This has always been a problem for me. I used to think it was a sides-effect of the dysfunctional home that moved, on average, every three months that I grew up in. I knew I developed coping skills that put a wall between me and others. You can only say good-bye to friends so many times before you stop getting close enough to care that you are saying good-bye.
Then I had kids and saw much of my own personality reflected back at me, but in different ways and degrees. At that point, I realized I probably always would have had difficulty making friends and would probably only had a couple friends. My upbringing made that worse, but wasn't likely the entire cause.
Now, I find that I don't know how to get around that. Articles everywhere say, "meet with people", but I feel more lonely in those situations because I don't know how to break into the conversation. Depression makes it worse, because you are constantly asking yourself, "why would they even want to know about me?" There's only so many times you can go to the entrepreneur meet-up and not talk to people (even after presenting) before it starts doing more harm than good.
I agree with the article that connecting with other people is of number one importance to fighting depression. I would really like to find the guidebook for doing that. :/
I had this problem (although in pretty mild variant) before I started to train. And the best part is that you can take it slow if you want. You can just introduce yourself and focus on the technique, and after few sessions you will start to talk to people, and maybe even connect with some of them.
I still get anxious when I come to the new club, but it lasts shorter every time.
I'm scared of both the dependency and the effects. I think my basic fear is that if I find something effective, it will be suicide-light, that I'll be killing off too many parts of my self that make me who I am. It's hard for me to trust the testimony of the treated --- I presume that there are many satisfied frontal lobotomy patients as well. So oddly, I guess I'm more interested in second-hand accounts. My personal experience with treated friends is mixed. A few seem to be more functional versions of their previous selves, others are much closer to zombie shells.
It's a hard subject to discuss, though, and I don't understand whether the differences are chance, personality, or drug regimen.
How do you feel about your newly drugged up friends? Specific treatment details appreciated.
this is the most important battle of your life, nothing else matters.
That's the part that's hard for me. I'm not sure that nothing else matters. My fear (mythic?) is that I'll be able to find a treatment that makes me happy, but at the cost of giving up my current and perhaps unrealistic goals of having a positive effect on the world. The new self will rationalize this as a worthwhile tradeoff, while the current one would lament the lack of purpose.
After being nudged a bit by a doctor and finding the right antidepressant, she has done a total 180 and is something of an advocate for mental medication, for those who need it/are diagnosed for it.
To answer your specific question, she seems to be spending much more time and energy on productive things, i.e. getting advanced degree, professional license, giving presentations for work, than on interpersonal drama and other side effects of depression that had haunted her. She did go through one or two meds before finding the "right" one. Not sure how long treatment lasted for her, I believe she is no longer on them.
I have come to realize as a result of this experience just how biased our whole society is against medication for mental health disorders. Just as it was biased against therapy for decades and decades (and now, ironically, therapy is considered by some a way of being tough and avoiding medication). I was so happy to see the "say yes to drugs" portion of TFA.
Anecdotal evidence is particularly unhelpful in the case of depression because most cases resolve of their own accord. Spontaneous recovery is the most common outcome and antidepressants are the most common treatment, so it doesn't tell us a great deal if the two coincide quite often.
The big metastudies are fairly unanimous - the efficacy of antidepressants is marginal at best. Kirsch et al (2008)  showed that response to SSRIs was only better than placebo in the most severely depressed patients, due not to better response to the drugs but to lower response to placebo.
For me, the takeaway from the data isn't that drugs are useless, but that anything treats depression if you believe it to. All treatments have roughly the same efficacy - that of placebo. Do whatever makes you feel good and you'll feel better. I'd be reluctant to choose drugs over another placebo because they're an expensive and risky placebo, but if you believe in drugs, take the drugs.
The real thinking point is what this says about the nature of depression as a diagnosis. Personally, I think the disease model doesn't work and that we're inappropriately medicalising something because we have a cultural preference to see unhappiness as medical rather than social.
I'm sorry, but huge CITATION NEEDED.
> The big metastudies are fairly unanimous - the efficacy of antidepressants is marginal at best. Kirsch et al (2008)  showed that response to SSRIs was only better than placebo in the most severely depressed patients, due not to better response to the drugs but to lower response to placebo.
Please cite the other meta-analyses that support this. I am somehow disinclined to believe you on this topic. Here are a few meta-analyses in patients with and without certain concomitant diseases that I found in the last five minutes published in 2011 that disagree with you:
>The real thinking point is what this says about the nature of depression as a diagnosis. Personally, I think the disease model doesn't work and that we're inappropriately medicalising something because we have a cultural preference to see unhappiness as medical rather than social.
Just because you think that the disease model doesn't work doesn't mean that it doesn't. I don't know if you have anyone close to you that suffers from depression, but it is most certainly not a purely social problem. There are demonstrable pathophysiological differences in depressed patients that are not present in non-depressed patients.
This isn't true. Again, look at the research:
I would be very interested to see a similar study for treatment of a disease that we understand better. IBS has no real treatment of cause; all treatments are palliative and all treatments effectiveness seem to be strongly correlated with the patient's mental state. Of course, even this could be hugely beneficial for a huge range of diseases like Parkinsons and the like.
I think this would be phenomenal if you were able to show a similar level of improvement with something like cancer or staff infections.
Some interesting preliminary research on using ayahuasca to cure cancer. (Which the indigenous practitioners say works because it puts the user in touch with plant spirits or whatever.)
“The response to placebo in these trials was exceptionally large, duplicating more than 80% of the improvement observed in the drug groups. In contrast, the effect of placebo on pain is estimated to be about 50% of the response to pain medication.”
The cited study included six drugs. There are currently more than 20 available on the US market.
One of these 6 is no longer used (nefazodone - see the black box warning if you're curious).
The study only looked at serotonin modulation. We have drugs that don't even affect serotonin now, and ones that do it much better than the old ones. [Venlafaxine is an SNRI but at low doses acts as an SSRI. To get the NE effects, one must go to the upper dosage range. Most patients can't do this because of intolerable GI discomfort. Since you're obviously negative on the subject, I'll mention that the GI upset is caused by nonspecific serotonin activity at 5HT3 and 5HT4, if I remember my receptors correctly].
