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Ask HN: How to cope with depression
69 points by lotsofthrows on May 4, 2015 | hide | past | favorite | 116 comments
I'm struggling with depression, and don't know how to manage it.

Just to get my background out of the way :

I'm a programmer and have been severely under performing at work (to the point of almost being fired), and routinely question whether or not I deserve to be alive. As a result of my difficulties, I've begun seeing a therapist and psychiatrist. Both feel that I should be on anti depressants, and I am not opposed to this.

Short of medication, however, they haven't really offered any strategies I can implement. Perhaps that will come later, but for now I was hoping to hear about what may have worked for others. All the logical advice (exercise, go to sleep on time, live a healthy lifestyle) are things that I struggle to find the motivation for. Perhaps the medication will help in that department. However, I'm concerned they will dull my focus (which is a bit silly, considering I can't focus at all right now).

edit :

I am sincerely grateful for all the thoughts that have been shared. I've read every post in this thread. A few follow ups :

1. I understand the limitations of asking for advice about mental health online, and I want to reassure any/everyone concerned that I will not make any treatment decisions without the input of the specialists I'm seeing.

2. Related to the above, reading about the (mostly successful / positive) experience others have had with medication has been very reassuring. I did have some lingering skepticism about SSRI's (which may or may not have come through in my original post), and I am very glad to hear that medication has worked well for others. Maybe it's a bit silly to have an opinion partially validated by a peer group, but so it goes.

3. This is probably as emotional as I've been in weeks : reading through the responses here makes me feel like I'm not alone. Thank you, very, very much.

I'm an Army veteran that was diagnosed with PTSD in 2010 after a particularly shit deployment to Afghanistan. I've also battled with depression my entire life. Name an anti-depressant or anti-anxiety pill and I've probably been on it at one point in my life. They definitely help you. Conversely a good therapist is also extremely helpful. They can help you find directions that are away from the meds. I've currently been off meds for about 1.5 years and it's been great, but it takes a lot of focus and quite literally years of therapy to get there.

TLDR: stay on the meds; do what the therapist says to do, no matter how dumb or inconsequential it may seem; exercise.

Have you tried MDMA-assisted therapy?


Incase it was never available to you, it should be soon. DEA approves study using MDMA for anxiety in seriously ill patients (Mar 17, 2015):


I appreciate the info, but I currently hold (and use) a security clearance. All these MDMA / cannabis / LSD-25 assisted therapies are doing great things for veterans, but when it comes time to fill out that SF-86 in a few years, it would bone me.

Still, I appreciate the info.

Thank you for this comment (and your service).

thank you for sharing your experience. it sounds like you've struggled more than I have, and I admire your persistence in making it through.

You will too dude/dudette. Keep your head up.

Take the meds; if you aren't able to feel like you can do the other things, your depression might be too severe for those to help anyway. I didn't realize I was depressed for a number of years, until my wife forced me to go. I am now on medication and I feel much improved.

The wrong medicine will dull your focus (I had a very bad sedative reaction to Lexapro) but the right ones will make you feel more normal. My work is the same as it was before, except I am happier now.

> The wrong medicine will dull your focus (I had a very bad sedative reaction to Lexapro) but the right ones will make you feel more normal. My work is the same as it was before, except I am happier now.

I'm really glad to hear that. It's surprisingly reassuring.

Out of curiosity, how long did it take you to decide Lexapro wasn't right for you?

You've gotten a lot of good advice here, and I just wanted to chime in on a related point to this--different anti-depressants may be more effective for you at different stages of your treatment. If you start on Lexapro/Prozac/Paxil, and it works great, but after six months you start to feel like it's not as effective, definitely talk to your doctor about looking at different meds, even other SSRI's. There are subtle differences in how they work that can make a difference (I'm not a doctor or bio guy, but they affect different receptors differently, even when they are primarily aimed at serotonin). Depression isn't a monolithic problem (it feels like it, but there can be multiple factors feeding into it), so as you do the talk therapy and the drugs your equilibrium between maladaptive cognitions, chemical imbalances, relationship and work patterns, etc. can shift, just be aware of how you're feeling (and if differently, how) and keep your doctor apprised. Also, therapy can be intimidating because you're talking about problems that feel insurmountable while you're depressed--but just spill it; they get less insurmountable once you've expressed them. Sometimes just hearing yourself say something out loud can make it obvious what the issue is, or how you could look at it differently.

Good luck, it's worth the effort. Something I read that I thought was useful to keep in mind when dealing with this stuff: you're not depressed because the world is shit; you think the world is shit because you're depressed.

Three days, and it was the introductory dose as well. I struggled to stay awake on Day 3 and couldn't recall things from my mind. It was bad. If you can avoid driving while figuring things out, that would be awesome.

I'm now taking Prozac which is way way better for me.

The important thing is that you have to keep trying at it; finding the right medicine and right dose will take time, but at least in my case (and it seems like others here too), there is a right formula. It's rough going for a while, but like I said before, I just feel more like the normal me, not like the angry, irritated, anxious me. And I have to believe that would have ended up a net positive productivity wise.

You don't have to see the medications as a permanent thing from the outset. You may have to take the meds to give yourself the focus/ability to start changing your other habits. After that point, you might be able to build up enough momentum that you'll be able to work on yourself in other ways and eventually not need the meds anymore. But depressed people often need that initial boost to help move them out of the cycle.

Also, not to argue against "depression" or meds or anything, but... sometimes, especially for people in the first decade of their working career, we might be trying to convince ourselves we "should" be enjoying our career circumstances even if we just don't. Those shoulds can certainly exacerbate depression. I'm just saying that your underperformance might also be an indication that you don't like your job, which is totally ok.

Finally, one of the simplest harmless things you can do to start, that you might be able to motivate yourself for, is drink a lot more water, and take a B vitamin every day.

But yeah, main thrust - take the meds, trusting that you may find it easier to motivate yourself to take other healthy steps in the future.

> we might be trying to convince ourselves we "should" be enjoying our career circumstances even if we just don't. Those shoulds can certainly exacerbate depression. I'm just saying that your underperformance might also be an indication that you don't like your job, which is totally ok.

This is fair. My work has probably exacerbated my difficulties. In the past, work (or programming in general) has functioned as an outlet - something to focus on. At the moment, it's probably making things worse for various reasons. I will need to change my job soon, but feel the need to fix myself before I make any new commitments.

As everyone else is saying, take the meds. But be sure to work thoroughly with your psychiatrist to monitor the effects of the medication, and stop anything that's going awry. Don't make the decision on your own to quit a med, either - make an appointment.

Don't self-medicate with alcohol, "drugs" (the non-prescription kind), promiscuity, video games, or other things that numb you. As the psych meds take hold, you'll be able to get up, but you'll be dragged back down as well.

Be very conscious of suicidal ideas as you heal. The real danger point for depression-driven suicide isn't when things are so black you can't even get out of bed. It gets dangerous when you start feeling energetic again. Then you have enough energy to hurt yourself. Have a support group or friends who understand, and check in all the time.

Consider getting a new job now. It might help you to have a fresh thing to care about, and getting fired from your existing job will only hurt you.

> Don't self-medicate with alcohol, "drugs" (the non-prescription kind), promiscuity, video games, or other things that numb you. As the psych meds take hold, you'll be able to get up, but you'll be dragged back down as well.

poignant. I either have at one point or actively self medicate with all of the above.

> Be very conscious of suicidal ideas as you heal. The real danger point for depression-driven suicide isn't when things are so black you can't even get out of bed. It gets dangerous when you start feeling energetic again. Then you have enough energy to hurt yourself. Have a support group or friends who understand, and check in all the time.

this is valuable, thanks. I tend to be very private about anything concerning my mental health, but this makes me consider sharing it with a friend I trust who I can check in with.

> Consider getting a new job now. It might help you to have a fresh thing to care about, and getting fired from your existing job will only hurt you.

this is something I've considered very strongly. I'm a bit hesitant because I worry I'll fail to produce in my new position (if i don't take the time to heal), but it's definitely worth considering.

Please, make sure you have someone keeping an eye on you. I've lost friends to suicide, but never while they were really at the bottom... it was when they were on the way back up. It takes real attention to watch for that.

Take the meds.

Expect this to be a journey - you have to try several and you may end up on a combination (I take four). If you're dozy at work as for some ritalin to help. I hope you have health insurance :( Also, if you go through 'high' periods you're not depressed, you have bipolar 2.

Take the meds. This shit literally saved my life.

To make that a little clearer:

'Bipolar' is a condition with depressive and manic states. Low lows, and high highs.

'Bipolar Type 2' is a condition with depressive and hypomanic states. Low lows, and just feeling particularly good. People who experience hypomania without depression often don't complain about it / see it as a problem.

