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Depression lies (wilwheaton.net)
496 points by bane 1839 days ago | hide | past | web | 229 comments | favorite

We have an incredible capacity for denial and self-deception. For years, I would periodically drop into severe depression; I would stop sleeping, stop eating, stop answering my phone or email. I wouldn't leave my room for weeks on end; on a few occasions I was so successfully reclusive that people worried that I disappeared or died called the police to investigate. A few times I almost did die; I think the biggest reason I never committed suicide was that I didn't have the willpower for even that.

Years. Call it 6, with bouts every 8 months. One semester of 'A's, one semester of 'F's.

Of course this caused me to fail classes and lost me friends, opportunities and respect. But every time I recovered I thought to myself "Wow, that was awful. Glad I'll never do that again!" I had to lose my fiancée and my funding in grad school before I finally accepted to the fact that this might be a problem. That there might be a cause other than being lazy. Because, you know, laziness makes people curl up in an empty bathtub and cry for 24 hours. That's normal, right?

Thanks to Wil for posting this. It's important to reach out to sufferers as well as their friends and family. It takes a lot to recognize when you or someone you know has a problem, even when in retrospect it's blindingly obvious.

I think the biggest reason I never committed suicide was that I didn't have the willpower for even that.

One of the most dangerous periods for depressed people is shortly after they start treatment. They are still depressed, but suddenly have the energy to commit suicide, and a certain fraction of them do.

My wife lost a cousin that way. :-(

Also consider that many SSRIs actually list suicidal urges as a side effect. In my transition from Celexa to Prozac to Effexor, I've found that transitioning period to be particularly bad. Not to go into too much detail but I've done things of late I never did before and my doctor has said it's likely my change in medication. They say things need to be at their worst before they can get better. That's my mantra.

Effexor literally made me think and act in ways I never had before. There's the disassociative feeling you get from depression, and then there's what Effexor did; effectively making me a ticking time-bomb with an insanely vivid, active (and morbid) imagination. Really dark times, and coincidentally a few months after I'd quit it, Time magazine had a cover article about the rise of [teen] suicides because of it.

Can I ask what you switched to after dropping Effexor? My email is listed in my profile if you wish to answer privately.

Quite honestly it scared the shit out of me to the point where I no longer felt safe seeking aid from people who claimed to have answers. At the end of the day, none of the other anti-d's I'd tried (all of the major ones) did anything but take any emotions - negative or positive - away, and that's not how I wanted to live. For years I wasn't on anything, but more recently I tried Wellbutrin to similar results. As such I've made it more of a mission to find out what it really is that's causing this, rather than apply a band-aid to what is really just a side-effect of a bigger issue.

I'm sorry anti-depressants didn't work out for you. Luckily I've only had to try out two different types before finding the one for me. Wellbutrin was my first ad but it made me feel like an emotionless robot. I then got on prozac and rather than make me a robot it made me feel normal. Not exactly happy but definitely not sad. Which is what I was going for anyway. Good luck, also, if you didn't try therapy, i suggest you do.

They're often on the tail of years of anxiety and depression, plus environmental stressors which aren't going to disappear through talking or medication.

Sometimes you take a pill and the problem is solved. But often, it's a matter of a struggle for better, not fixed. Or a decision between the illness and the side effects of continuous medication.

But ignoring it is a terrible option.

I had the same problem. My depression had been latent since early HS but it really manifested when I began college, and my grades were horrible as a result despite having been a model student until then(well, until the last year of HS; college only hastened its development). I'm 29 and I've since gotten treatment but the effect on my professional development has been incredibly damaging. It's less a stumble out of the gate than a foot shot.

I know intellectually that I've achieved as much - or possibly more - than my typical peer because I've worked through my problems and traumas and come out the other end alive and healthy, but they're still the ones with the comparatively advanced careers, living in nicer cities, and taking care of their young families while I'm still working saw jobs in the midwest and living, alone, in a studio apartment.

But I'm alive, and I'm able to finally live a normal life, which is priceless.

Comparing yourself to others is an easy way to think negatively and possibly even descend into depression. It's important to accept who you are and what got you there and not think that your life would be so much better "if only things had been different". Things weren't different. You were given the genes you were given from parents who you didn't choose and countless other variables influenced you to become depressed and then recover at the time you did. No need to feel bad about it.

I don't mean for this to sound like a personal attack. I'm in a similar position to you and I've found it incredibly rewarding to realize that it is useless to worry about the past and what could have happened.

I would say "Maybe".

Maybe they have better lives, or maybe they are (or will be) depressed like you were.

The point is, you don't know, so enjoy you live, I think you deserve it.

Cannot edit anymore, so what I wanted to say (I was not very clear) is : The lives they have is not necessarily as nice as you picture it, nor yours as bleak as you think. In the end, I would not really think too much (even if I know it's hard) about them. After all, they might had enormous advantage, or actually a shitty live, because everything is too perfect or maybe they struggled so much to be where they are and so, are exhausted intellectually and depressed.

You achieved an incredible feat by controlling your depression, I'd be proud of it.

Knowing you "have a problem" doesn't mean you or anyone understands the problem or what to do about it. And even if you know what to do, doesn't mean you can do it either, the psychological, social or just practical barriers can be impossible to climb.

Medication has a statistical significant effect, but is often marginal at best, and most of the effect is placebo.

And this assumes an accurate diagnosis, and don't count on that, I have had the head of psychiatric care of a major European capital say to me that the science of psychiatric diagnosis is basically worthless, I wouldn't go that far (the split between research and academia and practice is also a huge problem), but is nowhere as simple as some like to make it seem.

People and lives are often much more complex than that and much more significant factors.

Doctors can also do much more harm than good, locking people up in horribly depressing kafkian institutions because they are suicidal is one of the most insane things I have seen in my life.

Imagine what it feels like being locked up against your will, treated almost like an animal, when you have done nothing to harm anyone, and being told it is "for your own good".

Knowing the problem is depression and learning to recognize how depression affects me has led to big improvements for me. It doesn't stop me from getting depressed and believing all the same old lies, but when the depression lifts, I get to enjoy not being depressed right away. Before I understood depression, the lies depression taught me tended to stick around. They were part of how I thought even when I wasn't depressed, and I wasted a lot of energy debating them with myself and fretting about problems that were insoluble but weren't really problems. By the time I started feeling hopeful about life again, the next depression was already right around the corner. Now it's much easier to shrug off those false beliefs when the depression lifts and just enjoy being relatively normal for a while. That doesn't mean I won't get depressed again, but depression casts less of a shadow over the non-depressed times of my life.

As a really crude analogy, imagine somebody slips a hallucinogen into your drink and you end up having a terrifying conversation with God where he addresses you as Satan, and for weeks afterwards you obsess painfully about whether you're evil or maybe you are actually Satan somehow, living in fear of what will happen next, versus knowingly taking a drug and afterwards saying, "Wow, that was shitty. I thought I was Satan, LOL." In both cases the experience is horrifying and real, but in the first one, the experience continues to be horrifying and real for a long time afterwards. In the second one, only the memory remains real.

Absolutely. I haven't seen anybody mention David Burns' book "Feeling Good" but it probably saved my life from a descent into insanity. It's my "bible" now. I knew something was completely and absolutely wrong with my self-destructive thought patterns but didn't understand what until I learned about Cognitive Behavioral Therapy (CBT).

A sad observation: everytime I encounter a struggling friend with dysfunctional thought patterns, I work through their thoughts using CBT techniques (without mentioning that's what I'm doing). This almost always results in a calmer friend who starts feeling better about the situation, or at least more confident in their ability to deal with it.

I then tell them what I'd done to improve their emotional state and how they can learn to do it for themselves by pointing them to CBT and Burns... and a few months later I find they still suffer from dysfunctional thoughts and haven't bothered following my advice.

Funny thing is I was the same; it took a bout of severe depression and reading "Feeling Good" exactly at the time when I could introspect my severely dysfunctional thought patterns for me to accept my situation (having purchased the book a year previously but being dubious about its claims of my "mild" depression at the time). I don't know if this is social conditioning (only "weak" people get depression) or general ignorance of the fact that the mind needs "maintenance work".

I do think it is great you take the time to help them like that; I also think this isn't something you should be doing, basically taking them through a "mini therapy".

Now, granted, the line between "I just wanted to cheer them up" and "I showed them CBT" can be blurry but as soon as you take it onto yourself to actively make them better, I'd say you are strolling down a path you shouldn't. The main reason being I doubt you are an expert. The other reason being that it can affect you because you are close to them. And lastly I do not think just one such hint in the right direction is going to help the person suffering. Practically all therapists and people who have ever taken therapy will tell you just how much it feels like 1 small step forward 2 steps back, how much of a constant struggle it is. Changing a behavior is never easy, much less so if it is something that was "programmed" into you since you were a child, something that is your very view of the world. Understanding the mechanisms and a few techniques of CBT can be empowering, absolutely, but it takes so much more to actually make them work and work in the long run, to actually make you feel better and get out of that hole or to change... and not all people have that much energy or ability to introspect and watch themselves what they are doing AND then come up with ways of making it stop. Maybe in the long run it would be more helpful for them to just seek therapy?

Whilst I agree it's dangerous to attempt offering people therapy when you don't have the qualifications to back it up, I think you're conflating therapy with helping depressed individuals to recognize their condition so that they may seek therapy.

Believe me I have no desire to rescue people. Been there, tried that. However, part of the problem with people who are depressed is that they don't realise they are depressed. So when you see somebody struggling with dysfunctional thinking you have 3 options:

1. Pretend you have no additional information that can help them and hope they find the appropriate resources themselves.

2. Decide that (1) is unethical and suggest appropriate resources that may help them.

3. If (2) didn't work the last time, acknowledge that sometimes depressed individuals can be either unaware or in denial of the seriousness of their condition. Since you can't force them to seek help, you have the option of asking them the very same questions CBT taught you to ask yourself in the situation. At this point the person hopefully sees the value in what you're doing and is more convinced in the value of your suggestions in (2). At no point do you take it upon yourself to perform therapy.

CBT is based on the idea that we're ultimately rational creatures but sometimes we're not aware of all the factors influencing our cognition. While you ought to have training if you are attempting to perform therapy, you don't need a professional training to point out dysfunctional thinking in someone and point them in the direction of professionals who can perform therapy.

Analyzing, talking through, and attempting to change thought patterns isn't just a clinical technique for serious problems. In my experience, the smaller the problem and the healthier the person, the more quickly and dramatically it seems to work. Other than people who have been in therapy or who have grappled with mental health issues on their own, I rarely see people using it, with one exception: I see the parents I know using it with their children all the time to help them deal with everyday emotional difficulties such as anger management. A decade from now, there might be a generation of adults who consider it common sense and have no idea it originated in the treatment of mental illness.

An excellent point and indeed I see my experiences with depression as a strength I can pass onto my children by teaching them to recognize and handle dysfunctional thought patterns in themselves and others.

You want to talk about statistics, but include anecdotal statements from anonymous sources, and end with an appeal to emotion.

You want to state that psychiatric medicine is mostly placebo, but don't have any good criticisms to levy against double blind studies of antidepressants with placebos.

Given the point of the article was encouraging/helping individuals who have depression to seek medical help, I'm not sure what the purpose of your comments are. It sounds like you had a bad experience with the mental health community.

Just like people who have a bad experience with any public service, I feel for you. I might even look at whether there are systemic issues in the provision of the service, in this case mental health.

