a roach and survive to spite everyone.

Well said

I really enjoyed reading this. The style of it. I'd like to read more like this. Thank you!

I find it very disheartening to see antidepressants described as "happy pills" that "numb your senses". Comments like this only serve to reinforce the stigma around these medications. This stigma is the part of the reason why I held out from seeking help for years.

My experience taking Mirtazapine has been the exact opposite. At the deepest point of my depression, that is when I was "numb". Like many people I would listen to sad music when I was depressed, but eventually sad music didn't make me feel sad anymore, I literally just felt nothing.

Since being on Mirtazapine, my depression is gone for the first time in 13 years and it's completely changed my life. I still have the full human emotional range - I have good/bad moods (mostly good), days where I feel bored/meh, I cry at the sad parts in films. The antidepressants cured my depression, they haven't given me a false sense of inflated happiness. The question of "am I actually happy?" doesn't even really cross my mind. I'm just content.

The only side effects I experienced were 3 days of extreme tiredness when I first started taking them, which then subsided. And my appetite increased, so I have gained a few pounds, but since I was already quite skinny and had started lifting weights, this has been a net plus.

I found this lecture by Stanford professor Robert Sapolsky highly insightful - https://www.youtube.com/watch?v=NOAgplgTxfc - We all get depressed, it's a normal part of life, but depression is a disease which causes you to stay depressed for no reason, and it's as real of a disease as diabetes (we know this because the brains of people with depression look different, even when they're sleeping)

What's weird is that, when I was depressed, I already knew everything that he says in that video. I doubt this will make sense, but it was as if I knew it, without really "knowing" it. I knew I had depression. I knew how depression affected the brain. I knew how antidepressants worked. But if you'd asked me if I wanted them, I would have said no.

One thing that I have come to realise, is that I had to unlearn all the negative preconceptions I had about "happy pills", and be ready to accept that the medication had the _potential_ to work, in order for it to work.

During the 13 years that I was depressed, there were still lengthy periods of time when I felt relatively happy. Unfortunately, this led me to the (incorrect) conclusion that I could cure my depression myself if I just found the right combination of lifestyle choices. I started exercising, eating better and trying to get enough sleep. I tried to maintain good relationships with my family and friends, and explore my hobbies. The depression always came back.

Ironically, all this time spent trying to get better without medical help, probably extended the years of suffering, yet it was absolutely necessary to create the conditions that were needed for me to actually get better. The final pieces of the puzzle were: to truly accept that I had a disease, caused by unresolved trauma in my childhood, to seek counselling to resolve those issues, to lose the preconceptions about antidepressants, and to start the medication.

This process alone took around 2 years. I am one of the lucky ones, I genuinely count myself as lucky that I "only" wasted 13 years. Depression is an insidious disease.

The final thing I will say is that I often felt at the time that the therapy sessions weren't achieving much - it is only looking back that the impact becomes clear. (Also, you don't have to be depressed to benefit from counselling.)

Talking to friends and family can have just as big an impact, but therapists are trained listeners, you don't have to explain "why" something was traumatic, they just get it.

you can add one more thing to that trello accomplishments list. vishnu.tech ! not all techie vishnus around can have a cool domain like 'vishnu.tech'. just one. :)

I think there are a lot of misconceptions about medications and people are pretty down on them, but they have been a literal lifesaver for me. For the sake of someone who may be considering medication, I'd like to share my experience.

I went through a pretty rough period of depression several years ago, but I realized later that I had cycled in and out of medium to mild periods of depression in cycles throughout my life. I wouldn't have said I was depressed at that time, because I had the common image of a person who can't get out of bed in mind. While that is certainly the case for some people, depression comes in many flavors. I was always irritable and had a hard time being patient for anything. I also experienced anhedonia, which is often described as "lack of pleasure." I feel like that is not necessarily the best description, and it's hard to describe it unless you've experienced it. It was more of an emotional flatness. Sometimes I felt like a robot: I sensed that it was a sunny day, food tastes good, but didn't have any positive feelings. It was like watching a movie that you're not invested in and don't care how it ends. While I didn't really notice it at the time (part of therapy is learning to pay attention to your thoughts more), I would also often ruminate on negative thoughts: how much I was disappointing people at work, how inadequate I was as a husband, father.

When someone talks about depression, well meaning people often suggest things like meditation and exercise. I don't think that is necessarily bad advice, but I do worry that this may trivialize how hard it is to climb out of the hole when you're depressed.

The one good habit I did have before and during the time that I was depressed was I consistently worked out 3-4 days a week, running, crossfit, lifting free weights. I would recommend exercise to anyone and I certainly think it helped me. But it wasn't enough to overcome my depression.

I was also meditating quite a bit at the time. I found a zendo near me and would often duck out during lunch time to sit for a half an hour. I also found the Headspace app really useful for short 10 minute sittings during the day. I would recommend meditation to anyone, but it wasn't enough to overcome depression.