> I hope you have health insurance :(

That's honestly one of the only reasons I haven't quit my job. I'm performing so poorly, and am so intensely ashamed of it, but don't want to go on COBRA while unemployed.

> Take the meds. This shit literally saved my life.

Thanks for sharing. It really has been reassuring to hear they've genuinely helped others.

I believe you can go on cheaper individual or ACA healthcare throughout the year if you have a change in "life circumstance". Highly likely to be much cheaper than COBRA.

I was in a kind of similar situation recently - I never went to class, ended up dropping out of school, would sleep 10-12 hours a day at odd hours, drank way too much, didn't really have much motivation for anything.

For me the dominant factor was anxiety, and I didn't get help until I started having panic attacks. Like you I started seeing a psychiatrist and a therapist, and I was very lucky to not experience any adverse effects to the medications I was prescribed.

SSRIs are an interesting thing - because they are such a gradual change, a lot of people write them off as not working. For a while, I wasn't even sure if it was doing anything, but at some point I realized that I didn't get the awful dread/despair feelings from normal everyday life anymore. I started reaching out to old friends again, and making new ones. I sleep 8 hours now.

I didn't realize how bad things had gotten, and how much better they should have been. I used to be very against being dependent on drugs, but I eventually came to the realization that I'd rather live till 40 and love it than live till 80 and hate it - even though I don't think that's the tradeoff I'm making, it's the one I was willing to make. So I just did whatever I could.

Don't write off drugs, meditation, exercise, diet changes, etc - try it all, and find what works for you. I mostly wrote about drugs here, but different people are averse to different things, or don't believe in them, when the reality is we still don't really understand mental health very well, and your best bet is just to throw everything you can at it and see what sticks. But you gotta do it. It's way better when you do.

I don't have any immediate answers, but I did want to quickly thank you for having the courage to reach out, rather than just suffering silently. This is something with which many of us struggle on a regular basis.

thank you. that's kind of you to say, and very reassuring. I honestly felt really apprehensive and guilty / self centered / narcissistic for posting here.

> This is something with which many of us struggle on a regular basis.

it certainly feels that way at times :(

Take the meds. Don't worry about focus at this point... meds are your way out of this situation. It is hard to see light at the end of the tunnel before you start taking them, but once you do, try to find hobbies that relax you and make you happy. Keep working with your therapist and psychiatrist to find the root cause... sometimes it is hard to find it when you simply can't talk about certain subjects because of the way you feel. Don't give up. You can overcome this and you will.

I've dealt with a couple major depressive episodes in my life. In addition to the standard advice of 'Go see a therapist!' heres some things that help for me:

1) Committing to myself that I'm getting out of this state, and reminding myself that I'm working on fixing it. Then having the leniency on myself that depression is not a solved problem, and I will keep trying until I actually have accomplished my goal - however unclear my progress may be.

2) Consistently enforcing myself to complete small achievable goals. For me, this is stuff like: getting out of bed within 3 minutes of my alarm going off, having an ironed shirt, show up at the gym and do some sort of exercise daily.

If you have motivational trouble, start with even smaller goals eg 'I will put water in my cereal bowl after I put it in the sink so the milk doesnt dry and get gross.' Then work up to 'I will put the bowl in the dish washer after I am done with it.'

3) Creating arguments for why everything is actually all okay. Many of them don't convince me, eg 'You've got a steady income', but some of them do eg 'Well I've read several papers that forcing yourself to smile releases neurochemicals that make you happier' was pretty convincing.

4) http://examine.com/topics/Depression I'm not a medical professional, but the evidence gathered for supplements listed on this site is convincing. In addition to Fish Oil and Saffron, I've seen a lot of evidence for supplementing Vitamind D and found it to be very helpful.

5) Go see a therapist that you like and respect. It was important to me to find one who I thought was smart and practical - I didn't want a ooshy gooshy feelings therapist. I've had the most success with CBT.

6) Learn to refocus your thoughts. This is tough, but, the worst part of depression for me is often the sad thoughts that come with it. I find that days are better when I don't allow myself to indulge in thinking sad thoughts. So this means 1) catching myself when I've starting thinking something sad 2) Successfully putting my thought train on a non-negative track.

If you take the meds, just be aware of the side effects of being on the meds and also be aware of the side effects of coming off the meds. I've found no doctor that really sufficiently warns of these.

If you ever want to chat, my email address is in the link in my profile.

I want to start off with a bit of encouragement. You've admitted that you have a problem and you're taking steps to solve it. That's a great thing, because it's showing acknowledgement of the problem and a commitment to getting better. Too many people lack that, and so you should feel proud of yourself for that.

That said, a therapist can probably guide you better than the internet can. The trick is finding the right one. Most of the effectiveness of a therapist comes down to the "fit" between the two of you, so if you've gone to about three sessions or so and you're still not feeling it, it's encouraged and expected to try another one. Your current therapist may even refer you to another.

Above all, just keep fighting the good fight, and never be afraid to reach out for the things you need.

> Most of the effectiveness of a therapist comes down to the "fit" between the two of you, so if you've gone to about three sessions or so and you're still not feeling it, it's encouraged and expected to try another one. Your current therapist may even refer you to another.

thank you. this is very helpful. you're the second person to mention this, and it's the sort of advice about treatment I may not have come by otherwise.

as it turns out, this is something I've been curious about (how / when to change, the etiquette of switching therapists, etc).

I don't have a lot of personal experience with that kind of situation of needing to "shop around", so I'm not sure I'm the best source of information for things like that. But if you do a bit of digging, you can find some links and information online:



Ultimately it does just come down to trusting your gut, and whether you feel comfortable with them and their approach. If you do choose to switch, your therapist should understand that things like this can and do happen, and shouldn't have a much of a problem with it. (If your therapist does have a problem with it, that's a huge red flag right there and you're better off ditching them.) Some of the better therapists may even make it clear near the beginning of your therapy that they can connect you with other resources or refer you to other places if that's necessary. But even if they don't you do have recourse to do that. Just keep trying, even if it means you have to go through a whole bunch of them to find one that's right for you.

Been suffering with depression for most of my life. Exercise does help (for me, it's walking or hiking). I took medication for a year and I hated it. I meditate a lot (I'm a Christian) and I spend a lot of time introspecting my issues. Much of my depression comes from having a crappy childhood so I often have to address them in creative ways.

There have been times work has made me depressed so I take some time off. I also have done a good job of not associating things with my identity, so work is work and if I lose my job, then it's my job I lost. I tend to segment things in my mind so that when I underperform at work, I feel bad but not to the point that I want to kill myself over it. Learning to value yourself can be difficult but it's not impossible.

I was in, or am in, a very similar spot. I've struggled with depression to the point where I got almost nothing done with work. I had the same fear you did about dulled focus, but you're right: it is silly to worry about that if you aren't productive already.

A few months ago I went on Prozac. I still struggle with focus and getting work done and there are some other negative side effects, but crucially I am able to think more clearly about the situation. I'm now working on strategies myself to get myself to a better place long term.

I'd advise taking the medication -- it's unlikely to put you in a worse spot, and very likely to put you in a better spot. From that better spot you will see more avenues you can pursue.

Please, I urge you to speak to a professional:


1. Try the meds. View them as a crutch on your road to recovery, not a cure all. You have to retrain your mind to see the positives in life. The drugs may help, they might not, but at the end of the day you are the one that determines if you are happy. 2. Try mindfulness meditation. TL;DR is go to quiet spot, close your eyes, breath in and out, and focus on just breathing deeply. Longer link at the bottom. Lots of good books out there too. 3. Everyone dies eventually, so there is no need to rush there. Push yourself to enjoy life, even if it if hard.

Good luck

Take the meds. That's what helped me to stabilize. Expect that you need to try multiple anti depressants before you find one that helps you. Therapy comes after that. For me what you call logical advice didn't work until the medication kicked in.

Here's what my favorite blogger has to say about it: http://slatestarcodex.com/2014/06/16/things-that-sometimes-h...

He's a psychiatrist but I judge him based off of his blogging not on his medical skills. I wouldn't have seen this had he been a great doctor but a poor blogger.

A psychiatrist is key - but finding the right one for you is also key. There's a book about it (edit: changed the link): http://books.google.com/books/about/How_to_Choose_a_Psychoth...

I used to have a 20 mile-a-day cycle commute and doing triathlons and I didn't find that it actually helped.

I have directly witnessed my mood improve from getting a good night's sleep. But I'll still regularly fall back into not sleeping if I'm coding - which isn't bad as long as I'm enjoying the coding.

Just simply having a 20 minute walk every day can be better than running or cycling as it takes no effort and doesn't involve pressuring yourself to do it.