But if your intention is to make people question the efficacy and usefulness of mental health treatment for depressed people, then I feel that you are attacking something that many people have fought hard to get, get attention for and get funded, mental health treatment.

Mental health treatment still has a stigma attached to it, that of some inherent deficiency that contributes to mental issues. Adding the unrealistic idea that depressed individuals are going to be locked up and treated like animals isn't helpful in my opinion.

I'm not saying that your experience, or the experiences you are familiar with, was/were invalid. However, hundreds of thousands of individuals who find psychological or pharmacological treatment for mental illness of benefit, and many more could benefit but go undiagnosed/untreated.

"You want to state that psychiatric medicine is mostly placebo, but don't have any good criticisms to levy against double blind studies of antidepressants with placebos."

Because maybe he assumes you aren't too stupid to do a simple Google search. Both Emperor's New Drugs and Anatomy of an Epidemic are extraordinarily well written, it's well worth reading both, and there are all sorts of other good books on mental illness as well.

This is exactly why HN has become like idiocracy, where anyone who takes the time to become well educated about something before speaking is basically called a faggot for reading books.

I don't understand where your last paragraph of bile is coming from. There's been no name calling here that I can see.

Read the section of text that I quoted. Someone who said something that's fundamentally correct is being criticized by a variety of other people who are too lazy to actually do the research themselves. That's the very premise of the movie Idiocracy.

Your language is noticeably nastier than anything you're responding to, here and in another comment below.

Of course you can disagree with, or be upset by other comments, but dialing up the language significantly doesn't do anything useful.

"Of course you can disagree with, or be upset by other comments, but dialing up the language significantly doesn't do anything useful."

While I respect your opinion, personally I think it's much better to have a community where people are occasionally assholes than to have a community where people are giving false and dangerous health advice.

> "it's much better to have a community where people are occasionally assholes"

The guidelines [0] disagree with you. "Be civil" is followed by a period, not by a list of exceptions for when it's OK to be an asshole. Likewise, "please respond to the argument instead of calling names" is followed by an example, not by exceptions.

When people give wrong advice, counter it, but do so without the name-calling.

[0] http://ycombinator.com/newsguidelines.html

"When people give wrong advice, counter it, but do so without the name-calling."

I have been. For several years. You're right of course. From my perspective though it's just extremely frustrating because I try my best to help people stay safe, but day after day people keep thoughtlessly posting the same crap based on what they see on TV commercials or whatever.

Don't think of "people" as a static entity; that's the problem. HN does have something of an "eternal September" effect that everyone has to deal with, permanently.

There's a constant influx of new people, many of whom will learn to contribute more valuable commentary, but haven't learned yet.

It's discouraging, but easier to deal with if you recognize it for what it is.

Pleas leave and don't come back until you are ready to be civil.

I'm not sure that the abbreviated sentiment that medication has little more effect than a placebo is useful in the realm of mental disorders. Depression/anxiety/ocd are very complex because they deal with the brain/mind, which is poorly understood. To suggest that antidepressants only have a placebo effect despite working in animal models of depression, severe depression, certain depressive subtypes, and less severe conditions in rats and monkeys is not helpful for many sufferers (like the author) who might otherwise benefit.

Who cares if something works through the placebo effect, as long as it works. I can't be bothered to look it up at the moment (on my mobile) but I do believe he is correct in that published studies in well regarded medical journals have purported to show just that (effect == placebo), but as I said, from the perspective of the person being treated, does it matter? I agree if it prevents people from seeking help that is bout desirable, but it need not.

Yes, actually, it does matter. Side effects of antidepressants include the period of getting just enough energy to kill yourself, and the risk of serotonin syndrome, especially when seeing multiple doctors for multiple issues, who might start SSRIs in near succession. The list goes on for a ways.

Fine, weigh the risks. But don't dismiss it out of hand. I've used SSRIs off an on for years and can honestly say my life is much, much better for having done so.

The stronger side-effects the more effective placebos. http://www.youtube.com/watch?v=yfRVCaA5o18

The consensus was that it works in severe cases of depression, but milder ones show little benefit.

> Medication has a statistical significant effect, but is often marginal at best, and most of the effect is placebo.

The point of the author's post is that medication made a huge difference for him

Hey's saying: if you have a problem, there might be help for you too.

Your comment was just negative side talk.

I can't read the full article (paywalls...grumble...), but this[1] would indicate better-than-placebo performance for those with major depression.

Please don't spread unsubstantiated rumors on this topic. As many of us know from personal experience, the results of giving people an excuse to say "that medicine doesn't work anyway" can be devastating.

1. http://psycnet.apa.org/psycinfo/1991-19312-001

I've gathered that selective publication of results is the main problem, actually.

Indeed[1]. It seems to be endemic of the entire medical field[2][3] and even further removed[4]. Combined with how difficult (if not impossible) it is to reproduce many findings[5], I would call these the most important problems in science today. Science cannot move forward without all of the data (positive and negative) in a reproducible fashion.

1. http://www.ncbi.nlm.nih.gov/pubmed/18199864 2. http://journals.lww.com/greenjournal/Citation/2003/09000/Evi... 3. http://jama.jamanetwork.com/article.aspx?articleid=198809 4. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna... 5. http://online.wsj.com/article/SB1000142405297020376480457705...

"Please don't spread unsubstantiated rumors on this topic."

You're the one spreading misinformation. How about you actually read some books on the topic before attacking others.

luriel, you added considerably to your post since I first replied, and I feel like it now merits a different response. I agree with almost everything you've said, but feel like your criticism is misdirected and may do more harm than good.

Knowing you have a psychological issue is like knowing your application is crashing for some customers. You might have only vague guesses as to what the triggers are, and no understanding of what's actually going on or how to fix it. But now you are in a position to assess the cost and allocate resources to fix the problem. Maybe it will take years of man-hours (in either case) to handle the problem, but now you have a place to start.

I don't think Wil was telling people to take medicine; I certainly wasn't. The only thing I'd like to emphasize is that Depression is a problem that can be addressed. Don't ignore it. If you have a problem with Depression, do your research; find out what helps, and what doesn't. Stop treating your mental state like it's an immutable part of your environment: change your environment and your behaviors as you discover what you need to be healthier.

"Changes to your environment" might include drugs, and even they don't work over the long term, they might temporarily be enough of a lifeline to help you get to a point where you can start hacking at the problem in other ways. Doctors can be helpful guides on this path; sometimes they're not helpful, but in aggregate, I believe they help more than they hurt. Scaring people away from seeing a doctor by telling them that they'll be locked up in a kafkian institution against their will is liable to prevent people from getting help. Of course this has happened, and continues to happen, but it's rare. I think a much more common (and in aggregate, more serious) mode of failure is people's belief that the doctor is in charge of curing them---that the drugs are all it takes---and that they can't or don't need to work on themselves.

Yeah this post is really harmful. Antidepressants definitely have significant and varied effects, and those with depression should not be afraid to explore their chemical options, especially if it means lifting out of a life-threatening suicidal phase. Antidepressants affect various neurotransmitters in the brain, either blocking reuptake, or providing artificial analogues, etc. To say they provide mainly a placebo affect is just ludicrous, and suggests a lack of understanding of the science, or any significant practical experience with antidepressants or mental illness.

And at least here in the US, there was a little thing that happened in the 60's called deinstitutionalisation (http://en.wikipedia.org/wiki/Deinstitutionalisation). No one is locked up against their will for more than 48 - 72 hours at a time, and even then only if they are deemed to pose a significant threat to themselves or others. Not sure what the situation is like in Sweden, but i can't imagine it would be much different.

Luriel your personal beliefs are ignorant and harmful. Please stop spreading disinformation that could result it people dying or suffering due to not seeking medical assistance for a medical condition.

Yes, psychoactive chemicals have a very real effect on neurotransmitters; this does not say the physical effect must bear out its stated psychiatric intent. Also while I have no real idea what was going on in the 60s, public mental hospitals in the USA are often terrible to the point of being inhumane. Alot of people I've talked to who've had long and or recurring stays in public institutions compare them, often negatively, to prisons. The private sector is infinitely better in that regard, though.

The real issue is just that psychology and psychiatry are both extremely frontier sciences. I agree that encouraging people to avoid them is harmful, but it's not apparent to me that most of what's happening in those fields isn't still largely guesswork.

Either way, I'd also like to see the studies Luriel's talking about regarding the efficacy of specific meds.

Actually, the evidence does show that many (most?) antidepressants have little effect over and above placebo. Look at the meta-analyses and you'll see that. I'm not sure why it's ludicrous - that's precisely what the science says.

Now certainly antidepressants can help many people (my wife for one), but again it is likely to be mostly the placebo effect, which is actually very powerful, especially in depression. For some people a placebo can be the 'kick' they need to get help them get out of their depression. In my wife's case she also used CBT with an excellent therapist, and I think that was likely more useful in the long-term (she is now free of depression).

True. It took a few years between accepting that I had a problem and finding a solution to it. For many people, it takes a lot longer; some never "solve" their problem at all. But knowing is a necessary first step, and for me, it was the hardest and the one that would have benefited most from posts like this.

What was your solution, if you don't mind sharing?

My only hesitation about sharing is that I don't want people to extrapolate from what worked for me to expect it to work on themselves. So don't.

With that disclaimer, I'll say that I went on several regimens of drugs for a few years. They had serious side effects, didn't work or worked only for a few months. They did keep me afloat long enough to get the rest of my life together.

Stephen Ilardi's "The Depression Cure" is 80% insipid self-help; I'm surprised I didn't throw it away in disgust. The remaining 20% (which is mostly the table of contents) had a profoundly positive effect. It did more good than all the drugs I'd taken combined; but I had to take it seriously and have the willpower to make changes.

In the end, CBT techniques got me to the point where I instinctively revise my thought patterns. Combined with a lifestyle that includes a lot more exercise, time outside, and physical contact with people I care about, I have been un-medicated for almost three years and haven't had a single major depressive episode.

Do you think pushing yourself to do what you think is right is a right course of action or part of solution to your depression?

I don't understand your question. Are you asking whether I think choosing to behave ethically is part of my solution to depression? What do you mean by "do what you think is right"?

I'm noticing some alarming similarities between your description and my current situation. Shit.

Do something! Talk to someone; start with someone you trust (not necessarily a doctor). Catalog your history, list the duration and severity of every time you were depressed enough to impact your school, job, or social life. You're doing this with someone because this is serious trigger territory. If you're on the edge, then do this with a therapist.

Don't try to diagnose yourself from this: the point is to let it sink in that you have an issue, and it's not going to get better unless you do something. Don't skip this step. Now that you're convinced, start hacking at the problem.

I recommend http://www.amazon.com/The-Depression-Cure-Program-without/dp...; but do your own research, talk to people, get better. Get better every day. You'll fail several times along the way; have people you can count on for help. Get better every year.

Maybe it will be an easy, short road for you. Maybe it will be a life-long struggle. That's okay, just make sure you live long enough to find out; it will be worth it. There's only one thing you need to know: problems you ignore won't go away.

You could be bipolar with a hypo maniac phase. You should check this with experts.

I was initially diagnosed with a Major Depressive Disorder; my first round of SSRIs sent me into a manic episode. That was enough to get me diagnosed with Bipolar II. I question whether that was an accurate diagnosis; my experience with bipolar medication was pretty awful, and with behavioral treatments (CBT and environmental changes) I seem to do okay without them, which is much more rare for people who suffer from Bipolar than for people who suffer from MDD.

