I have been struggling with depression for as long as I can remember.
Life has taken me on ups and downs but as far as I can can tell I'm fairly lucky, well-off and have every reason to be happy.
Unfortunately I'm not.
I wake up with a pit in my stomach that I carry around all day and no matter how hard I try I just can't shake it.
It also gets really bad in waves to the point where I nearly can't function but most of all it makes me procrastinate on almost everything.
I usually end up using all my effort just to be a functional member of my team at work.
The sad part is that I know that if I didn't have this condition and I was able to sleep when I wanted to I could be many times more productive, not only at work but also in life.
The obvious solution to these problems are SSRIs and other anti-depressants. These drugs are very powerful but have really bad side-effects for most people that take them.
For these reasons I am completely shit-scared of them. I see them as my option of last resort but increasingly I feel my options running out.
I have tried therapy, I have tried all sorts of coping mechanisms but nothing solves the problem permanently.
So HN, what has your experience been with depression? Have you tried the drugs? What worked or didn't? Have you been able to triumph without chemical assistance and what did that look like? Is my utter terror of these drugs warranted or should I just bite the bullet and try them?
If you are based in the US and live nearby a university they usually have good counseling services and the infrastructure to refer people even if you're not attending the school. Search "{school} counseling services" on google.
It's important to understand the economic pressures in psychiatry. I went to see a psychiatrist, who prescribed me antidepressants. They helped give be a baseline level of energy to get me out of my acute depression, but they addressed none of my underlying issues that caused me to get depressed in the first place, and a couple years later I was right back in the depths again. And I'm fine if my dr's economic model meant he couldn't do psychotherapy with me, but he never recommended I get therapy, and that's what I'm so bitter about regarding him.
I've heard it said that giving antidepressants to a depressed person, without any therapy, is like giving amphetamines to a tired person: yes, they may temporarily cure your "tiredness", but what you really need is to go to sleep.
So while I don't think OP should take detailed advice from random strangers, he should be aware of his options. Talk to a therapist first to see if they can uncover what some of the root cause issues are. Be open to medication - some mental issues really are largely organic in nature, but a good doctor and therapist will know they are just one tool to improve your mental health.
> I've heard it said that giving antidepressants to a depressed person, without any therapy, is like giving amphetamines to a tired person: yes, they may temporarily cure your "tiredness", but what you really need is to go to sleep.
I don't even know where to start with this comment. This whole thread should be booted waaaaay off HN.
A few people have problems with medical professionals. It's true, assuming you're in america, we're definitely not the best. But you find a few 1,000 people online with bad experiences (obviously, because people with good experiences have moved on and don't spend their time researching that issue) and assume you have a complete picture but you're only looking through a pinhole of information returned with biased search results. You probably aren't googling, "how many people have gotten their lives back after using anti-depressants?"
> he should be aware of his options.
Yeah fine, be aware. Talk to professionals, get second and third opinions if necessary. Take a holistic approach to your well-being. But please lets not glorify google medicine here.
I basically got diagnosed online by 2 different people about 2 different issues, one is biological, and the other is mental. And they were right. This is nerds out there who read about topics constantly, way more than the average doctor, not even close. So a stranger can help.
Also depends on where you are located, doctors can be dogmatic, there is countries that give antibiotics before extracting teeth, and there is those who don't. Countries who believe ADHD can stay into adulthood and go undiagnosed, and others who believe it is impossible to have ADHD as an adult.
In the ADHD case, depends on who what countries are right, some group might be living a lie taking meds for an illness that doesn't exist, or the other group is suffering being undiagnosed with ADHD despite seeking help, the doctor just tell them its not possible to have ADHD.
I would rather research and try to solve my issues over hand my situation to the medical zeitgeist of my country. Also I am sure if I give myself days of research, thinking, talking to people, comparing situations over some doctor talking to me for 15 minutes then giving me the two meds given to everyone who enter that door (SSRIs and benzos), I might probably be up into something.
I will never stop researching my medical issues, I will never trust my doctors fully, I will always google, research, ask, ask second opinions. Some doctors care more than others, some doctors are capable more than others, you have no idea which ones the RNG gave you.
Asking for advice on the internet is a very valid strategy, given the terrible state of mental health care in the US.
My psychiatrist was fairly clear on what was what and which things needed to be treated with therapy and which medication could help with. (Medication helps symptoms, it does not cure.) Finding the right medication would take months or years and will not solve everything. There will be side effects that I needed to monitor and report. And so on.