I found looking for interesting projects worthwhile. Code on things that you enjoy. If you hate some of the code you work on just try some ideas out for yourself how you'd improve it - it shouldn't be for anyone else - just for yourself as you enjoy it.

Yoga, meditation, Taoism, Buddhism, easy reading (about these topics), talking, beer(s) all help too.

Accentuate the positive (in any way you can).

Take the meds. The meds get you to a level of normalcy. The underlying issues causing depression can then be dealt with. But once you are diagnosed with severe depression its rare for your dr to take you off of the meds. Speaking from personal experience I have been on 20 mg of Lexapro for 10 years. When I am off for 4 months my depression comes roaring back so I stay on it and don't experiment with my brain anymore.

30 minutes of Exercise + 10 minutes Meditation every morning did wonders for me. Finding the motivation to get started will be a constant struggle, but once you establish the habit for a few weeks it gets much easier. Start small if you have to, but do it every day -- building the habit is the key. If this doesn't work, or you can't muster the motivation to do it, then the meds are probably worth a try.

I dropped exercise for the past year, worst mistake I've made. Everything changed, my productivity, my happiness, my stress increased, etc. Now I'm forcefully pushing it back upon myself and as a result I feel better, I'm getting things done at an amplified level at work and at home. Once you get in that rhythm of having it you don't realize how important it really is.

Before going to work? what time does it make you wake up then? Well I'm not a morning person

Timing is much less important than the activities themselves, but I think mornings are most desirable because anything positive you accomplish in that period will build positive momentum for the rest of your day. Hal Elrod's book The Morning Miracle discusses this concept a bit more depth, if you're interested.

I do my exercise first thing in the morning. I wake up, hydrate, brush my teeth, put on workout clothes, and I try to be out the door by 6:30AM. I never thought I was a morning person either, but my body adapted pretty quickly.

I've posted this elsewhere before. I hope it helps.

The truth is there are no real fixes in our lives. Everything gets worn down. This is pretty much a central concept in many philosophies and religions through the ages. Fighting burn out, re-energizing, being unsatisfied for while, being satisfied for a while, etc is just going to happen to you. Work with it. But don't be short sighted to think "Oh its my career, if I was instead $some_other_job_youll_hate, things would be perfect."

Personally, I follow a lifestyle of relatively low materialism and focus on engaging experiences instead of chasing products or salaries. This mostly translates into traveling instead of buying. There's no way to win this game, you can only occasionally step off it. I also find side creative side projects help as they take my mind off work and remove work from the "fulfillment" side of my life. Who cares about bullshit at work when I have a robot to build at home or when Im trying to finish the game I'm writing or the basement remodeling I'm planning.

I also have a lot of success with meditation, being slightly more compassionate and tolerant (even of things I know are wrong), and living a slower paced/low drama life. I try to think about the right things, not the default things. I try to not let the world get to me. I'm not often good at it, but at least I'm cognizant of trying. DFW talks a bit about this here if you're interested:


I found bringing these attitudes into my work life helped a lot. Its hard to explain, but I think when you get your ducks in a row in a general they naturally get in a row at work as well.

> they haven't really offered any strategies I can implement

I think I made two mistakes the first time I sought help:

* I stayed on the first medication I tried for far too long

* I stayed with my first therapist/psychiatrist for far too long

My new doctors are far more helpful and push me further than my old team ever did. If it's not clicking, don't give up, but maybe see if there's someone else that might be better for you.

> I stayed with my first therapist/psychiatrist for far too long

This is meaningful to me. I'm still seeing the first therapist / psychiatrist I sought out, and the inertial barrier of seeking out an entirely new set of professionals is kind of daunting. Knowing that this could potentially have a real impact at least means I'll probably be open to consider switching if I really feel like it's necessary.

First off; you deserve to be alive. Suicide is not a solution to anything. Life gets better, stick with it.

I've dealt with depression my whole life as well, and have also had those feelings of anxiety and hopelessness. They are your brain playing a trick on you. It's not reality.

What works for me is to focus on things that I enjoy, and to remember that killing myself will only hurt the ones I care about. I think about wanting to see my niece grow up, and one day be at her wedding, etc. Things like that. Specific things that matter to me, not just vague ideas about loved ones.

I also try to throw myself into things I enjoy when I find myself starting to feel down. Listening to music I like, singing along to it helps me often. I make plans with friends. Not future plans, like immediate plans. If I find myself starting to feel down I will reach out to friends and try to make plans to see them ASAP. Even just to go to dinner or something. This often helps to refocus me on my relationship with them, and importantly, I listen to what's going on in their lives.

I was doing marathon running for a while, running 5+ days a week and that did help as well. Unfortunately I fell out of the habit. If you can find a form of exercise that you enjoy, it definitely will help. But obviously you're only going to do it if you enjoy it.

Another thing that is important is to try to adopt an open minded attitude about trying things. This has always been hard for me, but if I can do it, it really helps. If I can open myself up to trying new things, and remember that if they don't work out it doesn't really matter, that helps. New experiences at least make for interesting stories.

Lastly, sometimes it can help to have a pet. My dogs' cheerful faces always brighten up my day.

EDIT: Also keep talking to your doctors.


Do not seek any advice from anonymous people on the web about depression, ever, you're seeing a therapist, that's a good start, If you're not satisfied with your current doctor, go see another one.

I don't know why seeking a connection even with anonymous people online is necessarily bad. There are a lot of people who have struggled with depression, sometimes hearing from people dealing with the same struggles can help.

> I don't know why seeking a connection even with anonymous people online is necessarily bad.

How many of these people are professionals? depression IS a mental illness, and must receive professional care, not random opinions by people who did not make a proper diagnosis of that person's condition. Finally listening to someone is different from advising him about how to get better. I'm all for listening but not for people playing therapists.

Seeking a connection is fine, but there are already people posting terrible advice - things that we know are not a treatment for depression as if they are a treatment for depression.

It'd be a shame if OP read all the stuff about exercise and thought it was going to be a cure. We know exercise is no better than nothing at all as a treatment for depression.

I dunno, nine out of ten appear to be telling him/her to go see professionals. Seems like good advice to me.

Here maybe, however you don't know if that person posted other messages on other forums. This is a general advice and the ONLY one people should be giving him. Saying anything else might put him in danger.

There's a joke in here somewhere

This is an understandable perspective. I'm not taking direct action based on these comments.

Hey man, thanks for sharing! A lot of us have battled with depression at various points so you're in good company.

Depression used to be an annual appearance for me, like allergy season, and even when I knew I would become depressed and could feel it happening, one little change in attitude let me take advantage of my depression and harnass its energy instead of feeling like a tidal wave crashed over me that I was helpless to hold back.

When I'm not depressed, some things like getting out of bed or getting out of the house whiles its still light out come easily. When I'm depressed making it out of the house at all is an achievement in itself.

The thing that flipped it around for me was one time while I was depressed I was also job hunting. Normally, I get anxious and nervous when applying, and rejection often stings. But when I'm depressed I'm just numb to that. I don't care, and tbe sting of rejection bounces off me.

So now I split things between "This works better when I'm not depressed" and "Save this for when I feel depressed". When I feel myself slipping into it I'm not afraid or disappointed anymore, I think "oh, I unexpectedly have temporary thick-skin super powers" and think through all the things that need doing that non-depressed me was scared of that depressed-me can get through no problem.

That shift was like a surfboard that let me ride that tidal wave and navigate until the season of dspression was over.

Instead of giving voice to your fears, doubts, and failures - let depression be a shield allowing you to fearlessly embark on edifying activities that will make life for future-you better! This depression WONT last forever, capitalize on the time you have left and pretty soon you'll find yourself not-depressdd and it will go back to the old routine!

Surfs up! See you on the beach :)

> Short of medication, however, they haven't really offered any strategies I can implement. Perhaps that will come later, but for now I was hoping to hear about what may have worked for others.

If you're looking for strategies, Cognitive Behavioral Therapy (CBT) is one approach that I know of that can help with depression/anxiety/addiction, etc. You generally work with a therapist to understand how your thoughts, behaviors, and feelings can create a kind of self-reinforcing negative feedback loop. They therapist will give you homework and tools to interrupt the pattern and think more rationally and mindfully about your thoughts. I guess you can also try self-directed CBT, but going with a trained therapist is better if you can find one in your area that you're comfortable working with.

If you are suicidal call the National suicide prevention hotline. 1-800-273-8255

I went through a somewhat similar phase in which I didn't particularly care if I lived or died (new city, shitty job which I wasn't doing well at, had no friends / gf, poor health, no immediate prospects etc). I think what helped get me out of it was focusing all of my available willpower and effort on one or two areas which were completely in my control and where success was readily attainable through consistent work. For me those were lifting and dieting, and those activities reminded me that I could be successful, reminded me that I had self worth, and boosted my morale. This created a positive feedback loop in which that success emboldened me to address other problematic parts of my life and create further success and happiness.