The study, published in 2008, only looked at 1987-1999. Very strange. Recency is in fact important with drug trial data.
PLOS Medicine is not exactly a respected medical journal... if you want good data, try Lancet, BMJ, NEJM, AJP, etc. Just because it got published definitely doesn't mean it's reliable. Very few people are actually trained to properly evaluate medical literature.
I'm negative on the subject because I have been on six different antidepressants and they did nothing but cause me intense discomfort. I took desvenlafaxine at a non-noradrenergic dosage level, and it still made me insomniac, gained weight fast, triggered manic symptoms, and caused intense withdrawal symptoms. I was also on an NDRI (non-sertonergic) and a tetracyclic. I am not a doctor, but given how a doctor is responsible for putting me on a carousel of medications that screwed up my body for over six months, I don't particularly care who's considered qualified to read papers.
On the other hand, if you have tried non-medicinal alternatives and you think you are getting worse (or you are already at a seriously bad state), the drugs can be life-savers.
But quick, they are not.
The problem with this literature base is that its really difficult to measure outcomes in the first place, and especially when there are methodological flaws in studies (two examples of these skewing the literature base in favor of drug use are withdrawal trials and six week studies, an example skewing the literature away from drugs is that the longer term studies can be at best correlative with poorer outcomes because you can't keep people on placebo for 15 years). However I think Whitaker does a great job of analyzing the methodology and will help you evaluate the evidence.
There's alot of quacks in the anti-psychiatry literature base. Reading Thomas Szasz isn't going to help you feel any better. You can't trust CCHR and probably not Peter Breggin to accurately represent the evidence. But Whitaker is extremely qualified, has won alot of awards for journalism, and even the people who disagree with him aren't saying that he's a quack--Whitaker is straight up science, no ideological biases against 'drugs'--he just is looking at outcomes.
There's been several discussions of his work on HN, and several people here recommended it a 2010 book to read.
You can look at the annotated bibliography for his section on antidepressants here http://robertwhitaker.org/robertwhitaker.org/Depression.html
My last book recommendation from HN didn't go that well, though. I saw Seligman's "Learned Optimism" recommended, so read it soon after. While it had some great insights, I fear my take home message was: yes, I'm horribly depressed, and this is likely the result of a lifetime of training and the influence of my depressed mother, and thus there is little I can do about it. Rather the opposite of the intent of the book, I fear. We'll see how this one fares!
Neuroleptics are an entirely different class of drugs - you absolutely cannot lump them together. They have varyingly opposing effects (e.g. blocking dopamine instead of increasing it). And just FYI, only old doctors call them neuroleptics anymore in practice - we just say antipsychotics. And there are two very distinct classes of antipsychotics that can't really be lumped together for most purposes - simply, first generation and second generation. The first generation (chlorpromazine, fluphenazine, thioridazine, haloperidol, prochlorperazine, etc) is much more likely to cause depression, whereas some agents in the second generation are actually indicated to treat depression (e.g. olanzapine, aripiprazole).
Looking at the page you linked, I have several comments:
1) As far as chronicity, depressed patients are likely to have multiple episodes throughout their lives. If they suffer an episode while on an antidepressant, it doesn't mean the antidepressant caused it. If they weren't on the antidepressant, they would likely be having even more episodes. Also, only one citation? From 1973? That doesn't stand in evidence-based medicine today.
2)"British researchers found that 50% of drug-withdrawn patients relapsed within six months." That would indicate that the drugs were working, don't you think? They can't relapse unless they first leave depression. Equally, this would imply that after stopping antidepressant therapy, 50% of patients /didn't/ relapse.
Replace depression with another disease state and think about it this way: 50% of patients with high blood pressure who stopped taking their medication (which lowered their blood pressure) had high blood pressure 18 months after stopping the drug. Is there anything surprising about this? No. The problem is the stigma associate with depression.
3) Patients with mental illnesses are more likely to suffer from chronic illnesses (if you wish, I will fetch citations for you). Therefore, quite logically, patients who take antidepressants suffer from more chronic illnesses becaues they have depression than patients who have never had a mental illness. Again, there is nothing surprising about this.
4) Cherry-picked journal articles. I know very few people read medical journals regularly, but you can find an article to prove anything. There are reputable journals, and disreputable journals. Standards are a big deal, and just because something got published doesn't mean it's accurate or true. For a nice ranking of journals, you can check out http://www.scimagojr.com/
Is this the entire bibliography for the book? Honestly, 8 page journal articles have more than this (I'm serious. Look up NEJM and pull any five articles over two pages. And then keep in mind that there is a citation /limit/ to get published in the journal).
If you would like to discuss any of the literature more thoroughly, I would be more than happy to.
In contrast, coming off the Prozac for the first time gave me the craziest burst of creative energy I've ever had and resulted in a 400-mile move, a startup, and the happiest period of my life.
But I wouldn't recommend this approach to anyone else who's feeling at a complete dead end and wants a burst of creativity. The second time round I didn't feel the same way - I felt dulled to the point of numbness and took myself off the tablets before I turned into a real zombie. Finding positivity in my work, outside encouragement (counselling), and forcing myself to get outside every morning (seriously!) all kicked me in the pants and out of the hump.
My psychiatrist is now fired after playing games with my brain and missing some pretty obvious calls, but my therapist is indispensable.
Dependency is not an issue. You will not crave your antidepressant. You may, however, feel strange if you stop taking it suddenly (I cannot clearly explain it - 'strange' truly is the effect). Some of these drugs do have withdrawal symptoms, and again, this is where conspiracy theorists jump out and say "That's because you're addicted!" No, you are not addicted. You were taking a medication that modulated your neurotransmitter levels. If it was successful, over a period of time, your mood will be altered. If you stop that suddenly, wouldn't you expect your mood to fluctuate until your body readjusts? Of course you would.
Taking an antidepressant does not 'kill off' parts of yourself. It will allow you to be /more/ of who you are - without the anxiety, without the sleeplessness, without the morbid thoughts, without the intrusive thoughts, without the feelings of guilt. It allows you to break through the wall that normally holds you back.