I'm afraid the bipolar diagnostic is probably right. I would say the recurrence of the depression is a sign of that. Correlation with season variations is the most common, but not the rule.

Medication efficiency and side effect are known to vary individually.

In the end, the only thing that matters is that you find a treatment that helps you to feel and live better. I have heard lithium could help smooth the mood changes. Did you heard of that ? Unfortunately, some people have too bad side effects with it.

not even psychiatrists know about their diagnosis, since there's no scientific method at all there, just bullet point stories to try to match with the pacient... so I'd suggest not trying to diagnose people over the internet too

Not to mention the politics behind the DSM.

I am rather disappointed by much of the discussion in these comments.

The HN community has always taken pride in being careful, analytical and data-led. If someone were to advocate an unproven cancer therapy based on anecdote, they would rightly be harshly criticised.

The evidence base for SSRIs is extremely poor. The most favourable metastudies indicate only a very mild benefit, similar to that of many non-drug interventions like exercise or conversation with friends. Other metastudies show only a weak effect in the most severely depressed patients. There is known to be a very serious problem of publication bias, with major statistical irregularities indicative of the non-publication of unfavourable trials.

We feel confident in making statements about the nature of depression, but in truth we know almost nothing with any degree of confidence. The long-held serotonin hypothesis has proven to be completely baseless and there is no good evidence that depression has a neurochemical etiology. fMRI data is often used to make the case that depression has neurological rather than psychological origin, but this is very poor reasoning; The brain is not merely a passive vessel for the mind and environmental influences can cause substantial structural changes to the brain, as seen in chess players, sportsmen and myriad other groups.

It is entirely possible that the idea of depression is itself a cause of depression, in much the same way that the western presentation anorexia nervosa has been imported into Chinese culture and is slowly replacing the far more common indigenous eating disorder, which presented as idiopathic digestive problems rather than a psychological aversion to food based in body image. It is entirely plausible that the belief that low mood is a medical disorder which cannot be ameliorated by the patient is itself pathological.

I believe that the only statement we can make about depression with any confidence is this: We aren't sure if "clinical depression" describes a phenomena that can be meaningfully thought of and treated as a disease, but we do know that if you do something that you believe will make you feel better, you will feel better.

The politics of antidepressant medication is a political minefield, all the more dangerous because it seems everyone has to have a strong opinion, regardless of a professional or personal experience. While it's true that the efficacy of SSRIs is not an open and shut case, skepticism such as yours is not exactly the medical consensus either. Some of those meta studies with unfavorable results don't make much of an attempt identify where ordinary low mood ends and clinical depression begins, which further complicates the research.

With all due respect, as I'm sure you mean well, I rather doubt you have ever experienced anxiety or depression on the scale addressed in this post. Low mood, if not excessively acute and prolonged, is quite normal and probably won't see much benefit from medication. Clinical depression and anxiety can be absolutely devastating, and while it's not the only coping strategy, SSRI medication along with behavioral/talking therapy work wonders for a lot of otherwise desperate people.

People for whom getting out of bed every day is remarkable achievement of willpower, and who always seem to struggle to reach an emotional baseline. People who are almost constantly doused in worry, panic and despair, even when spending quality time with those they love. People who have tried everything else to no lasting effect. And yes, people who are so desperate to make the pain stop that they would consider killing themselves. Is this your life? Would you tell those with Bipolar Disorder or Schizophrenia that their suffering is simply due to a pathological awareness of the disorders themselves?

Warning the public against overmedication is one thing, but I for one am fed up with the stigma attached to seeking medical help for mental illness. The GP is reaching out to those for whom these treatments could literally save lives.

But I'm sure they just need more exercise.

The first two paragraphs were good.

Before I actually experienced depression first hand I might have made a comment pretty similar to yours.

Before you actually experience the sapping, frightening, frustrating, even debilitating condition that is depression, it is easy to stand on the sidelines and make all kinds of logical arguments and find bits and pieces of research supposedly supporting any particular viewpoint, for or against.

I would even have been quite judgemental about the character of people claiming they had depression. After all it just in the mind isn't it? Pull yourself together, get some exercise, eat a healthy diet, would have been my advice. I would also have been missing the point completely. Those are of course all good things to do and will help with depression. The point, is that depression makes you almost incapable of doing these things. Until you experience, either in your own self of through someone very close to you, the full manifestation of depression, you just actually don't have a clue.

You are a virgin trying to talk about sex. You may think you know the theory, you may be very widely read, but you are still a virgin.

Depression is a highly complicated and very subjective condition that cannot easily be diagnosed. It is far from scientifically understood. No one knows exactly why certain drugs work or don't work. This just makes it harder for the sufferers, who often have to undergo all sorts of different drugs/treatments to find one that works for them, that is if they are lucky enough to actually find a treatment that works.

I personally was lucky to find a treatment that worked. It was a combination of CBT and drugs. You can call it placebo effect, you can call it anything you want but for me it works.

I personally know 4 other people who suffer or suffered from depression. 2 of them recovered without drugs after many months, 1 without any treatment and 1 with the "wrong" treatment, i.e. tranquillisers. The third person, like me responded to CBT and drugs, albeit different drugs. The 4th person is not fully cured and suffers bouts. Any amount of different drugs and treatments have not completely controlled the condition.

I am not even sure why I am posting this, other than to try raise awareness that Depression is not simple, it can happen to anyone and often happens to highly intelligent, motivated people as well as your average Joe.

You seem to be refuting an argument that I haven't made.

Firstly, how very presumptuous of you to assume that I haven't suffered from depression.

Anecdote is not the singular of data. Whether I have or have not suffered from depression has no bearing whatsoever on my ability to analyse the available data. Having had cancer gives you no insight whatsoever into the biology of cell division.

Depression is known to spontaneously resolve in the vast majority of cases without any treatment, which creates a wholly misleading picture of the efficacy of treatments for depression amongst patients. Our most effective treatments for depression only shorten the duration of depressive episodes by a few weeks and reduce the likelihood of relapse by a few percent.

I am not arguing that depression is a simple phenomenon, but rather that it is a complex psychosocial problem for which our best treatments are utterly marginal, and that the clinical model may be a fundamentally inappropriate approach.

our best treatments

And that's the point, isn't it. These are our best treatments. Are they great? Hell no, they aren't. If you are being subjected to them, it can be downright uncomfortable. But for some percentage of people, they work.

Your comment makes it seem like you think antidepressants are snake oil. They aren't. The problem is that the problem they are solving is incredibly complex (maybe what we call "depressions" is 5000 different syndromes) and we've just barely started to do anything remotely like real science in this arena (Freud, anyone?).

So rather than say "I'm surprised HN would think anti-depressants are worth anything", perhaps we should be saying "we need more and better research into mental illnesses."

Have you, personally suffered from depression or are you just making more logical arguments?

I have suffered from depression and agree with jdietrich. I hope that is enough for you to rest the "sex and virgins" argument, which is logically fallacious and makes rational discussion of published information difficult.

FWIW I get your point totally and agree. Never having suffered depression, I had a completely new view of it after having a relationship with someone who was on at least three meds. Spending time like that completely changed my view on what it mean to suffer from depression.

Other metastudies show only a weak effect in the most severely depressed patients.

That's not the conclusion in the articles you posted. From the PLOS Medicine article: These findings suggest that, compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients.

And from the JAMA article: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

These conclusions are the opposite of your statement.

So depression is not pathological but the idea of depression is pathological? How meta.

Your comparison with cancer is odious, as you indicate. The idea of depression may be a cause of depression? Check. The idea of cancer might be a cause of cancer? Ridiculous.

The OP may well have helped people with depression (or their friends) recognize or diagnose or de-stigmatize their condition. Your comment? Not so much.

The social stigma of mental illness is real, and castigating people for relating their experiences, and others for applauding and adding to it, for not being strictly evidence based is not nice. Why didn't he perform a double-blind trial on himself, for goodness sake, and hold off on his blog post for a while? Crikey.

Lots of people commit suicide. Why should it matter to them, or their loved ones, if the cause is neurological or psychological? Why does a better life through SSRI's have to be justified to...anyone?

> The idea of cancer might be a cause of cancer? Ridiculous.

Not ridiculous at all. There are all kinds of plausible mechanisms for the idea of cancer to cause cancer. Here's just one example off the top of my head: stressing out over the possibility of getting cancer can stimulate the production of excess stomach acid, which can lead to acid reflux, which is known to increase the risk of esophageal cancer.

Stress is not a meaningful cause of stomach ulcers.

Did not know that. Why is that such a commonly held belief?

It's only in relatively recent times been widely known that the majority cause is a bacteria http://en.wikipedia.org/wiki/Peptic_ulcer#History Stress was the common theory beforehand

The fascinating bit is the original researcher proving it by ingesting the bacteria, and giving himself an ulcer, and then curing himself with antibiotics. A Nobel Prize seems reasonable.

Actually, stress does seem to be a significant cause of stomach ulcers. It seems to be a common myth that H.Pylori entirely causes ulcers, but in fact 50% of the world population are infected by H.Pylori and it generally doesn't cause ulcers. Stress seems to be a significant cause. See http://en.wikipedia.org/wiki/Peptic_ulcer#Stress

Anyway, I'm not sure what this has to do with the original post.

H pylori has fulfilled Koch's postulates as a cause of ulcer disease. I don't agree that emotional stress is a major cause of ulcer disease.

From Harrison's 17th ed. ch 287: "H. pylori and NSAID-induced injury account for the majority of DUs."

From Malfertheiner's "Peptic Ulcer Disease" (Lancet 2009): "Emotional stress and psychosocial factors are frequently identified as important contributors to ulcer pathogenesis. Although stress cannot be neglected as a contributing factor, convincing evidence for it being the sole cause of duodenal ulcer is scarce. A good example of stress as a contributory factor was the rise in bleeding gastric ulcers in elderly people after a severe earthquake in Japan."

Note that in general, when the medical establishment talks about "stress", its practitioners generally mean physiologic stress states, such as burns, trauma, sepsis, or multiorgan dysfunction. Does physiologic stress cause ulcers? Indeed. Emotional stress? It may contribute, but is not, in itself, an important cause.

Another: Hypochondria causing lack of sleep and resulting in poor health. Making it less likely to be able to fight disease. Can't cite anything (although it may be out there) but certainly makes intuitive sense.

Lack of sleep of course would also cause one to drink more coffee which can be a gerd type irritant (I speak from personal experience here).

Hypochrondria is not the idea of cancer. It's the idea of having cancer.

A commenter asked for citations, so here are the most important:

Meta-analysese of the efficacy of SSRIs: http://www.plosmedicine.org/article/info:doi/10.1371/journal... http://jama.jamanetwork.com/article.aspx?articleid=185157

Evidence of the non-publication of antidepressant trials: http://www.nejm.org/doi/full/10.1056/NEJMsa065779

A good summary of the evidence against neurochemical hypotheses is Eero Castren's "Is mood chemistry?" (Nature Reviews Neuroscience 6, 241-246 (March 2005)), but even the most cursory search on pubmed paints a very clear picture.

> The brain is not merely a passive vessel for the mind and environmental influences can cause substantial structural changes to the brain

I have always thought that. Now I am not a neuroscientist or anything closer to that field, so it is just a hunch. To me, it always seemed odd that such a large community of scientists never questioned that. In other words, there is sort of a tacit assumption that if we see it on fMRI and thi s region is lit up then the brain causes this.