When seeing any doctor, you are your own best advocate. It helps to come prepared, knowing your family history, and things you are struggling with.
Researching medications can help, but most people are not qualified to use them without supervision, myself included.
Note: This is assuming you need medication. It was fairly clear in my case medication was absolutely required to at least treat psychosis.
I prefer to refer friends to a therapist or psychologist, who do not prescribe medication.
This type of side-effect is thought to be mediated by 5HT2C activation when initially starting SSRIs, however, over the period of about two weeks, 5HT2C receptors downregulate and reach an equilibrium that can cause the effect to diminish or go away entirely. As an aside, there's research that suggests that abnormal amounts of upregulated 5HT2C receptors are present in suicide victims.
One of the reasons Prozac is recommended as a first line of treatment, besides the fact that it has a long half-life, is because of its 5HT2C antagonism that can block 5HT2C from extracellular serotonin activation from SSRI effects.
There are also plenty of antidepressants that don't typically cause that particular problem, especially if they aren't typical SSRIs or serotonin agonists.
FWIW, my understanding is this has little to do with the drugs and mostly to do with the recovery process.
In a deep depression, you might have suicidal thoughts, but lack the will to take action on those thoughts (because depression takes away your motivation). As you a person comes out of depression, they tend to recover their motivation before their suicidal thoughts dissipate. This creates a situation where a person with suicidal thoughts now has motivation - which means they have the potential motivation to take action on their suicidal thoughts.
The important nuance of this is anti-depressants don't necessarily make your suicidal thoughts _more_ suicidal. In fact, it's likely, anti-depressants are making your suicidal thoughts _less_ severe. However, they do increase your motivation before they can fully eliminate suicidal thoughts.
I'm not saying you should take an anti-dpressant willy-nilly. It's just BS to be fear mongering like this without considering why this situation happens.
And you think a random stranger knows any better? I know firsthand that the medical profession has serious limitations in its understanding of and ability to treat depression, but no way in hell am I taking some rando's advice over that of any of the many doctor's I've seen.
My current OPINION is: Until you have read studies and got some plausible experiences from people with the same medication, one doctor alone isn't a good source for taking medication.
I will only take medication in the future if life wouldn't managable without, but not for issues that just take time.
Tapering SSRIs is the normal unless a provider has alternative indication it shouldn't be done.
Tapering doses for all sorts of medications are routinely done, and any pharmacy can handle such an rx. If they can't - you don't want to go to such a pharmacy anyway.
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No one with depression is going to read this and go “Oh, you’re right.” It’s self gratification disguised as help.
Everyone knows they really ought to see a doctor. There are plenty of reasons to be scared to. An untimely hospital visit bankrupted me thanks to no health insurance. My sleep doctor had to cut me a deal of only $50 per visit instead of the usual $150, and she really cared about me. I was part of a lucky few.
I think what rubs me wrong about your advice is that it’s positioned at the expense of all other advice. No one’s allowed to have an opinion except yours. Smart people like OP see right through such things, and it tends to push them away. Which is particularly troublesome when the advice is good, like yours is here.
Yea it's mainstream and to be expected under legaleeze circumstances.
But it's not the kind of advice I would give to a friend whom I'm genuinely concerned about.
Have you known anyone who was depressed and managed to get better by following the advice of a generic "profressional"?
I haven't.
Quite the opposite. I've seen people get worse in one dimension or another by taking medication or following other professional advice.
It’s worked.
My advice to friends and family experiencing such issues is to take those issues seriously, and to see a doctor about them.
My opinion, doing both is good. Consult a professional and read about other people's experiences.
At the very least maybe somebody mentions a form of therapy that you've never heard of that you can ask your doctor about, or find a therapist that specializes in. If you ignored everyone's advice online you'd never even hear about that.
Personally, I'm starting Internal Family Systems therapy, which has seemed more promising for my psyche than many other modalities. But there are countless others. CBT is a good place to start, but doesn't work for everyone.
In reality, roughly 3-10% are good, the rest just go by standard guidelines only and/or punt you off to someone else.
I have learned way more useful info on online forums from people who were going through the same experience. Yes you have to be discerning but the advice “go to a professional” is thoughtless. There are a lot of incompetent people working in mental health. I am sure it’s easier if you have tons of money or just lucky to run into a good therapist. But already being down and then being disappointed by the professionals is devastating. At least it was for me.
For everyone who had their life turned around by medication I have met two or three who either did not see improvement or had negative side effects on all options tried so they gave up.