If you are interested in further discussion, please email me. I have a lot to say on the subject.
 Run around the block. Do some squads, pushups and crunches. No tools or commute required.
But although I'd be in better health, I'm not sure I'd be any less depressed. I think they are largely separate matters. The times in my life when I've had more such luxuries were much less stressful, but I don't recall them being particularly happier or more hopeful.
The first thing that pops into my mind is personal bankruptcy. Also, I don't know who those people are who would loos their job and anything about the overall situation. Are you responsible for them or do you just feel responsible. Ask yourself how sustainable your current approach is. If you brake down in a few months will anyone be really better off?
And yes its true, if you follow all the advise above but don't see enough purpose in your life it will still suck.
Though, I wonder if one would actually find purpose if one would follow those rules for a few months. The problem would probably be, that you won't keep up with following the 'rules' because you lack motivation. Thats why I replied this to the medication idea. If you are motivated enough to take medication you should be motivated enough for sport, too. Not getting enough sleep is hardly a longterm solution. Especially when you have to take responsibility for others.
Don't fool yourself. If you keep fighting an impossible fight your body or mind will break down eventually. Its called burnout. I just read an article in German news today , where a nurse who pushed herself over the limit for years ended up in a wheelchair. I can hardly believe it, but the doctors really claim that her legs and right arm got paralyzed because of mental burnout.
Their primary use is to put the symptoms out of the way while you work on stuff, or at worst: keep the symptoms down to make you able to live at all.
Why does legality play a role at all?
Philosophy aside, tylenol will seriously fuck up your day and is entirely legal, while I think we are all aware of certain "illegal" drugs that are completely harmless. It is pretty obvious that these laws are not looking out for our health. Hell, the FDA requires that drug companies load up some legal drugs with tylenol simply to make it deadly. Regardless of my opinion on the rule of law in general, something so blatantly anti-health should be disregarded on the spot.
Modern drug laws are the moral equivalent of laws mandating self-flagellation.
Compared to real mental illness, the side effects of these drugs are minor. Real depression and panic (both of which most people never experience) are more dangerous than the milder, first-line treatments for those illnesses, which are a lot less drastic than frontal lobotomy.
What is important is to separate normal emotions (which can be plenty difficult, but shouldn't be medicated away) from actual mental illness. This is a tough judgment call to make and it isn't always made right, especially with regard to teenagers. For example, if you're sad because someone close to you died, this is normal and you shouldn't be on meds for it. That's not clinical depression; it's normal sadness.
For the record, when the dosage is right, people still experience the normal emotions (sadness when something sad happens, anger when appropriate) but don't have the biological problems (the thought loops, mental fatigue, irrational fear and anger). That's the goal of treatment: not to make someone ridiculously happy, but to remove the purely biological objects in the way of happiness.
It's that 'normal' part that's hard for me. From the inside, I'd say that my negative emotional state is decidedly non-normal, frequently counter-productive, but mostly rational. I'm in my late 30's, in a fine long-term relationship, and unhappily running a promising but struggling small company. Most days I'm miserable but quite productive, the mental health equivalent of a functional alcoholic. I feel I'd easily convince a mental health professional that I'm clinically depressed, but I'm not sure where this will lead.
That's the goal of treatment: not to make someone ridiculously happy, but to remove the purely biological objects in the way of happiness.
My base problem might be that happiness is not a primary end goal for me. I want it in so far as it's absence makes effectiveness difficult, but I'm scared by being distracted by pleasure. What I want is a purpose I can believe in! I worry that what I really need is a complete lifestyle change, and ideally a different world in which to live. I'm torn as to whether settling for greater satisfaction with this one is a good thing.
Have you ever been on a modern anti-depressant? I was on Zoloft for about six months during a bout of really bad depression. I wasn't giddy, I wasn't exuberant, and I was still myself. It didn't make me happy. It wasn't pleasure, it's not an opiate. What it did was reduce the internal, negative dialog, and it made it much, much easier for me to focus on my work. It also made me much more willing to express myself to others, which led to better relationships.
You still have to do the work to improve things which are broken in life. If you work environment is awful, for example, it will just make it more tolerable. Your neighbor will still be an asshole, it just won't bother you quite as much.
What I want is a purpose I can believe in!
I think that's what everyone thinks they want, and what few of us achieve. Also, I think that many times, out dissatisfaction with our situation is less due to the situation, and more due to our own mental state.
I bet there's a lot in your life (e.g. long term relationship) to be fulfilled by, but you probably find yourself focusing on negative feelings around your work.
By the way, I'm very much on the same page as you regarding, "whether settling for greater satisfaction with this one is a good thing," so don't take anything I've written as condescending or negative.
"In the NCS-R, the lifetime prevalence of major depressive disorder among the 9,090 adult participants was 16.2%, with a 12-month prevalence of 6.6%. The NESARC, which included more than 43,000 adults found slightly lower prevalence rates than the NCS-R (13.25% lifetime and 5.28% 12-month), perhaps because the sample included previously omitted groups of individuals with lower prevalence rates (655). A number of sociodemographic factors appears to be associated with an increased prevalence of major depressive disorder, including female sex, being middle-aged, being never or previously married, having a low income, being unemployed, or being disabled (655, 976), In the NESARC, being Native American increased risk relative to being Caucasian, whereas being Asian, Hispanic, or black decreased risk."
from the American Psychiatric Association Clinical Practice Guidelines for the Treatment of Major Depressive Disorder
IMO, avoiding Ibruprofen is silly. It's an anti-inflammatory that can be used as a tool to accelerate healing. Medicine isn't about running away from problems, it's about confronting them and accelerating their cure.
How do you feel about your newly drugged up friends?
That's a strange question. You're turning it into an externalized judgment. And "drugged up" seems unnecessarily tinged.
How about, "how have you or your friends been helped or hindered?"
I suggest that you talk to a few people you're close to and see regularly. Tell them that you're going on medication and would appreciate honest feedback from them. It's normal to try a few different medications, as individuals respond differently. Did you tell your friend(s) that they were zombified?