At some point, I hit a point where everything seemed to be unraveling and I started talk therapy. I would say this is one of the most important things I've done in my life, as I realized I had a lot of maladaptive mental patterns. Therapy isn't an easy road. My first therapist was good, but not a fit for me. When you are in therapy for depression, often your assessment of how well therapy is going starts to factor into how you feel, and I began to become hopeless that I would ever feel better. After almost a year, I sent my therapist a text out of the blue one day saying I wasn't going to come any more, which probably wasn't the best way to handle it. Someone else who encouraged me to go in for a last session. The therapist and I both agreed it wasn't a fit. I found another therapist that was much more effective for me, and made a lot of progress. I got better at catching myself having negative thoughts or ruminating. But I still felt very flat. My therapist asked what I would do if I never felt good again. At the time, I said "I'm not sure I'd want to go on." But shortly after that, I accepted that this may be the way I would feel from then on, and, while I didn't feel great, it was, in some hard-to-describe way, better.

Finally, after several years of therapy, still feeling flat, I decided to try medication. The first one I tried was Wellbutrin, which has relatively benign side effects. I knew it could take a long time to find the right medication and dosage, so, while I was hopeful, my expectations weren't too high. When I first started taking it, I didn't notice anything, not even side effects. But one morning, after being on it for a while, I was driving my car to work in rush hour and suddenly realized that I felt at ease; I was enjoying the drive. It was so amazing I wanted to cry.

People like to describe these medications as "numbing," as if they were some sort of opiate, but that's not my experience at all (I'd add that I subsequently also added an SSRI for anxiety). They more shifted my perspective, gave me more space to be mindful of my thoughts and emotions. Some people have had very bad experiences with these, and I don't to minimize that in any way, but I'd also say medications are useful for some people.

Thanks so much!

All you have to do to see that depression is a disease of the bourgeoisie (I feel dirty using that word) is travel around the world a bit.

Some of the poorest people out there are the happiest and living hand-to-mouth doesn't leave much time for feeling melancholy. In fact, it seems to give satisfaction, purpose, and fulfillment.

To put things in perspective for the HN crowd, if you make over $30k/year, you're in the the top 1% worldwide. And at that level, all your basic needs are met by a large margin.

You are free to pursue the kinds of wildest aspirations of your heart and mind – if you chose.

This parroted advice is unhelpful and almost always incorrect - simple caricatures of the "travel the world" and "you don't have it so bad" and "just follow your dream" are just empty platitudes. Depression can not only affect people from all socioeconomic backgrounds, but is often highly correlated with economic distress, especially if you look in areas like the upper midwest. Depression often negates your life's sense of purpose. Saying that the "poorest people are the happiest" and poverty somehow alleviates depression because they're too busy working for their next meal feels condescending and tone-deaf.

Depression knows no class, race, creed, gender, or anything else related to the human experience. Any human brain is susceptible to it. Now, whether people of a certain group are willing to admit it, share it, and seek help without feeling stigmatized, is a different story.

I think in poorer societies people care more for one another even if they barely have any food. The community is stronger. That may aleviate some forms of depression but not all. Remember, depression is sometimes invisible so travelling around poor parts of the world and people smiling at you doesn’t mean it’s all dandy.

But I feel that your point is somewhat related to the obliteration of the community in general and the tendecy to care for oneself first and foremost in the western world. Money and wealtg is not everything. And then how that is distributed also is another thing. People feel worthless if they don’t attain a certain definition of success

I'm having trouble understanding what you're saying. If living hand-to-mouth gives people satisfaction, purpose and fulfillment, then why are you offering some vague advice about choosing to pursue the wildest aspirations of heart and mind? Why would that work instead of the proven route of struggle for basic needs? (I also doubt those poor people are pursuing their wildest aspirations, they're probably just trying to not die).

Ah yes all the poor alcoholics who are barely alive must be really enjoying their life. And all the poor who just killed themselves have accomplished everything and decided to call it a day.

Please, if you're lucky enough to not know depression, you can't really decide that it's just the affluent who never worked the fields. I know this is most of HN, but Depression being an affliction of the bourgeoisie is just a bad conclusion.

I think partly true. But, the melancholic temprament is recognized throughout ancient literature.

While it can help some people, statements like this can also add to the guilt that some people already feel due to not being happy, especially when they already know that they're "really lucky" and have "everything they need".

> travel around the world a bit.

Like the bourgeois?

You don't need much money to grab a backpack and go someplace, or do volunteer work abroad. You could even get paid for some of it.

That comes from a position of privilege.

Round trip plane tickets across the ocean or hemispheres, and factoring cost of food lodging and travel while there, is plainly expensive. Travel by land has less of an upfront cost, but depending on how far you want go can take ample time. That's time spent not earning, burning through vacation days just to get somewhere, which from where I am, can scarcely be described as traveling the world.

Working abroad for say TESL (teaching english in the second language) is a contract, commonly up to a year, though shorter options exist. That's a complete displacement, it may be suitable for a young graduate but isn't short-term travel.

> Some of the poorest people out there are the happiest

yes, because the depressed do not live long there.

i feel you haven't travel enough to spot people who are poor ( financially ) and suffering from depression. travel more, my friend.

The blog design screams 'depression' to me :|

there's a light mode switch at the bottom, though on the posts it's rather hidden. on the main page it's more accessible.

If just CBT works for you, great. Everyone else, just do yourself a favour and go get some medication. Life's too short to live it miserably stubbornly denying the effects of drugs.

Ooor don't, you can always stay miserable or kill yourself, I guess.

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