Some drugs, like the typical or atypical antipsychotics that treat bipolar or rapidly oscillating bipolar, have the side effect of reducing your energy and making you more passive. It's hard to pick out the effects of some drugs from actually solving the issue or just making you more likely to not cause a fuss.
I find this comment so overused, ignorant and dismissive. In my city it can take months to get a 20 minute appointment with a specialized doctor, while the internet is full of useful and scientific information and helpful people. That isn't even saying if the doctor really understands your problem or just dismisses it (had that often enough), like you dismiss other people's anecdotes. What are people supposed to do while they are waiting for an appointment for months with acute issues? I'd rather spend days myself and read the same information that a doctor (hopefully) would read in order to work on the problem before it gets worse or kills me.
So yes, try to talk to a medical professional at least once if you have the chance. If not or if it does not help, keep doing what you need to do and try to get the best information that you can find.
why ? they don't really have a solution for it other than prescribing anti depressants. I don't see why they need to see a doctor.
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Depression can be caused by hormonal imbalances. It's tricky to get things right-- see a doctor!
An option if you prefer an entirely-online experience.
But yes, your mental help is not worth asking strangers on the Internet for help. You deserve better than what we here can offer.
asking for advice and personal stories regarding navigating an issue as complex as depression and the way it's treated is not only prudent, it's smart.
a good healthcare provider is one that is fully willing to discuss unorthodox strategies found via independent research. take advice from the internet and find a provider who is willing to discuss it with you.
My opinion (not a doctor): What is wrong in your life? Are you:
+ Working too hard
+ Commuting
+ Not exercising and taking care of yourself
+ Eating a diet with lots of processed foods
+ Using drugs and alcohol as a crutch
+ Overweight
+ Not resting regularly
+ Sleeping poorly
+ Have other health issues not addressed
+ Without genuine friends
+ Without a good partner
+ A certain age without kids
+ Spending too much time on social media
+ Spending too much time watching TV
+ Not engaging in hobbies, such as reading
+ Neglecting talking to family
+ Wanting to do something different in life but ignoring it
+ Harbouring regret, judging yourself and generally being cynical
+ Judging those around you too harshly
+ Not trusting people
Etc.
I fully understand that depression causes people to avoid addressing problems like I’ve listed. I’ve been there too, and it is not easy to climb out of the hole. It’s a positive feedback loop though: you start neglecting things (maybe due to time constraints), you lose a bit of happiness/stability, you neglect more things & so on. The hard part is to break out of the loop and start ticking these boxes. Start small and don’t judge yourself harshly if you slip.
Really do examine my small list and see if any of these things are pulling you down. If there’s something there you can’t fix, don’t beat yourself up on it. That’s the last thing to do. No one can be perfect, so don’t worry.
> + Commuting
Prior to 2020 this was the vast majority of all jobs, including tech. Most got by just fine. And today still encompasses the majority of jobs, so I would argue this is classist.
> + Neglecting talking to family
Many people have reasons not to talk to family that end up with positive mental health outcomes. Sure, it can be negative, but this seems exclusionary.
> + A certain age without kids
C'mon. This isn't the 1940s.
Please be careful when putting out lists like this.
This is juxtaposing genuine, universal indicators of depression alongside subjective ones, which when read by the wrong (misinformed, uncertain, etc.) audience, could lead to adverse outcomes.
I was in the same boat.
Don't listen to the haters. Anti-depressants are amazing. Most of the people who 'cured' their depression through some kind of cheap trick turn out to have been self-diagnosed.
Anti-depressants, if dosed and chosen properly, have basically no side effects. The only change is you get to experience life like neurotypical people. So like, exercise is fun, not a form of torture. Emotions are OK, not the harbringers of the apocalypse.
Living with depression is awful, and it almost never goes away. It's also extremely dangerous. Look at the stats: depression is a dangerous medical condition. Anybody telling you to take some herb or read a book is on the level of the people who prescribe smoothies to cancer patients. Get medical advice. Take drugs if they are prescribed. Depression massively increases your risk of death from all causes. Anti-depressants have like, a slight chance of causing dry skin.
That said, my first go-around with anti-depressants was a hugely overdosed prescription of venlafaxine from an overenthusiastic doctor, which is pretty side-effect-tastic, so my eyes were rolling out of my head and I was falling off chairs for a week and it was still far superior to being depressed.
Not taking anti-depressants because you're worrying about the side effects is like not wearing your motorcycle helmet because there might be a scorpion in it. The risk of dying from depression is really high. The risk of suffering from anti-depressants is fairly remote.