Perhaps. I think it's silly in the same way that a lot of voluntary diet restrictions are silly. As a small college athlete I was bothered by the reliance many people had on it as a regular recovery aid. But yes, in combination with other treatments, for the right acute purpose it can be very effective.
And "drugged up" seems unnecessarily tinged.
I wasn't sure how to soften the question while still keeping it serious. I started with a smiley face and then removed it. I guess the question I'm asking is a little different than helped or hindered, though. I'm wondering more about the side effects than the primary. Yes, they're alive --- but how is it affecting the rest of their personality?
Did you tell your friend(s) that they were zombified?
No. It's a touchy area, and didn't feel appropriate.
This bears more emphasis. I was on medication for a very long while and whenever someone asks me how I got to where I am now, I'll jokingly say a very lengthy and close relationship with various different anti-depressants.
Of course this ruffles feather in people in all the wrong ways, but its the truth. Anti depressants and psychotropics aren't going to magically cure you, but they are going to help you get to that place where you can figure out what's wrong and work towards getting better.
The other thing that has really influenced my thinking is how it is for people I love to live with me. Doing something to treat depression might have a noticeably positive impact on them. So even if my preference was to not receive treatment, based on a sense that the joys I love about life might become muted, or that I might not be able to think as well, or whatever, there are other people to consider.
My desire to socialise atrophies, I do not feel like leaving my house, I want to focus harder and harder on creating things, learning, etc and I have less and less time for "normal life". It's possible to focus on what I'm drawing away from and characterise it as a loss, but to my view it is simply a sacrifice I choose to make of my own free will for something that I find more valuable.
To my view removal from the tribe is not terrifying, it is not even undesirable. You lose some things, but you gain others, as with any narrow focus. There is no single right interpretation of what that actually means. Until you add in the subjective values of the interpreter, it's just a set of occurrences.
I also found out on myself that one may become tired for some type of activity, but I could switch to another type of intellectual activity giving a rest for the other. This is like switching to an activity using your arms when your legs are tired.
Every depression or burnout is different by its cause and they way we react to it. One should be carful with popular advices. I believe in the need to rest and get a break from what is exhausting. Then work out the small positive steps, etc. Or switch activity. Checkout vitamins, B especially.
That might be the case, except most of my social interactions are failed social interactions, which make me even more depressed.
So definitely do it, but don't have expectations going in other than you'll get that nice runner's high .
Deep depression is unfortunately a horrible bastard which doesn't allow you even the relief of things which are reliably great for the mild variety, and simply requires other people to help you. So if you find it doesn't shift, go out and get help. That's the hardest thing I have found from my own experience.
At some point a couple of years back, I read some research on insulin sensitivity and glucose tolerance that led me to believe that they are related to some problems with depression and attention deficit. The natural conclusion from the research was that 1) regular aerobic exercise would help out a lot by improving glucose tolerance, and 2) improvements or impairments in insulin resistance/glucose tolerance would accumulate over time.
That implies that intensive cardio may be beneficial, but it's not a magic bullet. It's not as important as making regular aerobic exercise a lifelong habit. So it has to be something you do even if you don't have a particular goal in mind on any one day.
To that end: whatever you do for exercise, enjoy it. Don't feel like you have to run yourself into the ground. Plant the habit and help it grow.
Oh, and also - for similar reasons, easing up on simple sugars and white bread is a good idea, too.
The process of getting fit, changing your diet and working out, will keep your mind off the depression. It will give you more strength and energy. You will end up feeling better.
Cardio activities also involves small challenges and small wins everyday. This will give you a sense of accomplishment. Its a huge morale boost.
But you have to be consistent with the Cardio, and make it part of your lifestyle to rip the benefits.
I used to (and need to get back to - been slacking off for a month or so now) do burpees. They are relatively quick, with a mix of cardio and some strength training, and hardly take any time at all.
I usually do the "pyramid" that is start by doing 11, then a minute break, followed by 10 all the way down to 1. It takes me roughly 15 minutes, but I end up feeling really good after that.
Also, taking a break from arduous mental activity is a good thing - watch movies, read fiction, step outside with a point and shoot camera and take pictures. Anything that let's your mind relax for a bit.
Finally, I have found that meditation really helps. It helps to slow you down, improves focus, and the world really seems different once you get used to it. Just concentrate on your breath, for 15 minutes a day (or twice a day) and everything seems a tad fresher and clearer.
Of course, this article (and the comments) have got me thinking about a vacation. I don't take enough time off and I should.
i am currently try to adhere to the "Paleo diet"...this may a bit too much for a lot of people (and also hard to do in western society) but eating healthy whole foods and cutting out sugar, dairy, grains, caffeine...makes a huge difference in terms of overall health.
Then I take it you haven't been paying any attention to the news this past week.
There are literally thousands of academic studies on depression. Is it really too much to ask that people learn something about the major findings in the field before giving others advice? Sorry, but it's extremely irresponsible to start taking drugs (or recommending them to others) without reading up on the academic research on what they do, whether we're talking about smoking crack or taking something your doctor prescribed.
That is not hyperbole. Suicide is a very real potential side effect of depression. Notwithstanding that, life is so gray and dingy when depressed that it feels like one isn't living in any meaningful way.
The other problem with this position is that it presumes the correctness of your view. Let's presume the opposite--that for the majority of people the drugs worsen the course of the illness, as per my post before. If this is the case, then your comment is the one that's doing all the harm.
So what happens is the depressed person hears comments like that above and, in a situation where doing anything for themselves is almost impossible, thinks, "I should make sure I am an expert on these drugs before I seek treatment", but they never do the research.
I'm an exceedingly educated shopper when it comes to medicine, to the point that I've taught my doctor about some medicines, but there are certain times where it is better to just get into the doctor and start moving forward. Antidepressants and psychotropics are inconsistent at vest and require experimentation anyway.
Finally, I think it is an extreme, and dangerous, straw man to take the position that, for the majority of people, antidepressants will worsen their condition.