Or say "we noticed this part of the brained is bulging out and that is related to the person being left handled, therefore left-handedness comes from a physiological basis".

In the most elementary discussions of scientific principle the causation vs correlation always comes up as a basic fallacy yet in the case of brain and behavior this view seems rather absent. And I always found that strange.

It is not that simple. In most brain studies I read there is a stroke or something like that which causes a lesion in the brain, and the changes came about after this. Since we already have a good idea where the change in the brain comes from, it is reasonable to assume the personality change is caused by it.

Excellent post. 1 point to make. I'd love to write more but I'm pressed for time right now.

"It is entirely possible that the idea of depression is itself a cause of depression" - This has been proven, again I'm sorry but I don't have the time to find the research at the moment.

The SSRI meta-study you're referring to is very interesting.

However, anyone reading this should know that there are routine antidepressants which are not SSRIs and do not work as SSRIs are purported to.

SSRIs are the tip of the iceberg when it comes to antidepressants.

There is no difference between neurological and psychological phenomena, as you cannot have a functioning mind without a functioning brain. What we perceive as "mind" is the emergent property of immensely complex physical (chemical) interactions in the brain. Now that is not to say that SSRIs are the best or most effective treatment for depression. I simply object to your attempt to sort problems neatly into exclusive buckets of "neurology" vs. "psychology." You can't just hand-wave away the topic of drugs by saying "oh that's just a psychological problem."

>entirely possible that the idea of depression is itself a cause of depression

This comes across as "it's all in your head". I hope you didn't mean that.

Scumbag HN user

Talks about evidence and/or the lack thereof

Cites zero evidence (via links) towards his assertion that there is no evidence

You're right, but Hacker News is not the place for memespeak.

I disagree. The post got its point across very concisely. If you set aside your snobbery you might perceive that this "meme" is very similar in form to senryu.

I'd also recommend reading psychologist Martin Seligman's book "What You Can Change and What You Can't", which covers a variety of mental health issues from sexual fetishes to fear of spiders to schizophrenia, and the treatment options available for each.

Cognitive behavioral therapy teaches people to recognize negative thoughts ("I failed the test because I'm stupid"), dispute the thought ("If I'm stupid, how did I get an A in math last week"), and propose alternative explanations that are transitory or shift the blame to an external source ("The teacher was in a bad mood when he graded the test/I didn't study hard enough").

It's been shown in studies to be as effective as drugs, and more lasting (if you stop taking the drugs, the sadness might come back).

It's an alternative - it might not work for everyone, the OP mentions he had trouble with therapy and I'm glad he is finally doing better.

Does it really work?

My guess is that's just how slim people tell fat people that laziness got them fat and so they should do more exercise, i.e. people that never suffered from a certain condition giving advice to people suffering from that condition.

"I failed the test because I'm stupid" - that's just how I felt when I got rejected after an onsite interview with a certain company that's renowned for its hiring standards that yield many false negatives. Thoughts going through my head, like "I was unlucky" or that "I came unprepared", had no effect.

You know how one partner tells the other on the verge of a breakup "it's not you, it's me"? Did that line ever work in the history of man-kind?

The mind is like an onion, having many layers. You can only control the first layer and hope that your actions will cause a reverberation in the layers below. And if you strongly feel a certain way, sometimes there's no stopping it, unless enough time passes to forget about it or make it seem less important (I guess that's why we forget things).

     The teacher was in a bad mood when he graded the test
I'm seeing people throw blame all the time, precisely because it's easier to cope with failure. But it's not healthy to pass the blame, unless you have concrete proof that the teacher's mood was in bad shape and that her mood indeed had an effect on the grade. I'm not seeing this as being good advice. Sooner or later you'll start thinking the whole world is against you, when it's a lot better to recognize your own mistakes and not blow the failure out of proportions.

It's also healthy to recognize that maybe you're not as smart as everybody kept telling you since you were in kindergarten, and that in the real world wit is not a substitute for experience and hard work.

I have some experience with cognitive-behavioral therapy. I can tell you anecdotally that it really does work, and it is among the most scientifically verified treatments out there.

I'm not sure if I understand your objections to CBT -- there's a lot of them -- so let me restate them. If I've misunderstood please correct me. You seem to be saying:

1) One can control one's highest-level, "executive" thoughts, but not feelings. CBT is assuming far too much control over emotions, and it's like blaming a depressed person for not "snapping out of it".

2) It is also bad to throw off blame onto other people when you should be learning lessons about your own failures.

Okay, first of all, I think you are quite mistaken about how much your emotions are related to the content of your thoughts. There are indeed people who have chemical imbalances in their mind, but for most people, their thoughts are the primary trigger of their emotions.

The basic assumption of CBT is not that you should blame others more, or yourself more. The assumption is that your thinking is clouded somehow and needs to be set straight. This is usually done by rigorously stepping through every part of the thought process to reveal the errors. One should accept the blame that is due oneself, but not go any further.

I never followed a program of cognitive-behavioral therapy all the way, but I have done it sometimes. I do remember a moment of revelation that occurred when I was out for a walk. CBT encourages you to slow down and listen to yourself very carefully. I noticed, for the first time, a voice in my head that was constantly leaping to very bad conclusions based on poor evidence (e.g. very minor setbacks, like an untied shoe, are connected into a pattern of lifelong failure). The thoughts were so automatic I had stopped realizing that they were thoughts at all; I only felt the wave of bad feelings that resulted from them.

My personal feeling is that a lot of people have this sort of problem, rather than any chemical imbalance. Antidepressants may be primarily useful in lifting the fog enough for one to have the mental energy to start CBT. Some studies show that using both is better than either alone.

Studies have shown the two to have the same effectiveness rate at treating depression, around 50%.

It turns out it is actually healthy to pass the blame. I'd suggest reading one of Seligman's other books, Learned Optimism, for more, but in studies of people in high-pressure situations (freshman year at Army, cold call insurance salesman at MetLife, etc), the most successful people are the ones who externalize (blame others for) negative events and internalize (credit themselves for) positive events. It may not be an accurate view of the world, but then again, depressed people score higher on assessing the world accurately than non-depressed people, so it's not clear seeing the world accurately is that helpful.

When bad things happen to me I make a concerted effort to blame other people or one-off events ("the company I was interviewing at went through a reorganization or promoted an internal person/it was just bad luck they asked about the same origin policy/whatever"), and when good things happen to me I credit myself ("I got the job because I'm smart, I work hard, and people like being around me.") When I say it like that it sounds a little silly, but so is not making moves in your career or your personal life that clearly make sense, because you don't think you're good enough.

Like anything, CBT takes practice. Eventually you want to get to the point where you do the recognition and disputation automatically, like tying your shoes or typing the letter 'e'.

I wrote more about it here: http://kev.inburke.com/kevin/lectures-for-basketball-coaches...

I'm skeptical, the way you phrase it.

Rather, I've always heard that it's best to think in terms of circumstances and not blame, for both yourself and others. There's a subtle difference between them. You've phrased it as "blame others, not yourself", but both of those alternatives are equally unhealthy.

Rather, you should figure out a variety of possible explanations for your low performance, and then ascribe meaning to the ones you can change and forget about the ones you can't. "I failed the test because I'm stupid" is a completely useless conclusion. So is "the teacher was in a bad mood". "I didn't study", however, is a very useful conclusion, because it suggests what you should do next time: study harder. So is "I don't actually like physics", because it also suggests a course of action: switch your major.

The overall point is to get out of the habit of learned helplessness and take responsibility for your own life. Blaming others doesn't accomplish that, because you've still attributed outcomes to things you can't control.

I read Seligman's book about optimism as well. He studied insurance salespeople for a time, which I think influences a lot of the advice. The best salespeople had a modicum of self-preserving delusion. Not enough to ignore correctable problems with their own performance, but enough to endure all the rejections one gets as a salesperson.

This advice is clearly more applicable to sales than to, say, spacecraft design. But maybe more things are like sales than we think.

Seligman's book is challenging to a hacker personality because he is saying that there's some information which it's best not to ruminate about. Many hackers are naturally inclined to perfectionism: analyze failures, perfect the technique before daring to try again. But a lot of success in life might just be about sheer persistence; trying again without dwelling on failures too much.

So, for a lot of the social professions, success is realizing that other people have minds of their own who may or may not agree with you, and that if they don't, that doesn't necessarily reflect on you or mean you're doing anything wrong. So if you blow an interview, it doesn't necessarily mean that you're stupid, it could just be that you drew a bad question or a bad interviewer or just weren't what the company was looking for.

I've been struggling with this for a while in the context of dating, which is another area where you'll face lots of rejection that usually isn't your fault. I think that's a lot healthier than to phrase it as "blame others" - you should respect others, but realize that what they want is not necessarily what you want. Heck, put that in a dating context and you can immediately see the problem: somebody who blames the girl when they're rejected is a creep, not a success.

> I think that's a lot healthier than to phrase it as "blame others" - you should respect others, but realize that what they want is not necessarily what you want.

The seduction community (/r/seduction to be specific) calls this outcome independence. A great deal of emphasis there is put on overcoming rejection.

Yeah, it is about the difference between being fixably flawed and being an incorrigible failure.

I don't know, maybe it indeed works, but the problem is you have to believe what you keep telling yourself and that's hard. In regards to seeing the real world and your place in it for what it is, I think that the extremes are hurtful.

For instance many of us here posses an over average intelligence (whether we were born with it, or we acquired it through hard work that's another discussion). Also, many of us here have overinflated egos because of that.

I remember seeing case-studies of smart people that weren't as accomplished as they should be because of fear of failure and rejection. Continually telling your child that she's smart will overinflate her ego, expecting nothing but success after success. A few years later the real world kicks in, and this is a recipe for stress and depression. Another thing that happens is that many of us here are the smartest amongst our acquaintances. This creates sampling-bias; you genuinely start thinking that you are amongst the smartest people alive. But then you start competing with a global pool of other smart people, because of globalization and the Internet, and you witness how you're just a grain of sand on a beach full of smarter people that are more accomplished from a younger age.

I prefer intermediate thoughts rather than blame others. "I should work harder" works better for me than "teacher was in a bad mood", because the first statement might always be true, while the second statement I know deep-down in my gut that it's just an excuse.

> but the problem is you have to believe what you keep telling yourself and that's hard.

Well, no. You just have to start by believing less strongly your original negative thought.

Situation: "I failed this test".

Hot thought: "I'm stupid".

Belief in hot thought: 80%

Emotion: Shame

Evidence to challenge hot thought: "I passed the test last month with an 'A'"; "I do better than many of my peers at testing"

Alternative theories: "I didn't work hard enough. And I spent a lot of time with the wrong section of the book." "The teacher is new and inexperienced. I have as much evidence that they made a mistake as I have for me being stupid, so maybe they did make mistakes in grading."

New belief in hot thought: 50%

So, you're not trying to convince yourself that these other theories are correct. You're just trying to make the negative thoughts you have less strong, less over-bearing, less destructive.

It's an iterative process too - the first times you interrupt your thoughts you lessen the severity of the negative thinking, and then you begin to strengthen the possibility of the alternatives, and then it starts happening automatically.

It's fine to have some negative thinking. But that negative thinking should be based on reality, and should not interfere with your ability to live a day to day life. People with depression are not thinking negative thoughts like "I'm a bit thick, I should learn more about $SOMETHING". They're thinking "I am hopeless. I am worthless. I can't learn more about $SOMETHING because I'm stupid and there's no point in even trying."

