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Depression lies (wilwheaton.net)
489 points by bane 589 days ago | comments


jdietrich 588 days ago | link

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.

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SeanDav 588 days ago | link

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.

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jdietrich 588 days ago | link

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.

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SoftwareMaven 588 days ago | link

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."

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SeanDav 588 days ago | link

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

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1123581321 588 days ago | link

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.

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larrys 588 days ago | link

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.

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readymade 588 days ago | link

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.

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im3w1l 588 days ago | link

The first two paragraphs were good.

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scott_s 588 days ago | link

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.

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jdietrich 588 days ago | link

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.

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cromulent 588 days ago | link

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?

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lisper 588 days ago | link

> 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.

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carbocation 588 days ago | link

Stress is not a meaningful cause of stomach ulcers.

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tptacek 588 days ago | link

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

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willthames 588 days ago | link

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.

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dwj 586 days ago | link

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.

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carbocation 585 days ago | link

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.

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larrys 588 days ago | link

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).

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saraid216 588 days ago | link

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

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rdtsc 588 days ago | link

> 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.

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atakan_gurkan 588 days ago | link

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.

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zethraeus 588 days ago | link

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.

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RollAHardSix 588 days ago | link

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.

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ta12121 588 days ago | link

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

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snowwrestler 584 days ago | link

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."

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DenisM 588 days ago | link

>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.

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lectrick 588 days ago | link

Scumbag HN user

Talks about evidence and/or the lack thereof

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

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jokermatt999 588 days ago | link

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

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MrMan 588 days ago | link

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.

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huggah 589 days ago | link

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.

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btilly 589 days ago | link

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. :-(

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navs 589 days ago | link

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.

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mnicole 588 days ago | link

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.

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navs 588 days ago | link

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

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mnicole 588 days ago | link

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.

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moistgorilla 588 days ago | link

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.

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grueful 589 days ago | link

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.

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luriel 589 days ago | link

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".

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dkarl 589 days ago | link

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.

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lusr 589 days ago | link

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".

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kahawe 588 days ago | link

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?

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lusr 588 days ago | link

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.

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dkarl 588 days ago | link

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.

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lusr 588 days ago | link

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.

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lsiebert 589 days ago | link

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.

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Alex3917 588 days ago | link

"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.

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locopati 588 days ago | link

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

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Alex3917 588 days ago | link

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.

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jtheory 587 days ago | link

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.

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Alex3917 587 days ago | link

"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.

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lotharbot 587 days ago | link

> "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

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Alex3917 587 days ago | link

"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.

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jtheory 583 days ago | link

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.

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DenisM 587 days ago | link

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

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SoftwareMaven 588 days ago | link

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

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philwelch 588 days ago | link

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

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SoftwareMaven 588 days ago | link

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...

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Alex3917 588 days ago | link

"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.

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jpeg_hero 589 days ago | link

> 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.

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huggah 588 days ago | link

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.

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EricDeb 589 days ago | link

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.

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ryanmolden 589 days ago | link

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.

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niels_olson 589 days ago | link

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.

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drumdance 588 days ago | link

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.

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d0mine 588 days ago | link

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

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ceol 589 days ago | link

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

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huggah 589 days ago | link

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.

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donniezazen 589 days ago | link

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

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huggah 588 days ago | link

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.

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donniezazen 588 days ago | link

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?

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huggah 586 days ago | link

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"?

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lilsunnybee 588 days ago | link

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.

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pharrington 588 days ago | link

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.

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dwj 586 days ago | link

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).

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diffeomorph 589 days ago | link

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.

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eggdude 588 days ago | link

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.

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msfd 588 days ago | link

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.

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msfd 588 days ago | link

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.

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borplk 589 days ago | link

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

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huggah 588 days ago | link

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.

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chmike 589 days ago | link

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

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huggah 588 days ago | link

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.

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chmike 588 days ago | link

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.

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Buzaga 588 days ago | link

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

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marklabedz 588 days ago | link

Not to mention the politics behind the DSM.

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throwaway120912 589 days ago | link

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.

http://www.iep.utm.edu/camus/

  <cite>
  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.
  </cite>
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.

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anonymous 588 days ago | link

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.

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DenisM 587 days ago | link

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.

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nkurz 588 days ago | link

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.

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rfugger 588 days ago | link

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

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ewest 588 days ago | link

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.

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kahawe 588 days ago | link

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.

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jhuckestein 589 days ago | link

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.

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jmitcheson 589 days ago | link

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.

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Evbn 588 days ago | link

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.

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huggah 588 days ago | link

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.

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jcfrei 588 days ago | link

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.

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lsc 588 days ago | link

>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.)

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ceol 589 days ago | link

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

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