These are the kinds of comments I have personally received while sitting at the bottom of a dark hole. All those comments did was make it harder for me to get the help I needed. Severely depressed people are not rational and saying, "you should do all this rational stuff before you get help", is patently harmful.
Again, there is an entire literature devoted to examining this claim. You don't just get a free pass on claiming this is true when there are hundreds of scientific studies looking at whether or not this is actually the case.
"I think it is an extreme, and dangerous, straw man to take the position that, for the majority of people, antidepressants will worsen their condition."
Again, it's not an opinion question, there is actual research.
"Severely depressed people are not rational and saying, 'you should do all this rational stuff before you get help', is patently harmful."
You are defining getting 'help' as abdicating all personal responsibility, and doing something with unknown safety and efficacy. This is completely irresponsible. There may be certain cases where the problem has spiraled out of control to the point where it's unavoidable, but as a general recommendation this is really crappy advice.
Yes, depression does make it harder for people to think rationally, and it does sap one's energy. But it's not all black-and-white. Some days are better than other days, and even moderately to severely depressed are still be capable of reading books and using Google most of the time. Otherwise bibliotherapy wouldn't be such a popular treatment.
I knew drugs were an alternative, but I followed the same thinking you are encouraging. I would do a little research on drugs, find the one post where somebody said the drug didn't work or some side effect was bad or some withdrawal was painful. That was all the research my broken thinking could do, and it ruled out every single drug that might have helped me.
I finally threw myself at my doctor's feet because I was close to suicide and I cared just enough about my kids to not want to do that. I had to let somebody whose brain wasn't broken do the thinking for me or it was over.
So while I agree people should be informed and drugs shouldn't be a first choice, I strongly object to anybody saying things that get in the way of people who are in the depths of depression I've experienced from getting help, which often does require drugs to break the mental feedback loops that get formed.
Conversely, drugs should not be taken without counseling to help retrain negative thought patterns that made it so difficult to get better in the first place.
No argument, did I ever say or imply otherwise? There's no doubt that drugs are sometimes the right choice, but the author was basically saying that drugs are always the right choice, which is moronic. People should make intelligent and informed decisions, it's part of being an adult.
Huh? That only reinforces his point. Millions of people are on cholesterol medication. People have an irrational, negative reaction to medication related to mental health, yet cholesterol medication is socially acceptable. He wasn't discussing efficacy, he was discussing willingness to use medication.
Whether or not it reinforces his point is irrelevant if his advice is wrong to begin with.
It doesn't. But people should be questioning whether the longterm use of HDL-raising drugs is a good idea, because it's highly uncertain whether this is actually the case.
The reason why I quoted it is that this common mistake is symptomatic of the same kind of sloppy thinking throughout the rest of the piece.
It's not an opinion question, there is actual research that's been done on this.
Sure, the actual depression is something physiological (neurons firing, hormones, whatever). That doesn't imply that it is caused by physiological malfunctioning.
1. Running. (Strength training is good for many other goals, but frankly handling heavy objects isn't safe when you're severely fucked up and can't see straight. I can run even when I'm pretty deep in the hole and it has an almost curative effect.)
2. Making friends.
3. Starting a project I was actually successful at.
4. Learning not to tie my self-worth quite so tightly to my performance. The notion of "human dignity" -- the idea that all people have worth, even the ones who have personal flaws or make mistakes -- is really important.
The dog got me out of the house. Where I met people and other dogs.
- first thing, check for physical causes (thyroid, etc)
- listen to motivational/inspirational speeches by people who made it
- get out of your house! Be among trees as much as you can, and get as much (indirect) sunlight as you can.
- work out: both cardio and strenght training. Regarding strenght training, bodyweight exercises are fine. Regarding cardio: do not run! Unless you have proper technique, you can injure yourself. Fast-paced walking is OK. Other favourites: stair-climbing, biking.
- watch what you eat: avoid high glycemic-index foods
- avoid consuming too much alcohol
- don't be alone all the time
I've only been happy at two jobs. At one, I shared an office with an awesome guy, and our personalities and senses of humor meshed well. We had a significant overlap in musical tastes, and enjoyed sharing music and witty banter throughout our days of work.
The other was a startup where five of us worked in an open room, regularly taking breaks for coffee and lunch together. We had a bat-shit insane CEO, which really gave us something to bond over. :-)
Looking at job postings is overwhelming. 50% claim a "work-life balance!" and a "work hard, play hard!" attitude, where I'm betting the work is harder than the play. The rest talk about "entrepreneurial spirit" and other codes long hours and isolation. It saddens me that listing hobbies and interests (more like passions) on a resume is considered unprofessional.
People are respectful with you need to get shit done but are also very social when you want. They also host a lot of events (at least one per week doing something - happy hour, game night, lunches, bowling, movies) which allow you to really meet the people working there if you want the social stuff. It's a great model to keep yourself not feeling isolated and productive.
But, of course, those periods never last forever. Eventually, the business changes, people come in or leave, and the company dies or takes another direction. The creative period may end suddenly, without ever resulting in a shipping product.
So the real issue - if you're looking to maximize "work happiness" - would be to find some heuristics at the resume or interview stage to determine who's actually got the mojo at any point in time. That, or find a way to constantly bring that spirit into a more independent business situation.
6. Exercise, with a mix of activities: swimming, running (outdoor is better) and strength training. He mentioned that the brain interprets social isolation as a sign of low status. It also interprets physical activity (or the lack thereof) much in the same way. Using your body (running, swimming, hiking) tells the brain that you're an alpha and that it needs to step it up a notch. Mild depression is when the body and brain go into gamma mode (more severe depression is a biological dysfunction of that system) which would be a form of hibernation, as observed in medieval mountain communities during winter, but society isn't tolerant of that, so it leads to misery. (Some mild depressives would be fine, aside from the loss of time, if they could sleep 11-14 hours per day.)
7. Avoid cigarettes at all costs. Use alcohol sparingly: one drink is fine, but it takes a week to recover from a night of serious drinking... and if you're coding, you actually notice the loss. Avoid drugs like cocaine and heroin like the plague. Jury's still out on occasional use of LSD or shrooms (but people with any history of mental illness need to be very cautious) but they certainly shouldn't be a habit.