Once negative thinking gets to the point where you cannot sleep; you do not apply to jobs because you "know" that you won't get them; you socially isolate yourself; well, obviously it's no longer serving a useful purpose.

This is a really good description of the process. The initial challenge for most people is to even be conscious of the hot thought (love that term). It's more like a flash that passes through your consciousness and immediately affects your mood. One you learn to catch it on the way through it's a lot easier to diminish it's power to affect your emotional state.

I've found as I gotten older that I'm much better at processing negative emotions and not letting them nag at me for hours.

> depressed people score higher on assessing the world accurately than non-depressed people

Citations? Chasing down this particular meme is a pet hobby of mine as I suspect the evidence for it is slightly fixed.

I haven't gone through them, but there are quite a few references here: http://en.wikipedia.org/wiki/Depressive_realism

Quite a few references refuting it as well.

Likely --- I haven't gone through them. I have no dog in this fight. I was merely offering the citations you requested, thinking you were genuinely interested in the topic. I won't make that mistake again.

Well that wasn't a very nice thing to say.

I was specifically hoping for a summary of results that discussed, among other things, experimental design. You gave me a vague Wikipedia article that points at a lot of specific studies I could probably summarize myself, as well as a lot of specific refuting studies I could summarize as well, but that's about it. And that's assuming I could get access to all the papers that it cites.

I apologize if I misinterpreted your response. Your curt reply "Quite a few references refuting it as well" struck me as a sign that you were looking only for confirmation of your existing belief, rather than for new evidence.

Yes, the article is vague, but I thought the citations were solid. I felt (and feel) that if you had a true interest in the subject, they would be of use to you. You declared they were not. I was reminded of the cartoon of the angry mother shouting "But he was wearing a hat" to the fireman who rescued her drowning son. No, you'll have to research and read, but that's about the best you can hope for when asking for citations from strangers. And no, not everything is available easily and for free -- blame Elsevier.

But if you are willing to pay, or willing to search a bit, most things are accessible. Here, for example, is a link for the 2012 metastudy mentioned on that page: http://www.researchgate.net/publication/227708596_Depressive...

You'll have to click on the "View" link in the upper right. I've only read the abstract, but it concludes that depressed individuals have significantly less positive bias than the non-depressed, but that both still have a distinctly positive bias baseline. Further, they conclude that studies that lack objective standards of reality and utilize self-reported measures are more likely to find depressive realism effects.

> Your curt reply...struck me as a sign that you were looking only for confirmation of your existing belief, rather than for new evidence....I felt (and feel) that if you had a true interest in the subject, they would be of use to you. You declared they were not. I was reminded of the cartoon of the angry mother shouting "But he was wearing a hat" to the fireman who rescued her drowning son. No, you'll have to research and read, but that's about the best you can hope for when asking for citations from strangers.

Wow. That wasn't a very civil or constructive response, either. I'm going to go ahead and take this discussion to email since I doubt anyone else is getting anything out of this anymore.

Does it really work?

Statistically, CBT combined with medication is currently the most effective clinical treatment for depression. Personally, having tried a number of sessions, I think it works very well for some, and not so well for others. If your tendency is to blame yourself for things that are beyond your control, it may be a great aid. If instead you want to understand the world so as to make it better, CBT probably isn't a good choice.

I'm seeing people throw blame all the time, precisely because it's easier to cope with failure.

See, you've already got it. Stop there.

But it's not healthy to pass the blame,

Why? The studies seem to show that for most any measure of 'health', it is better not to blame yourself for the mistakes you make. You'll be happier, and live longer. You (and I) might wish that taking personal responsibility would always be the better choice, but statistically it's often not.

My conclusion was that CBT is effective to the extent that you are willing to give up on the concept of truth. People who train themselves to see only the positive are happier than those that insist on truth. I decided that truth was more important to me than happiness, dropped the CBT, and stuck with the meds.

> My conclusion was that CBT is effective to the extent that you are willing to give up on the concept of truth. People who train themselves to see only the positive are happier than those that insist on truth. I decided that truth was more important to me than happiness, dropped the CBT, and stuck with the meds.

I think you may have gotten the wrong impression of CBT. The point isn't to delude and bombard yourself with constantly positive thoughts. In fact, that rarely works for us HN-types.

In fact, I'd posit that it's the opposite of self-delusion: It's about viewing plain facts as well as your emotional bias towards them, and the (maybe false or exaggerated?) conclusions that those biases lead you to.

It turns out that some of us have different cognitive biases such as badly weighted risk assessment, picking the worst possible conclusion etc. It doesn't help that these form a vicious cycle. Nor that these biased thoughts sometimes seem to happen automatically (rather than you consciously coming up with them) and appear to be plain facts, already assumed and taken as granted.

The point is, something that looks like a crisis to me may look mildly uncomfortable to someone else. The idea is to dig down and see why.

edit: Another point I forgot to make is, this arms you against future encounters. You know how your mind falls into certain pitfalls and you learn to recognize them. The next time, you're not fooled as easily. This is a very powerful notion: knowing your own faults. Not to mention the feeling of victory that you get when you catch your mind red handed :)

This feels like a false dichotomy. Is it really abandoning the truth to make the effort to give equal or greater weight to "something is wrong with the company for not hiring me" as "something is wrong with me for not getting a job at the company"? In this case, you cannot know the actual truth (unless you really did screw up, but I've never seen anything about CBT that says "ignore your mistakes"), so why should you take 100% of the blame?

BRW, I hope it doesn't sound like I'm trying to convince you to give CBT another shot. I have a lot of respect for people who have found their "happy" place. I would just hate to see somebody else not try it because they think it means becoming self-delusional. As somebody who suffers from "if it went wrong, it's my fault" syndrome, I can attest that, in reality, I'm really not that important.

The problem is that it's not just about the patient. None of those studies address what happens to the people around you if you start blaming them for your screw ups. This is the problem with evidence-based treatment: you end up with treatments optimized for whatever outcome you are measuring and not addressing the actual problem.

This is the difference I've personally seen between CBT and other forms of therapy that don't focus on evidence-free self-talk (including DBT and EMDR). I know CBT reduces depression; I have yet to see any evidence that it makes one a better, more empathic person or more pleasant to be around. It doesn't teach skills that are useful in interpersonal relationships.

The problem with insight-oriented therapy is that you have to actually find a therapist with insight. The job just doesn't seem to pay enough to often attract the level of intellect that it requires. It also tends to make symptoms worse for a bit while one gives up denial and avoidance. On the other hand, it doesn't require rejecting the idea of truth or lying one's self better.

> Does it really work?

Yes, CBT does really work. There is plenty of very good evidence to show the effectiveness of CBT.

You've taken a very brief example sentence, demolished it, and used that to dismiss an effective therapy.

The fact that you don't appear to understand CBT, nor know much about it, hasn't stopped you dismissing out of hand as bad advice.

>My guess is that's just how slim people tell fat people that laziness got them fat and so they should do more exercise, i.e. people that never suffered from a certain condition giving advice to people suffering from that condition.

Actually, it appears that diet, and especially simple sugar consumption, is the main driver of obesity, per, for example, Gary Taubes's book Why We Get Fat.

It is highly unlikely that people have evolved to be much fatter from 1950 to the present. So the solution has to be somewhere in behavior/environment.

The example was very simple but basically it was correct. The difference is, in CBT it is a lot deeper, there is more going on. You will work on discovering where certain thought patterns come from, what triggers them and that alone can be very helpful. And then you will work on changing these patterns.

It is not so much someone "slim" berating a fat person; therapists actually don't tell you what to do or think and they never judge you. In CBT they interact with you a little more than in psychoanalysis but you never get told "that's just because you are lazy!"... but you would discover e.g. you are (ab)using food as an escape mechanism to counter fear, anxiety or depression. By knowing that, you already have your finger on a harmful behavior you might not have understood before and then you can do something against it. But it all comes 80-90% from you, the patient. The therapist helps you understand what's going on, they can frame or re-frame situations for you, give you a different insight or share stories of other patients in similar situations. Often, the real problems are things, thought patterns which have been with you your whole life and typically were established when you were a child; you aren't even aware of them, they have always felt and come natural to you. You just end up feeling bad, afraid or depressed but all the behavior and patterns ultimately leading to that feel normal and "right", natural.

And at the very least, the fact you are talking about your problems and there is someone who actively listens can be beneficial.

Also, no, this is NOT something "a friend would just do for you", no matter how much it might seem like that at first. I made the mistake to listen, to show empathy to a severely depressed and suicidal friend and it caused a chain-reaction in my own mind to the point where I now firmly and consciously tell myself that I will never ever do that again for anyone. Not because empathy for friends was wrong in any way but because in a very selfish, very self-preserving way I do not want to bleed energy and thoughts into a black hole and when people who are so close to the edge ever open up then that's what they are... they cannot help it. But you best let an expert deal with it, it will be much better for you and the person suffering. I know this sounds terrible and cold but I think it is for the best for everyone involved. Be there for the one suffering but don't attempt to be an armchair-therapist to them, don't become their dump for all their negative emotions and problems. It WILL overwhelm you and will show you a side of life and the human mind that you cannot un-see.

I'll preface this with the fact that I know that people will see me as being cold or just generally not agree with my opinion but I am going to share it with you all anyways.

I have experienced this first hand. I have attempted suicide twice in my life and have gotten help for it. Because of my experience, I think I have come out of it with a different view which is this:

Suicide is somebody's choice and theirs only to make. Does it affect others? Yes, of course. But I still believe that it is up to the individual to make that choice. I remember thinking after my attempts and hearing how it is a "selfish way out" that the my family too, was being selfish, for I was suffering and medication and therapy just wasn't doing anything yet they selfishly wanted me in their lives just as I wanted to end my life and stop all of the pain.

A few other things that I just want to throw out there because I'm experience an odd flood of emotion. The assumption that suicide is bad is solely based on the notion that life is better than what lies beyond, which is something we just don't know. Also, people call suicide the cowards way out or giving up. I just don't see that. To me, it is just not delaying the inevitable. We all die. It is a fact.

The best description I've seen of depression-induced suicde is "a permanent solution to a temporary problem."

The thing I always hated about hearing that phrase is that it completely invalidates what the person is feeling and makes the person saying the phrase. In some cases, it truly may be a temporary problem, in some cases it may not be. How can you say something like that to somebody with Fibromyalgia? Surely they would be apt to feel depressed and unlikely to continue wanting to live. While that may not be a common situation, it is something that could happen and, again speaking from my experience, from what I've encountered the people spouting off that line are the ones who don't know 100% what the person they are talking to are going through.

That phrase also has implications as to what happens after one dies by stating it is a permanent solution. Sure, they won't be here any more but that doesn't mean they won't exist anymore (though that is a discussion for another time).

For certain situations like the one you describe, I agree. But for straight-up depression with no other exacerbating factors (and which responds to treatment), I think the statement still stands. It certainly helped me when I was suicidal.

For someone who has suffered depression for 35 years continuously (almost all my life) and had tried talk therapy, CBT, and over a dozen different drugs ranging from SSRIs like Prozac and Paxil, to Tricyclics like Tofranil. I'd hardly call it temporary. The only meds I haven't tried are MAOIs, but I've been resistant because side effects.

I'm truly sorry to hear this. Have you looked into ketamine? NPR had a story about it in January: http://www.npr.org/blogs/health/2012/01/31/146096540/i-wante...