> All the logical advice (exercise, go to sleep on time, live a healthy lifestyle) are things that I struggle to find the motivation for.

In my experience, that is largely the point. Take "cold showers", for example, as this is something that is regularly suggested in cases like this. Is there a benefit to actually being in a cold shower? Tough to say. But really, the benefit is that it's a small-bit-slightly-unpleasant task that's easy to avoid, and if you make yourself not avoid it, you build some small momentum for other things in your life that you lack motivation for. If you can muster the courage to stare into the shower head and turn it to cold, it doesn't really matter how long you wait until you turn it to hot after that.

Take the meds, Take the meds ........

Well that's what people (specialist or not) told me.

But that were my worse mistake

Anti depressants may not be too bad (they are said to even increase gray matter) but a year ago, I was prescribed antipsychotics by injections (because I had some paranoia against cigarette smoke) and those have been the worse thing I had to live, basically it deconnects your brain. So be happy and think there's worse, much worse elsewhere. Also sports helps, do 40 minutes of bike everyday (like going to work by bike), this must be the best medicine

Anti psychotic medication, especialy depot injections, is very different to anti depressant tablets!

worse? (in term of effects)

Yes, anti-psychotic medication have worse side effects.

They tend to be more sedating or have more severe weight gain associated with them.

Hi. I can only offer my own anecdotal evidence. I suffered from depression for about 9 years, and I've been past it for about 4 years now. I am not a doctor, so YMMV.

Good that you are seeking help. That is the first step.

Meds: Take them. I always felt they dulled your emotions so that the highs are not as high and the lows are not as low. That's not ideal, but it's worse than the alternative: not taking the meds. The goal is to not have to take them anymore.

Focus: In my experience, meds didn't harm my focus; maybe it even improved, as I wasn't as often caught in the throws of depression.

Motivation: You won't get motivation from meds. The meds help you get through each day, they help you feel less of a huge burden on your shoulders.

Strategies to implement:

Learn about yourself. Learn what makes you happy and what motivates you to do things. Learn what types of things are more likely to get you out of bed in the morning. Include more of those things in your life. Include less of the things that drag you down. Pay attention to how you feel, when, and why. When you're on your way to figuring those things out, wean yourself off of the meds. This takes more effort than it seems; recovery isn't a quick process.

Go out and do new things. Don't feel intense pressure to go do everything. As others have stated, this is a journey. Just make a measured effort to do a new thing every so often. Eventually you'll latch on to something that motivates you.

I second the other comments suggesting to at least treat online advice with a grain of salt. That said...

I burned out some years ago and have been struggling with recovery since, depressive thoughts aren't far away but by now I've found coping mechanisms. It's annoying I don't feel I can talk about it with my real ID because I still don't feel like my performance and drive is even 80% what it used to be, and I fear that would impact my future chances of switching jobs if they discovered my inner struggles. But my performance seems to be enough for my coworkers to value me, so I keep going another day. I too almost lost my previous job during the early periods, but at the end of it I was valued again. (I just observe external praise, I never feel it. Whatever.)

I'm anti-big-med for myself, but I won't discourage you from taking them as a lot of people say they help and some even report total elimination of depressive thoughts. I would encourage you to see if extra caffeine helps you at all while you wait, especially as the big drugs tend to take 3-4 weeks before kicking in at all and caffeine seems to have a more immediate effect. How much caffeine do you take per day? If you don't take much, you may want to get a box of 200mg pills and try for 200-600mg per day and see if it helps you at all. Caffeine has some anti-inflammatory properties, and depression is increasingly being recognized as an inflammatory disease, plus caffeine as a stimulant itself can help with the focus. Anecdotally, what cripples me some days is never-ending introspection about my value to the world and my performance. Sometimes taking more caffeine than usual that day will allow me to shut my mind up about itself and think about other things, and that allows me to get things done. (Work, laundry, going to the gym.)

Last year I finally did start feeling like I was recovering a little bit, then my mom unexpectedly died. Expect life to continuously shit on you. But whatever. If you keep on keeping on you'll develop your own coping mechanisms (those that don't die) so even setbacks won't necessarily send you over the edge as you've been there before. Lastly, killing yourself in a nice way would take effort, it's not worth it. Just look forward to sleeping instead. You might also consider getting a pet, or a house plant -- something whose continued existence depends on your existence.

Take the meds. Best money I've ever spent.

Regarding exercise, just do something that's slightly more than what you're doing now. You don't have to go running or go to the gym if you don't feel like it.

Start small. Just get up right now and go for a walk around the neighborhood.

For something more formal, I like this guy's method:


It can seem strange that medication might help a psychological condition, but definitely take the medical advice.

A friend of mine was found in his dorm room with blood on the walls; he wasn't taking his meds. After a lot of battling (with a number of issues), he finally got around to it. He got back to finishing his degree, and got over his problems, getting a phd in the process.

Don't let it define you as a person that you happen to be ill.

While I don't have actionable advice for you, on the subject of depression I strongly urge everyone to read this blog post by Wil Wheaton: "Depression Lies", http://wilwheaton.net/2012/09/depression-lies/ It moves me to tears.

Afterwards, read his wife's account of it, "The Other Side of Depression", at http://www.annewheaton.com/the-other-side-of-depression/

For an overview of the current scientific knowledge, an introduction to brain chemistry and the psychology of depression, and -- most importantly -- a forceful argument that depression is a bona fide illness, a biological/medical condition, not just some "oh, pull yourself together" thing, see this video of Stanford professor Sapolsky: http://www.youtube.com/watch?v=NOAgplgTxfc

Among other things, I recall the following to have worked for me:

* 12-step work (Al-Anon / CODA)

* Intense enough exercise. You want to get a strong endorphin high going. Anaerobic exercise can be a very powerful mood- and motivation-builder. A bodyweight/kettlebells mix taught locally as "combat conditioning" works very well for me. Kinda social enough but still good for "loners". Competitive only towards oneself. Motivation starts rearing its head strongly when body picks up on the endorphin high. I find it very hard to get motivated for straight-up weight training. Rock climbing has been very therapeutic to me as well. (The body is a subtle pillar. Living life in a strong, supple body and a trained endorphin reward system makes every single thing more enjoyable. Just walking feels good.

* Meditation. Any meditation is good. "Dark" / tantric meditation is invaluable as an aspect. Headspace.com works well. Meditation does really open the mind towards enlightenment, I have found. I have experienced brief glimpses of full serenity in everyday moments through meditation. Not during meditation but in the life that is lived around it.

* This unbearably beautiful Nietzche quote: "Reife des Mannes: das heisst den Ernst wiedergefunden haben, den man als Kind hatte, beim Spiel." ("Maturity: To have finally rediscovered the seriousness one had as a child at play.") Apply it to exercise, meditation, the discovery of life and living it.

* Offroad motorcycling. It cannot be adequately stated in words how transcendental, intense, and meditative the experience is.

* Edit: Giving up smoking!!! Nicotine is such a subtle poison. It's an illusion that it is hard to stop, but the illusion is tricky to break, but still it is easy. Very subtle and tricky. Allen Carr's Easyway to Stop Smoking worked for me.

Worry about the medication first. Don't try to overwhelm yourself with other solutions right now.

There are a lot of different medications you can take, and they have different side effect profiles. Prozac is different from Wellbutrin is different from Lexapro, etc. Sometimes doctors don't have a good reason to choose one over another in any particular case. If you sit down and have a serious talk with your doctor about which side effects often come with each medication, and which side effects you can live with, you're more likely to get off on the right foot.

People telling you to exercise are right, but that is pretty hard advice in that format. The real answer is to find the kind of exercise that works for you, and don't give up until you do. I've never been a morning person, and I always hated running and other cardio, so for years I didn't really exercise at all outside of walking places. Turns out I really like biking and rock climbing. If you can switch to biking as part of your commute (biking to the train maybe) then you don't have a way out, and you have to exercise. Use the days when you do have energy to make plans for later days when you may not. Try to do things for other people.

The best thing for me in the end was 1. Getting out of the life situation where I had been depressed for a long time. 2. Getting into something totally new and overwhelming, and doing it totally by myself. I spent all of college and grad school dealing with some pretty severe depression, and when I finally graduated I took out extra loans to travel for a few months over the summer before my job started. I bought a one way ticket, planned almost nothing except listing a few places I wanted to see, and went alone. When you are traveling alone in a foreign country, it really hits home that you are entirely responsible for your own experience. There are beautiful sights, incredible food, life changing encounters to be had, and you have to make the choice every day between getting up and out and interacting with the world and crying on your hostel bed. You'll still spend some time crying on your hostel bed, but you might also smoke a joint with a Brazilian and some French women in a park in Prague and start a travel romance with a former professional trail runner in Barcelona.