8. Relax. Sometimes it's necessary to spend time in the woods and just (sorry for sounding hippy-dippy) be mindful. 24/7 Internet connectivity is not always helpful.
9. Read novels and watch movies. There's something healing about narrative that isn't provided by (as much as they are enjoyable to read) books about formal semantics of programming languages.
10. Music. It helps. I have a lot of friends who say they never would have gotten through their teenage years, or a bad turn of business, without music.
11. Go somewhere new, do something different. It doesn't have to be an "exotic" or expensive vacation; if your goal is to heal, it's better that it not be. Just a trip to visit friends 50 km away can help.
12. 2 weeks of real vacation, as an absolute minimum, per year. Take unpaid leave if you need to. Four weeks is best. Total productivity is maximal at 3 weeks of vacation and per-day productivity is maximized at 7-9. Europeans have it figured out: you need two types of vacation: exploration vacations to new places (Alaska, Cambodia, Andes) where difficulty and stress are OK and relaxation vacations where stress levels are low and variation of activity is not required. Unfortunately, Americans get stuck having to choose one or the other, and generally do only the first kind of vacation when they're young and only the second kind when they're old.
For the record, if you only get 1-2 weeks but can take unpaid leave without it hurting your career, you probably should. A 2% pay drop for an extra week of vacation is worth it IMO.
13. Fruits and vegetables. The casual arrow is unclear and probably goes both ways, but depressed people tend to eat a lot of white carbs. Americans tend to get dieting wrong, as if it's some set of religious prohibitions that have to be followed to the letter, when in reality there are few foods one should never eat. Instead of dieting negatively ("I won't eat X") it's better to diet positively and replace unhealthy foods with better alternatives (e.g. 70+ percent of your desserts should be fruit).
14. "Don't fuck crazy". High-power programming/technology, as a career, is only 10-20% more time-intensive than the average job-- you haven't seen bad hours till you've worked on Wall Street-- but it's 200% more energy-intensive. You need a supportive and decent partner who will be your rock of stability, not someone who will drain you.
The act of walking every morning to get a Starbucks and paper is what I credit with recovering from a sinkhole like this. I've a tendency to duvet and hope the world goes away. Of course, it's hard to motivate yourself to get outdoors when you feel like that - I was actually told to by a counsellor and had to report back to her, so I felt I had to do it.
Breaking tasks down was the second most effective thing that worked for me -- having an external person to describe the task to and what I should be doing was the catalyst here (anyone can break a task down in their head but jumping over the six foot high brick wall to get started is the hard part).
This goes inline with working out, but it's certainly harder to convince yourself to do 45 minutes of strenuous workout vs a nice long walk with your best friend(s). I figure, even if I'm sick, tired, and my body aches, I can always walk miles.
at most times i'm in the middle of 4-5 books minimum
About working on hard problems - personally I'm at my best when my mind is relaxed and entertained. I have a hobby (photography) and I also like spending time with my 11-months old baby boy.
If you can't find the time to read a book or do something you like other than programming, your mind doesn't stay still, even when programming, no matter how much you like it. You'll always be thinking about your next next project, or about that new and shiny tool you are dying to try out but don't have the time, or about how you're going to save the world someday with your awesome software. Your mind and body crave for other activities other than programming, even if you don't realize it.
Also, TRY DOING NOTHING every once in a while. It's a lot harder than it sounds, but does wonders for your attention deficit.
I disagree. Perhaps this is a personality issue and not a fault, but like the person above I'm always in the middle of many books. This is optimal since I'm letting your mind ruminate on the info, rather than just taking it all at once for the sake for completing it. They key is to take good notes (assuming technical books) and reviewing them each time before starting on the new info.
That's said there's certainly something to be said about sitting still and doing absolutely nothing.
It takes effort and focus to get into a new book. Maybe you can bypass that by just re-reading a old favorite?
Just a suggestion. Obviously, this may bore you.
However, I don't dive into too many books at once though. I have a rule for this, to restrict myself and keep reading what I began. I can only be reading one novel, a few (2-3) technical books (on programming/software engineering/...) and one/two books on startups at once. I don't know how to fix this, but I'm okay with it I guess.
With those beers I finally just let go and put what I have been thinking down on paper, I can finally concentrate. Now I haven't been diagnosed with ADD or ADHD but I have a hard time concentrating mainly because my thought processes are already 100 steps ahead of where I currently am and are thinking about things that are completely irrelevant for now.
If anyone else has experienced this, or knows what I can look for in myself/and start improving please let me know. I really would love to be like my co-workers who can just instantly dive into a task and have their mind focused. I always feel like I am not able to produce the amount of work they produce because I am so easily distracted.
That is not to say that what I ultimately produce is not good, no it is fantastic, it is well thought out, takes care of the little details like memory management, but it takes me a long time to get it done.
In other words, we can do science to ourselves.
The thing that has helped me, as stated before, is alcohol. It allows me to concentrate and just get code down. Now do I think that is good for me and or my body? No. I would rather have my full brain capacity to work just as hard, I want to be able to focus on one task.
That is why I was asking if other people had found the same, and what they were doing about it, or how they were solving the problem.
Pot slows it down to roughly the same speed that i can work at. It does not make me stupid or turn me into a 'stoner'. I am more productive when under this influence, and I write better code. Obviously, this is not a solution during work hours for me either.
I tried SSRI's for about a year and did not find a medication that 'Worked for me' in that time. Some of them were downright worse than the disease, so I stopped taking them.
If you work it out let me know :P
For different reasons the same works for me. I've had OCD that has gotten worse/changed over the last 7 years since I started having problems. I've been on various SSRIs that help, but not in the ways I need. About one beer is what I need to be able to focus and accomplish something and be happy with how I spend an evening.
Frankly, I would have never finished college were it not for a strange mix of kidney-liver assaulting caffeine/alcohol liquids concurrently being imbibed. At times it seems the solution is the same for writing code for extended periods of time..
I'm going to bet ADD. I was never diag'd either.