I also take methylphenidate (Ritalin) for ADHD and it is MUCH easier to stop stimulant medication in my experience compared to anti-depressants. And while stimulants affect sleep, I found the SSRIs to be much worse in this regard since they made me sleep poorly regardless of when I took the SSRI unless I skipped a day of the SSRI (and I was on the lowest possible dose).
Not only do these medications have side effects, they have severe side effects, at least for some people.
I get that's not everybody's experience. However, my feeling is that if you shop around until you can get the right dose and the right meds, the only side effect pain is when you start, and when you stop or draw down your dose.
The real danger of starting meds is that it can give a severely depressed person the motivation and wherewithal to commit suicide, so I do think it's worth starting them in a setting where you're not going to be alone. Still, I'd say that's less a 'side effect', and more just an effect of having severe depression and suddenly not feeling so debilitated that you can't do anything about it.
In general, I just find the conversation around anti-depressants completely unhelpful and baffling. People focus on the extremely long-tail side effects, and ignore the massive bump in the bellcurve that is a depressed person either committing suicide, or just living a totally miserable life until they die from some substance abuse problem. People who are diagnosed with depression do not live good lives without medication. The statistics for life expectancy, etc, are just awful (it's worse with stuff like schizophrenia or bipolar). So all the stuff about antidepressants making you fat or whatever is just totally irrelevant.
My advice is try it. Talk to a psychiatrist and go on a minimal dose for a few months. Get therapy while you're going. If it doesn't work, it doesn't work. But it really could change your life.
What should be said though is that there are some great anxiolytic out there, it's just that no one knows them, e.g opipramol, emoxypine, etifoxine
As soon as you are off them, you will likely relapse back into depression. While it can help someone that is in immediate risk, it does not solve the core issue of what depression is which requires a holistic, non-conventional view that Western medicine shuns, and is doomed to never address.
Stop treating it like a medical issue and it will open doors. There's a reason Western society is riddled with drug abuses, addiction, mental health issues while other societies is riddled with war, poverty, and diseases.
Please be careful; this attitude places the blame on the person experiencing depression, and feeling guilty about being depressed is a vicious cycle that can have catastrophic effects.
There are some for whom depression is a product of their environment. For some of those, a "tough love" approach may work. But there are also those for whom depression is a physical condition that requires medical treatment
Medical professionals have been finding that in cases of clinic chronic depression, the patients brain doesn't produce nearly enough endorphins compared to others. Also, antidepressants are from a time where we didn't yet produce problems to sell the solution and they have helped millions of patients.
But I guess you know something we don't?
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A lot of friends have ended up on prozac or other drugs, with profoundly hit or miss results.
I've struggled at times, but found that vitamin D, magnesium, zinc, decent amount of protein, and good sleep did a lot for me. Regular outside activities, even if just walks, or exercise also a lot for me.
Keep in mind I live in Western Canada, so my walks often happen in -30C weather.
Also just finding something that produces joy was big. Not fun, not cool -- joy. Making less money and doing more things that bring me joy made a big difference. Most of the people I know making "the big money" are miserable people.
Also, avoid caffeine like coffee etc. Caffeine can make things worse.
EDIT: why the downvote?
However, caffeine does heighten my anxiety (with or without the impact on sleep). Maybe I should quit caffeine, but I like my morning coffee ritual so have no plan to right now. Instead, I take periodic breaks from caffeine to make sure I'm not addicted again. If I can go a few days without caffeine and without getting a headache, then I'm good. If I can't, then I'm probably consuming too much and it will (or already has) exacerbate my anxiety.
I’ve heard plenty of people say it doesn’t work for them. I have to assume they’ve actually tried it for a length of time and it’s true. But it’s at least worth finding out of it works for you before resorting to medication.
https://pubmed.ncbi.nlm.nih.gov/24026850/
Even if you can't stand, you can get health benefits from bouncing while merely sitting on it. Even people who are paralyzed can benefit by sitting on it and be bounced by another person.
You can watch videos or chat while doing it. You don't have to worry about bad weather. It's almost silent so you can do it even while others are sleeping in the same room. You can hold or wear weights while doing it to increase strength. It doesn't take much space and some have folding legs for storing behind or under other furniture and some even fold the frame for storage or transportation.
Treatmills and stationary bikes are boring; going for a run or hopping on a bicycle works much better.
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I went through a couple different psychiatrists and multiple combinations of meds before I found something that was mostly effective and without major side effects for me. Along the way I went through times where I was severely overmedicated and couldn't really function but quickly recognized that and worked with my psychiatrist to move onto another treatment. You have to give stuff a shot and see how it goes for you, chances are the first thing you try is not the thing that's going to work.