Why would you ever want a temporary solution to any problem? It might be an accurate description, but to someone like me, the first reaction is, "Sold!"

I think whether people have a right to do it (which I also believe they do), is less important than realizing that their desire and decision to do it is based on faulty logic. Depression completely changes the way people think.

> Depression completely changes the way people think.

But that's the point, right? Depression causes so much pain that some people decide it is better to end their life rather than suffer. I don't see how it's any different than someone in chronic pain from any terminal illness desiring physician-assisted suicide. Of course their decision is affected by the pain they're suffering. That's the whole point.

I agree there are parallels between cases of chronic pain, but I also think there are significant differences. Someone with just chronic pain might think "This pain is too much. I don't have it in me to suffer anymore" whereas a depressed person often causes their suffering with distorted thoughts like "I am always depressed. I have tried everything possible there is to try to get better. No one likes me or wants to be around me. Everything is hopeless. I have no reason to live"

I believe suicide is a right, but surely there is a difference between someone committing suicide with a clear mind and someone doing it out of severe depression.

I fully realize there is a circular logic set to trap you here: we can define severe depression as wanting to kill yourself, thus taking away that right completely.

"I believe suicide is a right, but surely there is a difference between someone committing suicide with a clear mind and someone doing it out of severe depression."

There is a difference, sure. However, the difference doesn't invalidate that right. Especially considering the subjective nature of the definition of "clear mind" and "severe depression".

Forgive the disposable account, I am a long-time registered user with high karma but even I think that once in a while there is a topic that requires anonymity (or at least further pseudonymity).

I do not feel I suffer from depression, yet I think of suicide frequently. Frequently as in, once every couple of days to several times a day, for as long as I remember.

Frequently these are just passing thoughts, of how I might do it, or of an opportunity not taken. Other times these are serious considerations and the weighing up of why not to. I don't pause on "why to" as I can answer that instantly every time.

Ultimately I conclude every time that life isn't worth living. It never has been, and never will be. But yet, to experience it is a gift and I should experience as much of it as possible before the end. To experience life is the only reason I can think of to live.

I always remember Camus, I always am mindful of the Myth of Sisyphus.


  The Myth of Sisyphus (1943) – If there is a single non-fiction work that can be
  considered an essential or fundamental statement of Camus’ philosophy, it is
  this extended essay on the ethics of suicide (eventually translated and repackaged
  for American publication in 1955). For it is here that Camus formally introduces
  and fully articulates his most famous idea, the concept of the Absurd, and his
  equally famous image of life as a Sisyphean struggle. From its provocative
  opening sentence (“There is but one truly serious philosophical problem, and
  that is suicide”) to its stirring, paradoxical conclusion (“The struggle itself
  toward the heights is enough to fill a man’s heart. One must imagine Sisyphus
  happy”), the book has something interesting and challenging on nearly every
  page and is shot through with brilliant aphorisms and insights. In the end, Camus
  rejects suicide: the Absurd must not be evaded either by religion (“philosophical
  suicide”) or by annihilation (“physical suicide”); the task of living should not
  merely be accepted, it must be embraced.
The problem I have is that I feel I already know that one day I will be at peace with the ridiculousness of living, and reject the "to experience" argument. One day dying will win the argument, and it only needs to win once.

There is one argument that wins for myself, every time. I won't do it, because it's the same as giving up, which I'm way too stubborn and proud to do. And yes, there are times at 4 in the morning when I'm still tossing and turning and shaking with anxiety, that I really wish it would just end for good; however, I quite literally can't let myself do it. It's against my inner principles, which are so concrete and immovable, no amount of wetware buggyness can override.

I do worry that I'm destroying my health with worrying though, the irony of which doesn't escape me.

Thank you for the reminder of the gift. Sometimes I also consider working to delay the extinction of humanity to be a good reason. Joy would be, and is for some.

I just requested the Myth of Sisyphus from the library. If you haven't read it, you might try Ernest Becker's "Denial of Death". http://en.wikipedia.org/wiki/The_Denial_of_Death

--Cronopio cronopio cronopio.

May your solitude be less embittered.

Let me suggest you a Jedi mind trick which just may work out for you:

Imagine a situation where you could fork() the curent universe and run two different copies of the world in parallel on two different CPUs. Now you can make a certain choice in one copy, and an opposite choice in another copy, and then let the events run their course and see which one was the better choice. Wouldn't that be nice? You could then see the unpredictable consequences of your choices, and there are always some of those. Sadly, we only have one CPU to run the world, and there is no place for context-switching. But! Turns out there is one situation where you can do just that - if the choice is suicide (yes/no), you can pretend that you have taken that choice and killed yourself; so now you know the outcome of that choice, and the CPU is free to run the other fork() of the world. Since you already know what's down the first path, might as well go look through the second one.

Thanks for mentioning Camus - I had not heard of him until I read your post.

This is HN's best feature - the discussions are often better than the story and often offer new things to learn about.

Can I ask what your reasons are for considering suicide that you consider so unassailable?

You do not need to be depressed to be suicidal. Seriously consider taking therapy, better today than tomorrow. There has got to be something going on, subconsciously, that causes these thoughts. Therapy will certainly slowly help you discover it, understand it better and maybe even find ways of getting rid of those thoughts.

one in four adults suffer from a diagnosable mental disorder in a given year

This is something that frightens me. What is a "diagnosable mental disorder"? I'm willing to bet this statement was far from true 50 or a 100 years ago. Not because I think people got more depressed or anxious, but rather because we're looking harder to "diagnose" things.

I think there's a big danger, especially in psychological afflictions, to always "look for" problems with yourself.

This may be a cultural thing as well. Until I came to the US (I'm from Germany), I never asked myself "Am I depressed?", "Is this what depression feels like?" when I was aving a down day. I also never considered that I may have/have had ADD now/as a kid but now people tell me I should "get that checked out" all the time.

I think you are right that these things were less common 50 or a 100 years ago, but consider this (first comment on the blog)

"It’s not a job that I want, or that I even feel really suited for, and it’s not paying what I need, but after 11 months of unemployment, you take what you can get. I’m not going to spill all my guts here, but life is really starting to suck for me, mostly because I’m shoulder-deep in debt and can’t see a way to scrabble myself back up. This is an important fact because with how little I make, and how much I owe, I no longer can afford health insurance."

How common was this situation 50 or 100 years ago? And 100 years ago people would have had better support systems from living in smaller communities. Modern life causes depression; I don't think it's necessarily an over diagnosis.

50 or 100 years ago a person might have flat out starved in the street, or died of an illness that no money could buy a cure for at the time.

Modern life causes more depression because basic necessities of life are too easy (on a historcal scale) and so our brains are too idle most of the time, so they get caught on logic bugs.

I am quite confident that mental disorders are not just more diagnosed, but also more common than they used to be. I don't know what all the causes are, but I suspect that it is somewhat akin to the "obesity epidemic" and that it has many factors of debatable relevance. There are social and environmental factors that are causing profound differences in disease rates; there's no reason to suspect that mental diseases are any different.

For my money, I would say that increase rates (real rates, not diagnosed rates) of mental disorders have gone up considerably due to, in no particular order:

* dietary changes

* environmental toxins

* less time spent outdoors (in bright sunlight)

* more sedentary lifestyles

* more low-level, long-term stress

* broader, shallower social circles (more severely exceeding Dunbar's number)

* changes in social norms (less physical contact, more space and time spent alone)

Some of the above probably have no effect, and there are probably important factors I didn't mention. But I think that as a population, we are more ill than we were generations back---not just more over-diagnosed or more often diagnosed.

absolutely agree. I believe that our body and especially our minds aren't prepared for the kind of lifestyle we're living today and that puts a strain on our mental sanity. especially the lack of physical activity I believe can have a seriously negative effect on your body, because you lack the release of dopamines and endorphines. furthermore I you're a frequent HN, reddit or similiar reader, the information overload might cause confusion and disorientation (in terms of mental goals) and also lead to depression. You're also more prone to lose touch with your body when all you're focused on is your work or the computer, you might just need a certain minimal level of social interaction to stay happy. I think it's wrong to believe that with enough will power you can work all day in front of the computer. it will eventually run you down, you'll become less productive and as a result less happy.

>This is something that frightens me. What is a "diagnosable mental disorder"? I'm willing to bet this statement was far from true 50 or a 100 years ago. Not because I think people got more depressed or anxious, but rather because we're looking harder to "diagnose" things.

Eh, 50-100 years ago, we couldn't do anything about it, so why bother? now we can do something about it, and I think that's a good thing.

> I also never considered that I may have/have had ADD now/as a kid but now people tell me I should "get that checked out" all the time.

Really? in America? Generally speaking, telling someone else they should see a mental health professional is considered extremely rude, especially for something that is obviously not life-threatening (for instance, ADD. Irritating, but unlikely to kill you.) I mean, that's considered rude in the same way telling someone that they need to lose weight is rude; yeah, it might be true, and eh, the person might even need to hear it, but unless you are the person's doctor or you are /very/ close, it's a very rude thing to say.

(note, though, if you do suffer from ADD... I can plot income when I am treated and when I am not treated? the objective difference is... dramatic. Of course, side effects are unpleasant, but the difference is so dramatic I can usually get away with 6 months on, get a lot done, then coast for the next 6-12 months.)

The winter blues are a real thing.[0] Wil could have very well been talking about that, which is fairly common. It's something you might not personally notice, but it helps to have someone else give their opinion.

[0]: http://en.wikipedia.org/wiki/Seasonal_affective_disorder

One thing that helped me was additional vitamin D. I did some quick research and found out that one must be careful, as overdosing will bring back the same symptoms, but after adding an additional 1000 IUs a day, I am not getting as depressed as I used to.

Please note that my depression was minor, more of the "there is too much going on, I can't get started on anything, I don't feel like working, I think I will just browse something new on the net" day after day, sometimes for weeks at a time. Also, I am convinced everyone's system is different, so tread carefully and consult professional medical advice, where appropriate.

I also had recently (4 years ago) moved to way northern California, US, along the coast, so I get Oregon's type of weather (much more rain, overcast). Sun was no longer so prevalent, and very much may have had a bearing on this. YMMV.

Vitamin D helped me too, it seemed to increase my energy.

It makes sense to add this to your diet if you're working behind a desk indoors most of the day.

It's my understanding that "overdosing" on Vitamin D is very difficult. I take 5000 IU every morning. Do you have links to the research you found?

From Steve Gibson's Vitamin D 'fan page' http://www.grc.com/health/vitamin-d.htm:

John Jacob Cannell, M.D. and executive director of the Vitamin D Council has this to say about Vitamin D Toxicity: http://www.vitamindcouncil.org/vitaminDToxicity.shtml

The Merck Online Medical Manual ( http://www.merck.com/mmpe/sec01/ch004/ch004k.html ) has the following to say: “Because synthesis of 1,25(OH)2D (the most active metabolite of vitamin D) is tightly regulated, vitamin D toxicity usually occurs only if excessive doses (prescription or megavitamin) are taken. Vitamin D 1000ug (40,000 IU)/day produces toxicity within 1 to 4 months in infants. In adults, taking 1250 ug (50,000 IU)/day for several months can produce toxicity.”

Until about 2 years ago I had a long period of heavy depression. At that time, thoughts about suicide did cross my mind often. This depression was partly caused due to a post traumatic stress syndrome.