This questionnaire http://easydiagnosis.com/cgi-bin/expert/start.cgi?mod=Attent...
is reportedly quite accurate for the adhd diagnoses.
Wow, 86% probability for me. Sounds high enough to seek medical advice I suppose? And I thought I'm just an average persone like everyone around me.
ADD though, not ADHD.
Edit: apparently they are the same thing according to Wikipedia.
I just tried this test and scored a 99% for ADD (ADHD was recently changed to be all encompassing - you can have either inattentive or hyperactive or both).
1. I came to conclusion that there are things that induce/ fixate short attention span patterns and things that help induce/ fixate long attention span.
The first are news, jokes and basically everything that makes you switch topics very often. The second are playing a few hours of Civilization, reading long books, basically things that are enjoyable and require a long focus on the same topic.
So you can at least move the first type of activities to the end of your work day, and do the second type before the work.
2. There are problems with concentration related to deep hidden fears that you used not to notice for years. "Core Transformation" by Connirae Andreas is a great tool to fix that and a lot of other mental blocks.
3. There is some noticable effect from taking nootropics like Piracetam. Expecially the first time if you never did it before.
I discovered the same thing. Alcohol stops the overthinking and lets me get stuff done. It seems that alcohol is a substance that different people react to very differently.
... sad thing is for most people at the doctor's office this isn't unrealistic at all.. Oh and if they say 'one drink' make sure you ask how big!
Obviously a cigar is still bad for your health, but having something that forces you to go outside for an hour can be a good thing ;)
So, the long-term effect of a bender is to upregulate production of alcohol dehydrogenase in your liver, which allows you drink more before you're drunk, but also allows you to pickle your liver faster. That takes a long time to recover from. That and the physical dependency. And the obesity. See, the liver saves you from killing yourself by turning that EtOH into fatty acids. And, since you probably ate a fair bit too, you'll get a lot of fat there. If you don't eat, you end up with Vitamin B12 deficiency. Even well-to-do, upstanding drinkers with the self control to not eat while drinking may end up with numbness in their extremities due to that.
Now, as for the short-term recovery from a bender: you need to hydrate before you go to sleep and then probably during the night. If you wake up in the middle of the night with heartburn, it may well be from the temporary gastroparesis induced by the alcohol. Drink some water and stay upright for awhile. Some advil will probably help. Then work out the next morning and, then have some coffee. Then eat. Preferably some yogurt to replace the gut bacteria you poisoned the night before. Then accept that you'll be cranky for the rest of the day. You're neurons generally aren't happy when the neighbors die.
But 36 hours after, when you wake up the day after the day after, you should be fine. Minus the alcohol dehydrogenase, fat, dead brain cells, and extra 1/2 lb of fat.
DTs occur in patients undergoing life threatening alcohol withdrawal. These people have often been drinking upwards of a twelve-pack of beer a day for years.
Almost all alcoholics lie about their drinking. This is expected in both ambulatory and critical care. Implying that this patient's alcoholism killed her because her liver couldn't handle the anesthetic is disingenuous at best. If you're talking about a patient who was admitted with DTs, she should not have even been administered an anesthetic. If it was something else entirely, from the limited information you've provided I have to find fault with the anesthetist. The Glasgow Coma Scale is your friend, and it (and other scales of conscious) must be constantly used.
A single bender is not going to upregulate liver enzymes, just like a single dose of medication won't. It takes weeks or months of consistent exposure to make that happen. Again, this has nothing to do with the original, uncited claim that a single night of drinking takes a week to recover from.
And finally, do not recommend to your heavy drinking patients that they should take ibuprofen. NSAIDs, by virtue of their nonspecific effect on cycloxygenase, decrease the protective prostaglandins that are produced in the stomach to maintain the mucosal lining. Taking Advil after a night of heavy drinking is only going to make it more likely that the patient throws up blood the next day and needs to go to the hospital. NSAIDs have absolutely no positive effect on acid reflux - they will only make it worse. If a patient has heartburn, give them the obvious recommendation: take an antacid. Heartburn is not the same kind of discomfort as hitting your thumb with a hammer.
Coffee before food will make this heartburn worse due to the acidity. Again, a single serving of yogurt isn't going to have an appreciable effect on your gut flora. You need to be eating it regularly for a few weeks before the bacteria can overcome your natural defenses and the other flora to colonize.
This is all misinformation you've provided, and it's not even relevant to what you're replying to.
With regards to your specific concerns:
> DTs vs anesthesia
These were intended as two separate examples. I could have made that more clear. I absolutely agree, anesthesia is a very bad idea for someone in DTs. The larger point being, alcohol is a bad idea.
> A single bender is not going to upregulate liver enzymes
I argue a single bender will upregulate liver enzymes. Not a lot, but a little. A single workout will build muscle and improve your physical fitness. Not a lot, but a little. The larger point no doubt being one you're in favor of: alcohol is a bad idea.
> do not recommend to your heavy drinking patients that they should take ibuprofen
I would not recommend a heavy-drinking patient take ibuprofen. That said, alcoholics in the hospital vomiting blood are classically associated with esophageal varices due to a cirrhotic liver, which bleed spontaneously and then they vomit. They are not coming in for gastric ulcers, which generally require days to weeks of NSAIDs, and are more classically associated with aspirin, which irreversibly acetylates the COX enzymes, whereas ibuprofen binds reversibly. The larger point being, alcohol is a bad idea.
> Coffee before food will make this heartburn worse due to the acidity.
I didn't recommend coffee as an antidote to heartburn. I recommended some water and staying upright. The coffee recommendation was for the next morning. The caffeine will activate cAMP, causing some dilation of cerebral blood vessels, getting more profusion to the noggin, helping overcome the headache. The larger point being, alcohol is a bad idea.
> a single serving of yogurt isn't going to have an appreciable effect on your gut flora
Are you arguing against yogurt?
Let me take the opportunity to suggest that I don't advocate drinking as a solution to problems. Quite the opposite. But keep it coming. Glad you came across my comment. Look forward to seeing you around.
Anyway, I'm glad we clarified things.