* Seek specialist

* Medication helps

* Logical - go for a run - blood circulation, oxygen, endorphins - cannot go wrong with that!

* Slightly related - http://www.startupsanonymo.us/

If you don't exercise then now would be a great time to start. Endorphins feel great and sometimes the intensity of physical activity is a good way to hit the reset switch on your brain.

You need a goal and objective to keep you motivated outside of work.

What inspires you? What are your ambitions? Do you like to travel? Build? Music? Gardening? Swimming?

Life is long and hard. This rarely goes over well online, however, if you have never read the bible, this link helps sketch a rough outline. I no information other than what you offered, I hope this helps as you gather support. http://www.matthiasmedia.com.au/2wtl/2wtlonline.html

Get a dog. They're called man's best friend for a reason. :) When I'm feeling like you are now, I look over to my little buddy and think, "What would you do without me?" But what I should really be thinking is, "What would I do without you?" Words cannot express the amount of joy that my dog brings to my life. I don't know if I would be here right now if it wasn't for him. When I don't feel like getting out of bed, he's always there to wake me up and give me a reason to get moving. I cherish every moment.

Here is a video I recorded the other week of one of our walks. We've walked along this path at least a thousand times. https://www.youtube.com/watch?v=iH4TsjD97cU

Get a dog. Give it all the love you have. You will receive the same, unconditionally. Go do all kinds of things that your little friend enjoys. Go for long walks as often as you can, morning and night, at least. Your friend's excitement and joy over the smallest things will rub off on you too. And you'll come to realize that, to your dog, you are literally everything. It really puts things into perspective. There really isn't much more to life than that, and I think there's a certain beauty to it.

Thank you very much for sharing. I didn't downvote you (obviously). I actually have at many times in the last year (before things got... really bad) wished for a dog, but I live in a very uptight apartment complex that doesn't allow large pets.

> And you'll come to realize that, to your dog, you are literally everything. It really puts things into perspective. There really isn't much more to life than that, and I think there's a certain beauty to it.

this, and the video, made me smile. thank you.

^^ This. Dogs are just love with legs. Some people rescue dogs; my dog rescued me.

Don't seek medical advice online, it's too generalized. Listen to and discuss these problems with your doctors and family.

Every case is a case, but one of my best friends took control of his depression and anxiety by:

1 - Take meds.

2 - Buy a piano. It seems crazy (he literally spent all his money in it) but I can confirm that it was the best investment he ever did.

My piece of advice would be to track any intervention you might choose to implement. Find some indicators that are personal and can tell you whether any given intervention is working or not.

I have no personal experience with depression. However, I've used self-tracking to improve my allergies cf. http://quantifiedself.com/2014/03/thomas-christiansen-learni....

I would also look a bit broader than just your mental state e.g. how are your other bodily functions running. Depressive states might be a signal from your body about something that's amiss in the layers below and/or in your environment.

Get a sabbatical year and go to Australia with a friend. It worked for me.

There is a lot of scientific research around this. I'd suggest three natural things. A quality fish oil, exercise, and do more social activities.

Sources: http://www.health.harvard.edu/newsweek/Exercise-and-Depressi... - http://mason.gmu.edu/~sslayden/curr-chem/fish-oil/fishoil-wp...

Here's a meta analysis that says:


> When only high-quality trials were included, exercise had only a small effect on mood that was not statistically significant.

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

> [...] The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

"In summary, exercise appears to be an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy. Observational studies suggest that active people are less likely to be depressed, and interventional studies suggest that exercise is beneficial in reducing depression. It appears that even modest levels of exercise are associated with improvements in depression, and while most studies to date have focused on aerobic exercise, several studies also have found evidence that resistance training also may be effective. While the optimal “dose” of exercise is unknown, clearly any exercise is better than no exercise. Getting patients to initiate exercise ---and sustain it – is critical."

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/

For more studies regarding this 'inconclusive' research. https://duckduckgo.com/?t=disconnect&x=/html&q=exercise+trea...

Also, I cited Omega 3 and social support. Are they 100% definitive? No. But are they solid steps to healing the mind? Yes.

See a professional and do what they say. It can take years to get sorted out, so don't expect it to work quickly.

In the meanwhile, exercise routinely, get outside and get sunlight, force yourself to hangout with people and do activities. Find thing you like to do that aren't your day-to-day life and do them and enjoy them. Build positive feedback loops in your life so you always have things to look forward to.

There's no quick solution, only retraining yourself to understand how valuable and important you are to your world.

Sleep, exercise, and a good diet are always a great start. I always to look to one of those three things when anything feels off in my own life.

Everyone here is suggesting you take your meds. One alternative that is increasingly popular, especially with depression, are psychedelics. I would suggest Amber Lyon's Reset.me [1] if you're interested in further reading.

Now for the downvotes...

[1] http://reset.me/

Suggesting hallucinogenics for someone with a known mental health problem is irresponsible.

Therapeutic uses would be of known doses in tightly controlled situations - neither of which are available to OP.

> Therapeutic uses would be of known doses in tightly controlled situations - neither of which are available to OP.

I wasn't aware of this and I wasn't suggesting that he go down and buy a hit off of the nearest corner. I was suggesting that OP consider researching alternative methods that are taboo yet effective.

I don't have depression but I am manic depressive so I imagine there are similar things that help.

Exercise definitely! Even just running a little bit helps. It seems like you already have talked to a therapist. Have you considered finding people to talk to as well? I think what usually happens with depression is that you shut yourself away from everyone else, but you really need to open up to someone to improve. At least, that's been my experience.

Bipolar disorder and depression are different illnesses. The medications used to treat are different; the therapies used to treat are different.

(I didn't downvote you)

I appreciate that you took the time to explain why I was downvoted.

Also, I'm pretty sure the things I described are good for both.. I was misdiagnosed with depression at first so I did a lot of research into it, but maybe my memory is failing me.

Well, there's no magic bullet. You could ask you professionals about getting cognitive therapy or look up a psychoanalyst in your area.

'Talk thereapy' like psychoanalysis has been severely out of fashion in recent years because it's intuitive rather than rigorous, so your existing professionals might not want to recommend anyone. Where it does well is in helping the patient to get fully familiar with the course of his or her depression - not so much to identify a single cause, which there may not be, as to help identify the differences between the malady and the ordinary ups and downs of life. If you're a very verbal, analytical person, this might be helpful for you. I sometimes feel a bit frustrated when I see a psychiatrist that he just catalogs a few details about my mood, sleep patterns etc. and we don't talk much about the experience of things - a bit like a doctor that writes you a prescription for a painkiller but doesn't seem to have any interest in the diagnostic aspects of the pain, eg 'it hurts much more when I do this, what does it mean?' 'Oh that's normal, take two of these and call em in the morning.' 'Grrrr.'

Exercise is very useful, But of course you feel demotivated. You could try to put in some effort finding what kind of exercise options are available. I find the idea of going to a regular gym insufferably dull, for example, but I enjoy climbing and martial arts, and you should be able to find options for both in any large city. Martial arts has a lot going for it because it gives you a simple problem to focus on - how to prevent your opponent from beating you up- but with the benefit that the opponent isn't trying to make you feel bad, so you don't need to take his or her assaults personally. If you investigate this don't go for a place that is heavy into competitions and belts and other stuff, look up the sort of people who do small tai chi classes in parks and so on. As a general rule, the less rent someone has to pay the more personal attention you'll get. Of course you don't have to go with an Asian martial art, if you've always wanted to learn fencing or something try that. The basic point is that it's really helpful to have something or someone external to grapple with, it takes you out of yourself. Also,as you learn more skill you can exercise mentally by running through sequences of different moves in your mind, like a chess game. This is very good for managing feelings of negativity and worthlessness, after a while you recognize patterns of unhealthy thought and learn to short-circuit them.

You could also consider getting a pet, particularly a dog. Now matter how shitty you feel, being responsible for another creature kind of forces you to get out of bed int he morning. Of course it comes with annoyances an irritations too, from cleaning up occasional toilet accidents to their refusal to take no for an answer when you don't want to get out of bed. But they're manageable problems. On the flip side, they give you an excuse for managing your life more rigorously; if you can function more consistently at work, then you can also say you need to go at the end of the day because you have to feed your animal. Some workplaces will allow you to bring in a service animal, and if animal companionship is helpful to you than you have very strong rights under the Americans with Disabilities Act (I'm assuming you're in the US). Use them. If you're already had an animal in your childhood then you know what you like, if not then get some advice. Dogs are generally more emotionally responsive than cats, plus they're more familiar as service animals, so unless you're already a 'cat person' a mid-size dog is a better choice. They're more work than a cat, but that is a Good Thing because it will get you out of the house.