In his article Wil states that he wasn't very interested in using medicine and I shared the same thought. I did went to a shrink though and eventually we agreed that instead of medication I would go outside more, eat more healthy, occasionally practice a bit of sports and visit friends more often. These things might all seem very basic, but when in a depression it's really very hard to get oneself as far as to actually make these changes. While all of this helps, my major issue was finding a new purpose in life. But I do feel making these changes in my habits did help me find this new purpose.

Now I live in a country with a very good social system, so I can imagine it's easier to make those changes in life compared to countries where it's very hard to survive when not having a job. I've had 2 jobless periods of about a year during my depression which lasted in total for around 7 years.

Do that, and also get some drugs.

If someone can take care of their depression without drugs, they should. The same way that if someone can take care of their depression with drugs, they should.

A lot of people think they are taking care of their depression without drugs. But until they try taking drugs, they may not realise how much the depression they think they are taking care of is actually messing up their lives.

Not sure if relevant but have you tried "EMDR"? (Eye movement desensitization and reprocessing)

From own experience, I can say this is nothing short of magic and voodoo but it does work.

I'm curious, as I see quite a few post like this regarding coping with depression and suicide, are these very common problems among the HN/tech/startup community? Is it in some way more prevalent in this community vs other fields? Or are these posts for the most part shared and voted up as a sort of public service announcement (maybe not the best way to say it but not sure how to phrase it)?

And I don't mean it to come off as somehow insensitive because if it even helped one person avoid suicide then it's more valuable than most any other posts... Just very curious as I've not personally seen this from my own relationships in this scene.

> "are these very common problems among the HN/tech/startup community?"

These are very common problems among humanity.

It's good that this community is willing to talk about them so openly.

The stress of start-up life can be very demoralising and depression is rife in our industry.

Brain scientists somehow have ways of measuring unhappiness -- don't ask me how -- and one the biggest instances they ever find isn't divorce or even death, it's getting a big amount of money and then losing it. This may be related to start-up cultures.

What I'm not able to reconcile is if the despair and anxiety resulting from nihilism is something that should be treated. I'm a staunch believer in existential nihilism (and hence believe life is inherently purposeless and pointless), so time to time it gives a sharp tinge of sadness on the lines of _why am I existing at all_. It's not a suicidal feeling, but very close to it. I have (rightly, so) convinced myself of all sorts of Nihilistic conclusions such as subjective morality, consciousness and free will as not being special rather an illusion and byproduct of evolution, cosmos being huge and indifferent, etc. etc. This belief definitely gives freedom in the sense that you aren't bound by any assumptions, so you can do whatever you desire. But it also leads to slight, nagging, constant sense of unhappiness.

Running a startup being a Nihilist is sort of a difficult task, and once I had blogged about here: http://paraschopra.com/blog/personal/startups-and-nihilism-d... -- I tend to agree with Camus on his Absurdist stance, but treating for having such a correct, depressing stance is something I still haven't come to terms with.

Any thoughts on what do mental disorders really mean, or what does treatment of those disorders really mean? My current opinion is that if happiness means blocking or ignoring certain truths (via medication or treatment), then that is preferable. But I'm still undecided on that.

Your despair and anxiety don't result from your philosophical beliefs, which should be trivially obvious since lots of people share your beliefs and do not regularly suffer from despair and anxiety.

You can feel how you please, but you aren't being faced with the binary choice of "believe X and be sad" or "disbelieve X and be happy." You also have the choice of "change whatever weird thing in your head correlates a belief in X with sadness." Feel free to just fix the unhappiness and leave your philosophy alone.

Interesting point. That is precisely what I fear: if I fix the unhappiness would my philosophical beliefs get diluted. Maybe that won't be the case, but I don't know that right now.

There may be Nihilists out there who are very happy and never feel any despair, and that's what I'm after too. Nihilism definitely doesn't mean you should be unhappy. In fact, in light of no meaning, the sole purpose should be to seek happiness (why would anyone want unhappiness). But it's just bit difficult for me to feel blissful and happy all the time in spite of the full awareness that it's pointless after all. Occasional despair is inevitable from Nihilism, won't you agree?

I think its difficult for anyone to feel constantly happy and blissful. At what point is it happiness if its your baseline? In my opinion and experience, despair gives context to happiness.

Ultimately nihilism is non-prescriptive as to how you should behave or feel. Under nihilism you can very easily turn "Why Bother?" into "Why Not?", or "Why do I exist?" into "Why would I not exist?" - because all are meaningless questions.

At least this is how I deal with the fatalist aspect. Live you life as you would "normally", take the actions you think are best and do what gives you emotional fulfilment. Nihilism is only a weight if you secretly want meaning (and are somehow disappointed that your actions are meaningless). Happiness isn't blocking certain truths, it is just a biological state. If you truly do not believe or wish for a meaning then Nihilism sets you free.

It's not that a man secretly wants meaning but the facts deny any such thing. I guess evolution has programmed the man to seek meaning (from a psychological point of view). So no matter what intellectually he believes in, there would be a certain push to crave for that meaning that in reality doesn't exist. Thus the despair on the helplessness of situation.

I know using medication or treatment I can block that craving for meaning (lack of which ultimately causes despair), but I'm just unsure right now whether such a thing should be done.

The way I've seen it is that the quest for meaning is something to give up, to let go of, and so accept the joy of a transient experience. It is like experiential art: part of the point is that it will only happen once, for no reason whatsoever. You can either be sad that life is frivolous, or you can marvel that something so complex as this cosmos exists for no reason at all.

Sometimes I look around a busy store and think about the massive coincidence in all these independent intelligences having come about and came to be here right now, buying detergent, and I am overwhelmed with the beauty of it. Not because it means anything, but because it doesn't have to. It just is, like fractals or recursion, and just like those forms of emergent beauty, that awe makes me happier than I could ever be striving for something that doesn't exist.

I'd recommend looking into Buddhism and ignoring the bits about reincarnation and karma; the rest of it is basically Nihilistic and still leads to contented, happy lives (after all, the ultimate reward in some branches is total annihilation.) I personally assume that the purpose of doing good things is because we have a choice: we can make the world better or we can make the world worse. With no reason to do one over the other, what kind of asshole chooses to make the world worse? Especially since they then have to live in that worse world. It's just stupid.

+1 on recommending Buddhism the philosophy, as distinct from Buddhism the religion. The philosophy teaches that everything changes, and all you have is now, so keep your mind on the now and the later will take care of itself.

Mindfulness meditation is extremely useful in tamping down panic attacks or dealing with chronic physical pain.

I used to believe similar things and suffered from depression. I tried to kill myself with a boxcutter.

I offer a suggestion for an antidote for your philosophy:

Carefully read as much of this website as you can: http://csp.org/index.html

Then you will have the knowledge to make an informed choice regarding the use of an entheogenic drug. Good luck!

What if the universe is suffused with meaning and purpose by a just and benevolent god, and you have just accidentally fallen through the cracks? How would you know?

In other words, what is the falsifiable hypothesis of nihilism? If you cannot answer that, your nihilism is just so much mystical gobbledygook.

I've had this very experience.

Until you have the medication, you don't realise how completely you've stood in the shadow of depression for your whole life.

I suffer from "mild" anxiety, which has lead to some depression. At times, it's hard to go to venues where there are huge amounts of strangers or even the office at big corporation X (it's not so great whenever you feel like you're choking); but I power through it somehow.

I can't get rid of it, but I've found that heavy exercise (ideally both weights and cardio) really helps to mitigate both the depression and anxiety.


Hey, sounds like you might have some (maybe mild, I'm not a pro) form of social anxiety. Talk to someone about it, since there are very good programs (e.g. http://www.bostonsocialanxiety.com/ I've seen lauded on reddit) to help you with that. I've seen people with social anxiety completely transformed.

Yeah I have and that was the diagnosis. Thanks for the suggestion though.

I only recently finished having suicidal thoughts. In fact, I had them 4 days ago. It's frightening, and disturbing. I have two small children and my wife loves me. Still the thoughts come. Awful.

Hey, look. Please go and talk to your loved and trusted ones about this, and go see a pro. Simply that is progress, and it is the kind that'll keep turning into more progress. Just make a few phone calls and get yourself into that office.

Don't fret about choosing the right doctor etc. It's like startups: release your MVP as fast as you can, and then tweak it later iteratively.

Thanks :-) I went to see a doctor a few days ago, they gave me some medication that literally took me out all night and all day. Won't be taking it ever again, but it helped stop the thoughts. Only a temporary solution, I'll be getting some help!

Thanks for your concern - it actually does mean something to read your comment :-)

No problem! I don't know much about this but it appears that usually there is a trial period where people have to go through trying several different medications till they find the right one.

Meanwhile, try reading this: http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808... I haven't really read it but I've been exposed to the CBT methodology that it's based on (see my other comments on this thread) and it works.

Get help soon, and good luck! :)

The brain is a complex system, and depression is a complex phenomenon. Sometimes it takes a few tries to find medication that works right for you, or to find the form of expression that works right for you, or ... whatever. Keep trying; let the doctors know how things are working every step of the way.

And definitely keep your wife informed. When my wife went through something similar, it was a big deal just to know what was going on and be able to give feedback.

I wonder how depressed people in the 3rd world manage to survive.

Well I lived in Fiji for a good portion of my life. Those that only lived and ever lived in Fiji considered depression as a condition formed from lack of exercise or not knowing God. I'm making a very generalised statement but this is based off my interactions with members of my extended family. When I did go and see a doctor about depression, I was given Prozac. When I compare things to New Zealand, where I currently live, I find people here are more considerate of depression. My university here has been of great help, helping me get in touch with the right doctors. The professors here acknowledge my depression as a legitimate illness unlike Fiji where many of my professors simply dismissed me as lazy.

I'm currently on Effexor and having a very hard time but I'm glad here in NZ I can find people to talk to, even if they are paid to talk to me.

I went to college (here in Kenya) with two sisters whose family had a history of suicide. Both committed suicide after they had graduated.

The sad thing is that people rarely talk about mental health issues[1].

There is also a shortage of psychiatrists and when they are found most people cannot afford them.

[1] http://edition.cnn.com/2012/01/31/health/frank-njenga-mental...

They have larger life threatening problems to deal with like earning their livelihood. There are always people around you and even if they can't help you they keep you distracted.

I've always wondered if that is the case. And if so, doesn't that mean there is a direct correlation between ease of living and depression? The less you have to worry about and deal with, the more likely you are to be depressed?

I suspect the most severely depressed in 3rd world countries, to be blunt, end up on the street and die (assuming they don't take their own lives first). That's one reason you may not see depression as obviously prevalent in the general population of a 3rd world country.

Yes, I would agree with that.

Humans were created to work, the harder they work the better they feel. Animals are the same way - if you give your pet an easy life, they will die early. Make them work (for example put their food where they can reach it, but have to work hard to get to it) and they live longer.

Developed countries have their own sets of problems. Developed countries tend to be more individualistic. In countries like India, you live a more social life, you can't just lock yourself up in a room and cry for hours. It is at least true for sub-urban area. You may like it or not there will be people around you. Life is also less automated. At many places you have to go and pay your electricity and phone bills. You will be more engaged most of the time.

I really don't want to imply I'm jealous of these people's life conditions, but I've noticed that the more not-intellectually taxing tasks I have to do, the less I notice I'm depressed. If I would be fighting for my life everyday, I might not ever notice I'm not OK. I think a simpler life might do me well too.

Probably not as well or successfully as the mentally healthy...