What I was initially looking for was something to back up the claim "it takes a week to recover from a night of serious drinking.". Niels is arguing that this could be true for alcoholics with DT. While I wont argue that, I don't think the original statement was referring to alcoholics, but rather anyone who goes out for a night of serious drinking. I haven't seen any proof for the original statement.
I'm not a doctor in any way, shape or form, but I would still like to argue the running point in Niels' second post, alcohol is a bad idea.. Overconsumption, yes, but that's true for almost anything. I don't think smaller amounts is a bad idea -- on the contrary. I recently heard a statement that the UK recommended limit (21 units per week) was just made up, and studies have shown that you're more likely to live longer if you drink around 40-50 units per week (somewhere after that number, the life expectancy starts dropping and goes below the life expectancy for people not drinking). I'm afraid I can't remember where I heard/saw it though, so I'll have to leave a  for myself for the time being.
Are active, stress-free people more likely to have a drink with dinner, or is a drink with dinner helping to relieve stress?
I quite enjoy having a drink after work, especially if it's been a lot of pressure during the day. It helps me relax, disconnect from the work situation. A couple of beers and non-work-related chat will take my mind off any stressful work I've been doing, which could otherwise carry on in my mind throughout the night.
Mixing alcohol with advil to relieve an upset stomach sounds like a dubious idea. Why not just vape a little weed, which would not only work better, but also doesn't come with the risk of dying. Plus using weed may help reduce the brain damage caused by drinking.
and I thought it was the ascending aortic dissection that traveled all the way to the right iliac branch whereupon the false lumen completely blocked any indication of a pulse for a period of at least 8 hours (in the ER, while the attending followed the wrong path on his ddx).
11 hours of surgery followed.
but seriously.. I'm sure it's the beta-blocker they have me on as a result (reducing contraction velocity).
(and I've all but stopped drinking since the surgery.)
The causality runs both directions here. For example, the adverse childhood experience study shows that having an abusive childhood makes one dramatically more susceptible to drug abuse and mental illness:
However, drug abuse also greatly increases the risk of depression and other mental illnesses. There are probably several different mechanisms here. For example, alcohol causes inflammation. Inflammation seems to be one of the things that causes depression:
Also, once one has an alcohol dependency then one is going to suffer depression whenever one isn't drinking. It's the same thing with any drug. E.g. you can smoke weed one or two times per week, or you can smoke weed 30+ times per week, but if you smoke weed say 5 times per week then you'll just be depressed all the time except for right after you smoke. (Because depression is a symptom of withdrawal, and you're essentially permanently in withdrawal.)
There is also a strong correlation among mental illnesses: once you get one (any one), you are statistically more likely to get one or more of the others within your lifetime. It doesn't help that they are often overlapping, though (e.g. bipolar disorder type 2 - bipolar depression). From the American Psychiatric Association Practice Guidelines: "in a study of patients in psychiatric treatment in the United States, 84% of major depressive disorder patients had at least one co-occurring condition: 61% had a co-occurring Axis I condition, 30% a co-occurring Axis II condition, and 58% a co-occurring Axis III condition (978). Anxiety disorders were the most common co-occurring disorder in the prior 12 months" (http://www.psychiatryonline.com/content.aspx?aID=655908)
As a slightly different example, 80-90% of schizophrenic patients smoke. This is because the stimulating effect of nicotine tends to improve their negative symptoms by increasing dopamine levels in certain parts of the brain (for about 15 minutes or so... then they need another one).
As far as alcohol causing depression: alcohol /is/ a depressant. It binds to GABA receptors (among other receptors) and increases sedation, decreases mental activity, etc. (GABA is the primary inhibitory neurotransmitter of the brain).
Inflammation as a cause of depression is not really significant right now. Look at our classes of antidepressants: tricyclics (which work in depression by inhibiting the reuptake of serotonin and norepinephrine), selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, dopamine reuptake inhibitors (bupropion is mostly what I'm going for here, though sertraline also has some dopaminergic activity), serotonin receptor agonists (e.g. trazodone), and alpha-2 antagonists (mirtazapine - it indirectly increases serotonin and norepinephrine levels by blocking autoinhibition of alpha-2 receptors in the brain). None of these have noteworthy effects on inflammation, and all of them are effective in a modest population of patients (unfortunately only about 1/3 of patients achieve remission on their first drug trial, regardless of which one). Inflammation isn't really a significant theory of depression right now, although I'm not saying it doesn't exist. Mental illnesses are unbelievably complex and medical science is only beginning to catch up with our needs.
The fact that taking drugs that mess with your neurotransmitter levels can sometimes alleviate depression doesn't prove, and isn't even particularly strong evidence for, the idea that depression is caused by some sort of neurotransmitter imbalance. Wearing perfume can also alleviate depression in some people, but it would be ridiculous to claim that depression is caused by a lack of Chanel No. 5.
There are certainly many theories, and depression is a complicated disease. It is primarily modified by neurotransmitters, however. That much should be clear. Beta adrenergic receptor sensitivity and downregulation are also involved - but to what extent? Hypersecretion of cortisol (or lack of cortisol suppression) is also a factor - but to what extent? Even thyroid hormones are implicated.
Like I said, I'm not saying there is no inflammatory problem in depression - I said that we have no antidepressants based on this idea (and as far as I know, there are none in the pipeline in at least Phase II trials). Do I think inflammation is involved? Yes, I do. Do I think it's directly going to lead to more treatments for depression? No, I don't.
Virtually every form of sensory stimulation has been shown to ease depression, from aromatherapy to acupuncture to exercise. What makes you think that neurotransmitters are the root cause of the problem? To me the fact that no matter how you mess with the neurotransmitters it eases depression shows that this is a function of sensory novelty, as opposed to some neurotransmitter imbalance being the root cause.
"There are certainly many theories, and depression is a complicated disease."
What makes you think it's a single disease?
have friends that take antidepressants and are ok. while others became totally disconnected with other peoples feelings, like they are small kids again. zero emotional intelligence, even tough they themselves seem happier.
btw, recreational drugs are better understood by medicine.
The problem is me, not my environment. I have to change.