Work-wise, maybe programming isn't for you. I got quite alienated in my 20s by the virtuality of programming; you're pushing stuff around in memory or in the cloud somewhere, shoveling bits to make $ and after a while it all seems rather meaningless and pointless if you're not solving a problem that you actively care about. Also, the never-ending stream of New! Stuff! coming fown the pipe (frameworks, protocols etc.) means that your knowledge base is being constantly degraded, which just gets a bit tiring after a while because unless you're writing for mainframes you may well feel that you're building on sand, an this becomes an Unpleasant Metaphor for Life, of the sort you can easily obsess over when depressed. Start asking yourself what else are you interested in besides code? If you weren't a programmer, what sort of things would you engage programmers to do? Let your imagination roam - run a winning formula 1 team? reduce world hunger? Solve humanity's most ancient mysteries? Bear in mind that outside of pure computer science, a lot of programming is service work - skilled service work, but still service work. It's like being an accountant - you have to be smart and on your game, but ultimately you're a functionary rather than a decision maker in many programming jobs. Just because you're good at it doesn't mean you have to do it for the rest of your life. The mental skills of programming are highly transferable to many other contexts, and you may very well find it profitable to move into a different domain and build up a pile of expert knowledge there, where you will also find new and interesting problems that could be easily solved by technology, allowing you to progress very quickly by being The Smart Person.

So as an exercise, imagine that you were fired and further imagine that you were put on some sort of programming blacklist and forbidden from working in the tech sector, forced to work in some other context as an underground programmer. What other fields are you interested in? Protip: while some highly specialized subfields like medicine obviously require significant qualifications to enter and would require you to go back to school for many years and at great expense, many interesting and exciting areas require no qualifications at all, just a capacity for obsession. You already have one of those, it's what makes your depression so intense. When you find something, start learning about it intensively outside of your day job; use the latter to finance your actual interest. You shouldn't feel the least bit guilty about this.

Of course, you don't have to leave programming. but you do have to know why you're in it, and that means it's important to be programming to some end that you are interested in. Who is it that decides what sort of programming problems you work on, and if that is not you, then why not? I have the impression that you derive a good deal of your self-worth from your job, and are disproportionately sensitive to how you do there, not least by the proximity of how you discuss your job situation with questioning whether you deserve to be alive (by the way, the answer to that question is that you don't, but neither does anyone else - you just are, and you don't owe anyone an apology for your existence unless you deliberately dedicate yourself to making other people feel awful). Shift your perspective to thinking about how you perform a service so they give you money, and focus on what other things you would like to do with money besides pay rent and put food in your mouth. This will help you get through individual bad days - it is perfectly OK to have an ulterior motive for work. Obviously don't say out loud that you're only there for the money, but start thinking of your line of work as a ladder to get to somewhere else you want to go.


If you're still having a problem imagining other places you want to go, work with your therapist to identify what sort of things you feel unambiguously positive about even though you may get intense anxiety that you don't deserve to enjoy such things. I have a theory (which I'm going to completely handwave here) that when we're depressed we often avoid thinking about the good things in life too hard because our brain is churning out hormonal painkillers of offset the mental and muscular pain of anxiety, and those painkillers are actually rather addictive, so you get used to feeling bad because once you feel sufficiently awful at least you get to wallow in your own hormones a bit and that yields relief. Thinking about good things initially makes you feel worse because you know they're good but you don't feel any chemical payoff, so when you try to model yourself enjoying this good thing you are only conscious of the burden of pain you're carrying and the temptation is to shift the focus back to that burden to get another shot of compensatory hormones. So say your happiest memory involves, I dunno, hot air balloons. You think about hot air balloons but you don't get any particular charge off it so you begin thinking that once hot air balloons made you very happy but now you only feel pain, and so you have lost your capacity to enjoy hot air balloons (or anything else) forever. But did your earlier self who derived great enjoyment from hot air balloons deserve to suffer for the sake of that enjoyment? Of course not. Can you imagine someone talking to that younger and happier version of yourself standing there saying 'oh, you're a horrible person, your naive joy in hot air balloons is an illusion will be crushed by a lifetime of misery, ha ha.'

I'm pretty sure you can because that's basically what you're telling yourself as a despressed person here in the present. Now focus once more on the imaginary person saying this to your younger and happier self, and actively trying to make that self feel awful in the same way that you feel awful right now. What an asshole, right? IF you saw someone else doing that you'd tell them to shut up and shove off, and stop trying to ruin other people's enjoyment of life. Well, that's what your depression is - an imaginary miserable person that you carry around in your head who is constantly running you down and telling you that you're No Good. It's your own critical faculty on steroids a useful faculty but one that has gotten out of control and turned into the mental equivalent of a scab that you keep picking at day after day and never allowing to heal. It's not evil, or inevitable, or or inaccessible. It's just a part of your psyche that's stuck in a self-reinforcing loop, a race condition if you like.

So all the coping strategies I've outlined above are ways of establishing different perspectives to stop seeing that psychic irritation as The Only Thing That Matters and instead acknowledge it as a Painful Thing but not the Only Thing. Drugs may assist with that process (or not; don't be surprise if it takes several attempts to find something that works, or that things work for a while and then stop etc.). I say 'process' because it's not a threshold thing where you have some big realization or turn a corner, come out of the darkness into the light, and you're not depressed any more. Instead it's this thing that just comes up more or less intensively and you need to develop a process of recognizing it as a symptom of your depression, remembering that its a painful internal injury rather than some objective moral flaw in the world or yourself, and then try to sidestep the pain the same way you would with the pain from a broken arm or whatever.

This process won't make much difference at first, the same way that taking a deep breath doesn't help much with the pain from a broken arm when you need to do something like buttoning a shirt or turn on a light switch, never mind things like pulling on your pants or lifting heavy weights. On bad days you have to remind yourself 100 times a day that it's only a symptom and that sooner or later it will heal if given the opportunity, and then do it again 5 minutes later. but after a while you find you're only dealing with it 80 times a day instead of 100, or 50 times a day instead of 80, and so on.

And that's how you learn to manage it. The more work you invest in managing it, the more it is to recognize as a symptom rather than The Awful Truth, so that when it waxes and wanes you can learn which strategies work best to deal with it, like when it's more effective to work or to take a rest. You know how kids are horrified by physical injuries because the pain if such a novel sensation and now they think this is how it's going to be for ever? Exact same thing. Just as it still hurts to hit your hear or cut your finger or break a bone, but you have learned that physical pain is transitory and treatable, you need to learn the same thing about mental pain, and keep patiently trying out different things until you identify the characteristics of of your particular mental injury and what you have to do to handle it. It is absolutely a manageable problem that becomes easier with practice - much easier, and that practice can significantly improve your competence to deal with other external problems and support creative and professional accomplishment.

thank you very much. I found your post quite helpful. I definitely have experienced at points an existential crisis wrt programming. I do enjoy it, but it's been a while since I worked on something I truly cared about.

my therapist described me as having an "idealistic streak" and mentioned I might be happier if I were working on something that motivated me more than a paycheck. This is something I'll have to take into account as I look for a new position.

I suffered from a major depression some years ago, and with "major" I mean a condition where I used to have panic attacks everytime I left my house. It was painful and took me a very long time (2 years in the middle of my twenties), but in the end I made it.

Some random advices based on my own experience that helped me feel better and bow out of depression (please consider that I am not a doctor):

0) You are not alone, so you don't have to feel alone; talk to people that you won't feel judged by (the internet is great for this, and so are the therapists) and spit out everything

1) As you pointed out, medications can alter somehow your ability to focus, particularly on the first days. I lived my depression as a condition where I hadn't really too much control over myself, so I decided not to take any med because I didn't want them to take control over myself: you probably want to do the same

2) Day by day, write down simple todo lists, and try to complete all items. These lists will help you distinguishing days by their completed items and reacquire the awareness of time. Additionally, there is always a little bit of satisfaction in completing things you were supposed to complete, and we all need that!

3) Your job pays your bills, work hard but don't forget that you're only in it for the money, your life is something else, somewhere else

4) When you feel you're at the lowest mood, don't question if you deserve to be alive or not, rather smile and think that one day you will be fine again. If you didn't deserve to be alive, you would be probably already dead so let that bad bad thought go away

5) Don't be ashamed of your current condition but at the same time try not to get into the collective imaginary as 'that depressed guy'; there's nothing wrong about being depressed, but the last thing you want to deal with now is people's pity. I occasionally run into people that knew about my condition and I can still clearly see that 'oh, poor guy :-(' look on their faces: a bit frustrating to be honest!