I had and have only mild depression and anxiety from time to time and I may sound ignorant/stupid now but for me starting to read and practice stoic philosophy really helped to keep a calmer and more rational outlook for my life. It does a good job for me to not feel worthless and to keep a good spirit in spite of everything falling apart.

The words of epictetus and marcus aurelius made a difference for me.

I've also saw a therapist for cognitive therapy at that time and I've found that reading the stoics helped me with the therapy.

But: It is not an alternative for seeking profession help and I'm just a single biased data-point.

I'll add myself as a second data point. Understanding the stoics has helped me as well.

The ancient stoics seem to have stumbled upon important insights into our nature and how to be happy. A good introductory book to stoicism is William Irvine's "A Guide to the Good Life: The Ancient Art of Stoic Joy".

Interestingly the founder of Rational Emotive Behavior Therapy, Albert Ellis, "credited Epictetus with providing a foundation for his system of psychotherapy".

Can't let Robert Sapolsky go unmentioned:


Came here to post this, in this lecture he makes the point that major depression is the most devastating disease you can suffer. He also compares major depression to diabetes in that you can't will yourself out of either one.

There are studies which suggest that people with depression have a more accurate perception of reality than others: http://en.wikipedia.org/wiki/Depressive_realism

So no, depression doesn't lie any more than a healthy brain, it just tells you the truths and lies you don't want to hear.

Of course, I agree with the article that if you are unwell you should seek help. But I had this thought once: the doctor who prescribes you medication optimizes for a different thing than you may want to. Say there are two possibilities (numbers completely made up)

(1) Not taking the medication, which results in a suicide 5% of the time and getting over it on your own and a perfectly happy life in 95%.

(2) Going with the medication and being not suicidal but slightly unhappy for the rest of your life with 100% chance.

Then your doctor's incentives are such that he'll certainly choose (2), but that's not what you might choose if you were aware of the options.

Yesterday, comedian Chris Gethard wrote a long and poignant letter to an anonymous fan wrestling with depression and suicidal thoughts. A very interesting read:


We live in a society where mental problems are considered to be a spiritual problem, not a medical one. The brain is an organ and organs malfunction. I think the younger people see this and are more likely to get the help and medication they need. It seems to be the +60 year olds who will go to their priest instead of their doctor.

TLDR: Take Your Meds. Most people will miss this part of the story.

I've had what would call an a depressive trait since i was a teenager until now at 28. When i was 20 i was diagnosed with severe clinical depression and received treatment, including counseling and medication.

My own anecdotal evidence - when i was at my worst the talk did nothing to help me. Citalopram really help leveled and my mood, dull my anxiety and helped me balance myself out. There probably was some sort of placebo effect, re-enforced by the physical side effects. It helped either way...

Over the years i realized that brain does lie to me. Sometimes my brain convinced me I'm depressed when I'm just ill, grumpy, tired, frustrated. etc.

I've know now not to trust my brain, my feelings or medication.

Talking helps keep your perception in check, i recommend it.

An article I found interesting on the potential evolutionary roots of depression:


Depression might be linked to low vitamin C levels in some cases:


> About one in four adults suffer from a diagnosable mental disorder in a given year.  That means if you think about your 10 favorite people in the whole world two of them could be at risk of suicide.

No, that means on average, an arbitrary set of eight adults contains two with a mental disorder. (Presumably this refers to adults in the U.S.)

“The mind is its own place, and in it self Can make a Heaven of Hell, a Hell of Heaven.” ~John Milton, Paradise Lost

If you are experiencing slowness while loading the site also, perhaps this link will help:


Has anyone ever explored the idea that depression is a western disease?

It's really not, though most of the research seems to be on refugee populations: http://voices.yahoo.com/researchers-examine-ptsd-depression-...

It's a global disease, it just receives much, much more attention in the west (for example, all the antidepressant ads during prime-time television).

Lab mice can get depressed as well - there is specific way by which it gets achieved, so it's not even a human-only problem.

I'm in this situation right now. I will try to pass this with some therapy and exercises, because the medication decreases libido and I don't want to lose my girlfriend.

I would hope your girlfriend would have the maturity and care for you that this wouldn't put your relationship in danger. You know 50% of sexually active people are in a relationship where their partner is less interested in sex than they are on average (inevitable logic, not statistics) and if you break it down to year by year interest that number must go up (again logic).

That said, I'm going to make the brash counter-cultural statement that if you wait until after you commit to each other for life before having sex, then you worry a lot less about whether you are going to lose your partner over sex. If a necessary medication causing a libido blip is enough to derail your relationship, maybe you should consider pushing sex further up the commitment ladder?

In other words: satisfying each others' sexual needs isn't a valid and important part of a relationship?

In a sufficiently long relationship, there will be periods during which "satisfying each others' sexual needs" is difficult or impossible.

Couples I know have had trouble due to depression, childbirth, work-related travel, injury, and a year-long coma. While sex is a valid and important part of the relationship, it's also important to be able to weather periods of difficulty.

I should also note, depression tends to make one less capable of meeting other important relationship needs. If treatment causes a temporary drop in libido but improves those other areas, that should be a net positive. Thus, I submit that if a relationship gets derailed by such treatment, there were deeper issues in play.

Sometimes it's unavoidable, but it's a concern that's worthy of consideration, and saying shit like "just don't have sex until you're married lol" isn't helpful.

The way you choose to build a relationship has a lot to do with how well you are able to sustain it through certain types of difficulty.

The comment you were responding to said something considerably more nuanced and interesting than "lol" in conjunction with the "don't have sex until you're married" part. It's OK if you disagree, but please do so in a more thoughtful way.

What I found interesting wasn't so much what was said as the unstated assumptions behind it. The comment was in any case almost deliberately useless in how to handle an existing relationship that already entailed sex.

Not all medications decrease libido, and depression by itself does. Thus you may actually see an increase with drugs.

There's medication which doesn't. Bring it up as a concern!

before doing anything that this guy auggests, listen up :

Leave the meds behind. meds are the last resport. you have to try everything else before doing what this guy did and let go of your supernatural expectancies from yourself. Work less, eat better, sleep more, enjoy your life more, stress less, change your life, live healthier, enjoy enough daylight, and first make sure that you are not infact surrounded by assholes & idiots. Try sports, fall in love, try dietary suplements, vitamins, make some major life changes, stop smoking, stop drinking, stop making yourself depressed all the time. Once you ealize that you are the admin here and that it is you that has to take control of yourself and maintain the system. Meds are the absolutely last resort. This guy for sure didnt try out all those above meantioned natural techniques, but went the easy and unhealthier way. Now there is one more pilled up dude out there that i will have to compete with. Although i do try to live my life the healthiest way i can afford and cut all other bs aside, i do find it sometimes difficult to compete agains all these people on meds as they don't have to deal with as much humane feelings anymore but can act out, in the worst case, their over the top happy personalities and don't feel like normal humans do, dont sence when to stop smiling etc. but yeah, if it really was the last choice for this dude, then i'm happy that this guy is happy again. For all i know this might be just one more of those 'talks' from big pharma companies about the benefits of mood enhancers and anti depressants. Anybody out there coping with depression, hang in there, you dont want to cloud your judgement with a bunch of pills. instead thry ALL natural ways to stay happy and focused. Own yourself.

If you're going to give medical advice that contravenes known best practices and lay blame ('stop making yourself depressed '), you'd better have something substantial to back it up with. You have nothing.

You started out with some good suggestions, and I do agree that meds shouldn't be picked up lightly.

However, I don't understand your rant when you go on saying that "i do find it sometimes difficult to compete agains all these people on meds as they don't have to deal with as much humane feelings anymore"

I'd also appreciate it if you used better spacing and punctuation (uppercase I for example), it makes your post harder to read and sound like a rant.

Depression lies. If you have some depression that came from the society, what can I do? I can't get ride of that..

What do you mean by came from the society ? Do you mean it' reactional to the context ? These are the types of depressions where cognitive therapy can be efficient. You can learn to direct your own thoughts, or avoid self bashing thoughts, that will prevent you from falling back into depressions and take control of your own mental wellbeing and your life.

Yes I think it can be done. I haven't done it but if you ctrl-f CBT one user suggests they've had success replacing their negative self talk.

Why not?

I am excited to see this on HN, anyone working on this from non-drug or even drug standpoint?

I thought I was depressed and anxious for almost two years. It turned out I just had a chronic sinus infection.

I'm suspicious that a lot of what gets considered as psychiatric problems are really physical health problems. Anecdotally, a lot of people switch to a nutrient dense diet and cut out potential allergens and wind up feeling all better.

Not just anecdotally -- plenty of studies confirm this. Some people -- 30% of the people by some estimates -- simply suffer from fructose malabsorption. This means that when they eat foods with excess fructose (even fruit), they fail to properly absorb nutrients.

In particular, individuals who suffer from fructose malabsorption fail to absorb tryptophan: http://en.wikipedia.org/wiki/Fructose_malabsorption

Tryptophan deficiency is extremely common in depressed individuals: http://www.ncbi.nlm.nih.gov/pubmed/2148339

Tryptophan is a serotonin precursor, so to anyone who has ever taken an SSRI, it intuitively makes some sense that it could be related to happiness.

Sadly, no one wants to be told that their diet is a problem, or that they have to do all the hard work of changing their diet. They just go for a pill. Which wouldn't even be so bad, if the pills we made were truly effective and side-effect free. But they aren't.

Or, you know, they just believe that non-doctor people telling them it will get all better if they just eat X are out of their minds.

Any time I have mentioned that someone should change their diet to help them deal with any number of problems (weight, mild depression, seasonal affective disorder, overall energy levels), I am universally met with disbelief and dismissal.

The fad diet industry has ruined people's ability to think clearly about the topic of diet. The part that gets to me the most is that I have had profound changes in my life due to diet and exercise changes, and they know that. They still won't even try.

Possibly because there are many people out there with any number of problems (weight, depression, asthma, acne, diarrhea, rising of the lights,...) who, when mentioning those problems, are universally met with suggestions to change their diet. From someone who has no idea what diet the sufferer has.

But I'm with you, there, buddy. It's like these people don't even know rutabagas exist and supply all of the particulas vitae necessary for human existence.

Nutrition is everything.

My dad last year suffered from a mix of dizziness, nausea, depression and if he got too nervous, muscular contractions.

Went to a bunch of doctors, each one gave a different pill, and his situation wasn't improving. I had to research the internet looking for symptoms and possible causes.

Then, in the end, talking with a generalist doctor, it ended up being a thyroid disfunction (he was taking pills for that) and magnesium deficiency. After a year taking kelated magnesium and cutting the thyroid medicine (the doctor told to), he's 100% again.

I also have some anxiety problems and from time to time my sinusitis shows up. What do you mean you just had a chronic sinus infection (instead of anxiety/depression)? What kind of symptoms are you talking about? This might be relevant to me...

Also very interested in your story. I have a deviated septum causing sinus problems and an anxiety problem.......

Did you try to get that fixed? it might be worth the money.

It happened 18 years ago. I never thought it had any effect until 4-5 years ago, when I started getting chronic nosebleeds. 2 years ago I went to a doctor and had the surgery setup, but canceled it cause I wasn't comfortable with the doctor. Going to another doctor in the near future.

> Anecdotally, a lot of people switch to a nutrient dense diet and cut out potential allergens and wind up feeling all better.

I agree with you, but also, the placebo effect is very powerful.

Did it make you congested? Could it have been sleep disordered breathing (sleep apnea)?

How did you treat it?

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