The psychiatrist that I stuck with was the one that suggested I should also see a therapist. My take is you need both. I went through a few different therapists before I found one that worked for me. They helped me develop the tools I needed to break out of the cycle and take control of the anxiety and depression.
Ultimately starting to take care of myself physically was the biggest impact and the thing that really got me off the meds and "graduated" from therapy. But I wouldn't have been able to get started on that without the meds and the therapy.
So I got some exercise. I bought a bike and put it on a trainer. I rode a few times. I loved riding my bike when I was young. That helped, a little. I think it helped me take my next step.
I'd been coaching my 9yo son at soccer for a year or so, but I never played soccer myself. So I decided I'd try playing a local soccer pickup game.
That was the trick for me. I don't know why. But suddenly I found motivation. Just enough to play soccer. Once a week, and then twice a week, and then three times, and now as many times a week as I can fit into my schedule. I lost 10#, 20#, 30#, even made it to 40# before the pandemic and found more motivation in other areas of life as well.
Soccer hurts. A lot of games I can barely shuffle through my garage after driving home. I was 39 when I started playing and I'm 41 now. I'm no spring chicken. But the mental and physical engagement of playing soccer, even just pickup soccer, has thoroughly enriched my life.
I have a friend who's a psychiatrist. I talked to him about this. He told me that I correctly anticipated my doctor's response. Exercise is the first line of defense and the first treatment suggested for depression. And it doesn't take much to try it and see if it helps. Your depression sounds worse than mine. Maybe you can walk before you run.
You shouldn't be afraid of the drugs: let the doctors handle that. But if you prefer to try something before drugs, exercise is the clear choice.
If you look for the 'solution " to most chronic ailments, exercise is usually at the top of the list.
So OP, if you dont exercise at least 40 mins every day, start with that. If you already do that, then your condition might require antidepressants
I tried exercise, read Feeling Good book, took different vitamins etc. None of this really helped.
What finally worked was giving into my depression. I would come back from work, listen to sad songs, cry like a child, pray, and drink until I passed out. Within a few days, I would wake up without pit in my stomach. Hangover was another story. Within a couple of weeks, I was not depressed. Depression turned into anxiety. And anxiety was a lot easier to deal with than depression.
Once depression was mostly gone, then I was able to use CBT methods to deal with my anxiety.
It is really hard for people who never experienced depression to understand what it feels like. It is worse than hell. I am sorry you are going through it. Just take one day at a time.
I have defintely had periods of unexplained very low motivation and lethargy. I've done the "listen to music and get really drunk alone" thing a few times. It did seem to help, though I didn't do it with that intent. It kind of slapped me in the face with a "you are pathetic, get over it" message that really sunk in. It has been a few years since I have done that.
I also started exercising (weightlifting) about 2 years ago, which is something I never did before. I have tried other exercising (biking, running, swimming, etc.) but none of it ever stuck. Weightlifting did for some reason. Barbells, not machines. Squat, bench press, deadlift. Read or watch some videos from Mark Rippetoe "Starting Strength." I can't say I enjoy doing it, but for some reason I have kept at it and I do like the effect on my body. I'm 55 and have the best muscle tone I've ever had in my life.
I also take a regular multivitamin every day, along with moderate additional C, D, and Zinc. I don't get headaches anymore and I hardly ever even get a cold. I don't eat fast food or drink soda, I eat mostly chicken, steak, and salad and drink water, coffee, or tea.
After 5 or 6 months of suffering, I decided, at some certain point, that I need to do something about it and that I need to get over it and not waste my life. I started small, step by step, waking up, taking shower, going out for a walk, etc. I used to WFH, but I reversed the habit and started to go to work place everyday.
Then, I got a gym membership and started exercising almost everyday (after so many years of physical inactivity. I am 25 BTW). I started cooking and eating healthy. I take multivitamins everyday with an additional dose of Vitamine D and Magnesium. I eat only vegetables (lots of them), rice, chicken and fish and sometimes beef steaks. I also take fruits everyday (usually Oranges, Bananas and Apples). I also drink Coffee (one cup in the morning and sometimes another in the evening) and Tea with Ginger.
I feel much better. Now, I have a routine, I am more active and I get some work done. However, I still suffer from a slight lack of motivation and happiness. I still feel a bit unhappy and I am not as motivated as I was before the whole depression thing hit me. I don't know why and I have no idea how to solve this part to become the super motivated, super focused and super productive person I used to be.