6) From time to time during the day, for several days, give your mood a rating, write it down, then look for patterns and ask yourself why, at some point, your mood was increasing or decreasing. You have no idea how this helped me

7) Read this two parts post [1, 2]

8) As you sense you're starting feeling a little bit better, that is the time you should ride the wave and get yourself out of it, no fear, no look back: you made it

[1] http://hyperboleandahalf.blogspot.it/2011/10/adventures-in-d...

[2] http://hyperboleandahalf.blogspot.it/2013/05/depression-part...

I've dealt with depression several times in my life (I'm 24).

First, when I was around 16-17 and then off and on throughout college with the worst of it being the year and a half that spanned by grandma being diagnosed with and passing away from cancer.

I can give you a little background on both. I don't know and won't guess on what exactly you're going through, but I can share my experience in hope that it helps.

Growing up I was a pretty high achiever, with that continuing into high school. Around my sophomore year, class rank came out, I was first (hooray). No one thought I deserved to be first and made sure to tell me that. If they didn't tell me I didn't deserve it, they would tell other people. I realize this seems like a non-problem, but it really messed with my head. All of a sudden, my peers and friends were basically calling me a fraud and I was struggling not to believe them. I put an enormous amount of pressure on myself to out perform them and, when they scored a few points higher than me on the ACT, I started to crack. Around the end of the second semester, I couldn't eat, I couldn't sleep, and I was essentially having a constant panic attack. I finally told my parents, who took me to see a therapist. I was embarrassed by this, normal people weren't supposed to see therapists. I wanted to avoid medication, most of it doesn't have much of an effect on me, so we just ended up talking. 'If you don't get straight A's, what then?'; 'If you aren't number one in the class, what happens?'; a lot of these huge pressures I felt were artificial. What I took away from all of it was that instead of taking satisfaction from the progress I was making by comparing myself today to myself yesterday, I was now looking outward for validation, which is never really a good thing. It's certainly helpful to use others that are better as bar, but it is terrible to continually point out the ways you are not as good as them. By adjusting my perspective a little bit, I was able to rid myself of all of the external pressures I felt and was instead able to focus on how exactly I could be better tomorrow.

After dealing with the high school stuff, I had a pretty successful last two years of high school and ended up going to our state school to run cross country and track and to get my software engineering degree. My college career played out like this: Freshman year: broken foot, death of family friend; Sophomore year: friend accidentally shot himself; Junior year: broken foot; Senior year: grandmother diagnosed with terminal illness and passed away 7 months later, broken rib. It was not great. Honestly some of the worst and darkest years of my life. Particularly my senior year. I skipped classes for about 3 weeks both fall and spring semesters, because of what I was dealing with, just doing enough to pass my classes. It was hard. I didn't sleep. A lot of nights I wouldn't fall asleep until close to 4. I ended up taking a combination of melatonin, sleeping pills, and extra sleepy time tea just to give me a chance at sleep. Ater I broke my rib, I drank a lot more because I didn't have to worry about running. I never thought about suicide, I had seen what it could do to families and felt that whatever pain I was going through was worth it for my family and friends. I did, however, think that it might be better to just not be here anymore. I knew it wasn't realistic, but it did seem better. I was determined to deal with it on my own. I read 'The River of Doubt' (a book about one of the darkest periods of Teddy Roosevelt's life) and it helped. His methods for dealing with shit really resonated with me (basically throwing yourself into the pursuit of some grand goal) and I started feeling better.

I still have moments. Depending on the situation, different things help. One is that nothing really matters, not in like a cynical mad at the world way, more in a there is no point in not trying, because the outcome, whether success or failure, doesn't really matter. If people want to look at you differently who cares. Most of the time, you can learn and grow from your failures. Another is that emotions like 'worry' and 'embarrassment' are often pointless emotions, it's just you making yourself feel bad about something that hasn't happened yet or about what you think people are thinking about you. The stuff with my grandma still isn't easy to deal with, but I have hope that I'm still making her proud. If you're not a religious person, you can still hope that what you're doing would make them proud. The ones we love never truly leave us, it's still valid to strive for them.

Life is too awesome to give up on. And you are never as bad as you may seem. Keep your head down and your chin up. Failure is something you should be proud of, most people give up before they have the chance to fail. I know a lot of this may seem like feel good mumbo jumbo, but fuck cynicism, feel good mumbo jumbo is usually pretty spot on.

Here's a quote by a person a lot more eloquent than me:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” - Teddy Roosevelt

A song I listened to a lot: Walt Grace's Submarine Test, January 1967 - John Mayer

If you just need someone to talk to, I would be more than happy. Just let me know your preferred method of communication, I'll reach out to you.

Change the variables: you can be unhappy in a town doing a job because you haven't got any friends in that town (e.g. colleagues could be a lot older or at a different stage of life to you and therefore not able to be the friend material you need, e.g. to go out on the town with, no time after work to do anything else).

If you move town for a new job then you can find yourself with some initial difficulties to make friends, but, after a brief settling in period you can have a life outside work with a scene etc. This has a lot to do with where you end up living. Just one or two new friends that welcome you in to whatever they are doing can make all the difference.

It is not necessary to take on a career advancing job for such a move. You can move sideways from programming to helpdesk. There are rewards of job satisfaction if you can help people, you can go home with nothing hanging over you, your shift is done. Plus actual shifts, e.g. an afternoon to evening shift, that might help.

On the helpdesk you are learning and there is promotion if you are good to team lead and that might be enough for you. You can go back to programming with a few more strings to your bow. Compared to your peers you will be much more customer focused due to the helpdesk experience, which would become a retrospectively made positive career choice.

Obviously there are other sideways moves you could make, that depends on you and what you can do. Maybe you have an 'angle', e.g. science, or an industry, to make that easier. If you start over in some new town you will meet some new people to live and work with. There is luck in the draw, but how else are things going to change? You could meet someone in the workplace that mentors you, you could get a housemate that shares a few of your interests and welcomes you into his/her social circle. You might find yourself participating in awesome banter, you might find people appreciate your work, who knows, could happen, and that sort of stuff is probably the best cure for depression.

The above could go wrong, or need to be kept on track. Sometimes a secondary house move might be needed in the new job so look for somewhere temporary that is adequate for initial purposes (e.g. saving money, meeting people, proximity) with a view to moving somewhere else, 'more you', when settled in. You will also have to be very committed to making the new job work, there is no time for depression if you have to do that.

It is actually quite hard logistically to start in a new job in a new town but there is satisfaction in surviving that. You will need to interact with people courteously because you don't have all the things you need when you first get there. If it all goes well then it will be fun and you will wonder how you ever were on that pill taking abyss, desperately seeking advice. Accomplishment + achievement = happiness.

This is not medical advice.

In England front line treatment for depression is a talking therapy. This would normally be cognitive behaviour therapy, butthere are others. This works best one to one, face to face, with an experienced practitioner. But some people like and get benefit from group therapy, or from telephone provided sessions, or even self-guided by book or website.

Meds should help. The side effects can be unpleasant and you need to be able to be honest with your clinicians about what the side effects are and if you're taking the meds.

It's really important to hold onto the idea of hope. Things feel overwhelming at the moment, but recovery is possible.

Once recovery has started you might want to look at "resiliance" - ways to protect yourself in future. This might be taking part in team sports or gardening or meditation or putting in place some stuff around work. People talk a lot about the curative powers of exercise for depression, but we don't have enough evidence to show that exercise is a cure. http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> When only high-quality trials were included, exercise had only a small effect on mood that was not statistically significant.

Exercise probably won't hurt, but don't beat yourself up about it if you're not exercising.

Here's a nice UK website discussing "talking therapies". http://www.mentalhealth.org.uk/content/assets/PDF/publicatio...

Here's the recommendations for treatment of depression in adults in England. http://www.nice.org.uk/guidance/cg90

If you want a book for cbt I've heard "Mind over Mood" is a useful workbook, although it's probably for the milder end or in conjunction with a therapist. I've heard "mood Gym", and Australian website, is also good. https://moodgym.anu.edu.au/welcome

There are other computer guided therapies. It's a good idea to check the research because some of them are not very good. The Cochrane Collaboration has checked some computer cbt programmes for anxiety or depression.

It's great that you are doing something to tackle this health problem! Good Luck!

Thank you for responding. I found this to be a very helpful comment.

This is probably not a good place to discuss this particular issue.

There is a frustrating mix of terrible advice and good advice. Is that why you'd recommend not getting advice here, or is there some other reason?

(I upvoted you.)

Oh, absolutely -- I always worry when someone who's having emotional trouble seeks out the greater Internet for advice.

There are some very good reasons why it takes a high level of training to counsel people.

I mentioned this elsewhere, but I'm not taking direct action based on any comments here. Yours is an understandable concern, though.

What I'm going to say here is going to be extremely controversial. I ask you to think carefully about what I'm about to write before raising any objections mid way through. I've helped a lot of people get through depression when meds/basic advice(exercise, meditation, etc) just wasn't working.

1. First, figure out if it's your situation. Chronic stress that comes from a source outside your control is number one cause of depression. Most people are depressed because they lie to themselves saying they are working at a job/going to school for something they love but they really don't. The little voice in the back of your head that tells you maybe you should actually pursue EXACTLY what you want out of life, instead of telling yourself doing it the 'safe way' is better, safer or it's just what supposed to be. Because at that point even though you raise the stress level, you allow the stress to come from a source that you CAN control (you are finally in charge and are doing EXACTLY what you want in life) instead of from an uncontrolled source (shitty manager, company stock falling, you don't get along with your peers and can't change teams).

2. Stop running away from negative feelings. Learn to have a perverted attraction for mishaps. You don't actively seek trouble or purposely put yourself in situations, but you simply learn to love the fact how life just won't give you what you demand 99% of the time, and it will let you cherish the time that it does. Learn that it is okay when things go bad, it is not the end of the world, it is not unfair, you are not damned. It is merely unpleasant and annoying, but life is full of that.

3. Poor omega 3 - 6 ratio. Not enough DHA. Among other nutrition advice, this is probably the most prevalent. Start eating omega-3 organic eggs and wild caught salmon every day for breakfast. Both those foods are extremely high in omega 3, and unlike plant omega 3's, the animal sources contain DHA which is essential for neurogenesis on prefrontal cortex neurons. Those neurons are essential for willpower, motivation, and decision making.

4. Take uridine supplements (sublingually) and make sure you get adequate choline intake. Uridine + Choline + DHA increases the rate of neurogenisis than simply DHA alone. Most people with depression have under developed pre frontal cortex neurons, which exacerbate the symptoms of depression. Before people freak out about drugs/nootropics, choline is found in highest ammounts in eggs, beef livers, chicken hearts. Chicken breast/wings/thighs also contain a fair amount of it. Choline is essential for proper memory funciton as well. Uridine occurs naturally in spirulina. I recommend you buy bulk powder of Uridine online since if you take it sublingually, it is about 9 times more effective. Oral capsules for uridine are pretty expensive. I use powdercity.com.

Side effects of anti-depressants exist, but not everyone gets them, and they're mild compared to actually being depressed. Depression is more distracting, debilitating, and hazardous than the treatments for it. If you have depression, starting medication is a positive-expected-value move. If your first medication doesn't work or has unacceptable side effects, then your doctor will gladly change it. Generally, treatment starts with the drugs with the fewest side effects (e.g. Lexapro) and higher doses or or more blunt drugs are used if needed. You're not going to end up on a high dose of Prozac against your will.

Also, many of the harsh and weird side effects of SSRIs (the yawns, the sweats, and the weird-ass dreams in the first week) are temporary and doctors will usually prescribe anti-anxiety medication if those become an acute issue.

You need to do something about this. Medication's a good start, because it will give you the initial reboot that will make you able to exercise and regularize your sleep. After you're well, the next job is to stay well and get into an exercise routine and start eating healthier foods. Right now, though, medication is the best source for that initial "push", and it helps many people. Once you're out of the depression, establish healthy habits to maximize the probability that you stay out of it.

Also, you shouldn't question whether you "deserve to be alive" because of one job. Most people have been fired at least once. Shit happens. If your depression is interfering with your ability to perform at work, then disclose the health issue before you end up on a PIP. It won't prevent you from getting fired but it will increase the likelihood that you get a severance if you are fired.

Good luck! Depression sucks but many of us have been there and gotten out of it.

First, sorry you're in pain!

Depression is psychologically being trapped in a prediction we feel we can't turn around. Financial, romantic, lifestyle and other elements play a role in the lack of powerlessness you feel. Either of these things may be significant enough to make every breath harder.

The way to fight depression is to empower yourself and give you more options to flourish.

If you're determined antidepressants are what you need - SSRI's are something we really don't know about. When you mixin meds into the equation, you're ceding your emotions to someone else, mixing in complicated medicine into your own personal growth narrative could sidetrack you for years from finding what your core problems are.


Switching cities / jobs helped me a lot.

Take some hallucinogenic drugs (look them up on erowid first). Write some poetry. Make some art. Stay up late. Get drunk. Purge your demons. Call your parents, call your best friend, vent. If you like to be alone be alone. If you like people go find some people.

Watch some art films. Chain smoke cigarettes. Go for a walk. Play hooky from work. Go thrift shopping and buy yourself a new outfit. Plot and scheme on things that you actually want.

Don't listen to any of this advice. Do something drastic.

I get that you're trying to be edgy, but none of those are full-on substitutes for the the results of evidence-backed medical trials. They are great in conjunction with standard pharmacological and therapeutic approaches, but might end up pushing someone already on the brink further into the abyss of depression. They might not have good familial relationships or friends to fall back on, or they might have issues with non-hallucinogenic drugs as it is.

I feel like his point was that OP needs to make an effort to find something that works and that no amount of online advice will likely help.

Thank you.

You owe it to yourself to take the meds. Keep trying different ones until you find what works for you. This is what I was finally able to do and I've gotten my life back. If your current psychiatrist doesn't seem to help, seek out a new one. You are meant to live a fulfilling life with love and happiness. And don't worry about getting off the meds. Your body needs them as much as it needs food and air. Enable yourself to have what you need. I pray you find your way out of the darkness. : )

I'm not trying to be edgy at all. I have anxiety disorder and personally suffered through depression. I spent years on medications that didn't work.

Sometimes you can't fix depression with pills. There are alot of mights in this situation because none of us know what OP is actually going through.

I would kindly ask that you consider my advice from personal experience and not downplay it so much. I never suggested OP not take medication or seek out a doctor, I was just giving other, more personal advice that may help them in their situation.

>They might not have good familial relationships or friends to fall back on, or they might have issues with non-hallucinogenic drugs as it is.

I listed a bunch of different things they can do, with ors and ands all throughout. Also, hallucinogenic drugs have very strong evidence backed-trials in their favor. Of course as long as you do it in a safe situation.

I was not, in any way trying to be edgy. It's awfully offensive that you and anyone who down-voted me would think that. The guy is already a programmer, he's clearly not benefiting from the ultra-safe sterile environment that the HN crowd constantly promotes.

Sometimes you have to get dirty. Sometimes you have to make mistakes. Sometimes you have to drop shrooms and find yourself in the middle of someone else's living room dance rave party.

Maybe it's not for OP, maybe it is. Maybe none of the other advice in this thread will work for them, either. But regardless my advice is just as fucking valid as anyone elses. Coming from the perspective of a person who, as I said, went through this, still goes through this at times, and who medication has had little effect on.

But, if you want to solve his depression with condescending suggestions of medical help and medications, back that up with medical journals and statistics, that's your prerogative.

//edit Also for more clarity, when I said "don't listen to this advice" I was actually referring not only to my comment, but everyone's. I wrote that when there was like 2 comments on this thread. I'm not trying to demean anyone else's opinion. Why would I do that? I'm not an asshole.

My apologies for the dismissive tone in my first post. I can't and didn't downvote any of your posts. I misinterpreted your "don't listen to this advice" to be the strict opposite of what your explanation was: "don't listen to everyone else, but DO listen to me." I too (as many of us have) have been in similar shoes re: depression and anxiety. Finding what works for each of us as individuals is the most important thing. I agree with the potential therapeutic benefits of hallucinogens, but I also am a firm believer in the trial-backed science of medicine and therapy as the first and best line of defense. "Ultra-safe sterile" or not, it's the best answer for the broadest range of people. Call me a Vulcan, but that's what I'd suggest for people that are on "the edge", instead of "getting dirty" or "make mistakes", both of which might help, but also might let people slide further into the abyss. At least with medicine and their "black-box" labels, you are under the monitoring of a trained professional that can catch and negative side-effects of the medication. Best of luck on your quest to get and stay better.

Thank you for the response. No hard feelings. :)

It's taken me a while to write back, because new HN accounts are severely rate limited.

The spirit of your post(s) is well taken. Also, I watched the shit out of the magic school bus (which is, at least, what "sometimes you have to get dirty. sometimes you have to make mistakes" reminded me of)

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