As far as I'm aware, it's been known for decades that we don't actually know what causes depression, and that whilst we know that antidepressants work, we don't know why they work.
> some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”.
> (please note that “clinically insignificant” is very different from “statistically insignificant” aka “has a p-value less than 0.05.” Nearly everyone agrees antidepressants have a statistically significant effect – they do something. The dispute is over whether they have a clinically significant effect – the something they do is enough to make a real difference to real people)
It's worth reading the article in its entirety because of how much information is summarized in one place.
> They also note that Kirsch’s study lumps all antidepressants together. This isn’t necessarily wrong. But it isn’t necessarily right, either. For example, his study used both Serzone (believed to be a weak antidepressant, rarely used) and Paxil (believed to be a stronger antidepressant, commonly used). And in fact, by his study, Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. But since the difference was not statistically significant, he averaged them together and said that “antidepressants are ineffective”. In fact, his study showed that Paxil was effective, but when you average it together with a very ineffective drug, the effect disappears. He can get away with this because of the arcana of statistical significance, but by the same arcana I can get away with not doing that.
> So. In conclusion, everyone has mapped HAM-D numbers into words like “moderate” in totally contradictory ways, such that one person’s “mild” is another person’s “very severe”. Another person randomly decided that we can only call things “clinically significant” if they go above the nice round number of 0.5, then retracted this. So when people say “the effects of antidepressants are only clinically significant in severe depression”, what they mean is “the effects of antidepressants only reach a totally arbitrary number one guy made up and then retracted, in people whose HAM-D score is above whatever number I make up right now.” Depending on what number you choose and what word you make up to describe it, you can find that antidepressants are useful in moderate depression, or severe depression, or super-duper double-dog-severe depression, or whatever.
Anecdotal, but I know several (over 5) people whose lives would be hell without Zoloft, and some who have gone through multiple anti-depressants but stayed with Zoloft.
Some antidepressants work for some people for some time.
Its often that folks have to try a bunch of them, each for 5week to 3 months at a time, with side effects often making them worse rather than better before landing on the "right one"
And even then you end up having to periodically up the dose, then eventually stack it with other drugs to mitigate side effects before eventually it becomes ineffective and you have to start the process all over again.
I don't see why bother when exercise has better results.
The problem of depression is that it makes incredibly difficult to do those things, getting exercise, eating better, sleeping well, anything that makes you feel better. That's why people use antidepressants, because they aren't well enough to start doing other things to help themselves.
Your advice ultimately boils down to "just don't be depressed" and that has never worked.
I don't see why bother when exercise has better results.
Go lift big stone, make sad voice in head quiet.
Go sit in hot room.
Eat good
Get sleep.
Grand. So what you are telling me is that you've not experienced the sort of depression that makes some of this impossible, and you've been lucky enough that poverty hasn't kept you from doing some of these things.
And honestly, folks don't periodically up the dose as a matter of course. They do not always become ineffective. Heck, people don't always stay on them for years.
Yes, folks often have to try more than one - but folks also do this with migraine treatments and allergy medications and insulin (to a point). This isn't because the treatments are necessarily bad, but because we don't understand the reason for this difference and are still learning things about the human body.
We shouldn't wait for a perfect cure or a perfect treatment - imperfect relief is still relief. I'd rather have ibuprofen temporarily take care of menstrual pain rather than have to suffer through it until it can be cured or until there is longer lasting/better relief. Same with other things.
And as far as side effects: Since our cures and treatments are imperfect, we have to weigh side effects to the cure. Often, I'd rather not want to kill myself and I'd rather not be depressed, so some side effects are OK. The same with other things, though. I have MS. All the medications have side effects, sometimes serious ones. But they stop disease activity and make it much more likely that I'll be able to lead a full life with use of my limbs and sight. And folks do have to change medications for various reasons, but the drugs still help. I'll take it. Sure, I'd rather not have side effects but like I said, imperfect relief or help is better than none.
Doctors literally do recommend exercise as a first port-of-call, but that only works if you're suffering in a fairly minor way.
More serious depression makes getting up and exercising impossible. When I was dealing with it, some days it was a mountainous struggle just to get up and put some food in the microwave. It took all of my energy, for the whole day, to do just a simple task like that. The idea that I could have got up and gone for a run or do something else like that is absolutely laughable.
SSRIs gave me back the energy that depression took from me. Only when I started taking them could I start being sociable again, start going out more, start exercising again.
I'd be surprised if depression turns out to have a singular cause or mechanism. It's simply a group of symptoms that often occur together.
The way we currently speak about depression is as if we labeled the combination of fever, coughing and sweating as "the hots". You'd expect to quickly find remedies like "Tylenol reduces symptoms of the hots", followed a decade later by papers "the hots not caused by Tylenol imbalance", with people contradicting it with "I can't live without Tylenol, it's as important to me as insulin for a diabetic". Both can be right, Tylenol just happens to reduce the symptoms without doing anything about the cause. Any actual cure you find would appear to only work for a small portion of patients. Not because it's ineffective, but because "the hots" isn't one distinct illness, but a symptom of many possible conditions, and you have to use different strategies to cure each one.
Yeah, any study that says something like "This specific SSRI doesn't work for some people, works massively well for others, therefore it's not an effective treatment" should really be tossed in the bin.
It's funny that you mention Tylenol as an example, as acetaminophen/paracetamol is the only over-the-counter pain killer that works for me. Ibuprofen does literally nothing for me and I've had to convince my doctors to list it as an "allergy" on my medical records just so my health care providers will stop suggesting it. But that doesn't mean ibuprofen is not effective for other people.
I was prescribed SSRIs for a while, back in a particular bad part of my life (financial stress, job I hated, lots of health problems with everyone in my family). If we're going to say that all SSRIs are basically placebo, then I was not in any mental mood to believe that anything a doctor would prescribe to me would be effective. And in my case, Wellbutrin was not. In fact, it had a very significant deleterious effect in that it made me a raging asshole. But Lexapro, on the other hand... night and day difference.
(Thankfully, job changed, everyone's health got better, and now I'm no longer on anything other than blood pressure and cholesterol meds, which, come to think of it, is round-about treating the knock-on effects of my years of untreated depression).
Placebo effect is never a large effect. If you see a large effect, it's pretty safe to say it's not placebo.
We sort of do know some of the mechanisms why they work: they increase BDNF and stimulate certain serotonin receptors, allowing new and healthier neural connections and associations to be formed, helping people more easily snap out of old ways of thinking, similar to how psilocybin and other newer "drugs" help people snap out of depression.
That's why antidepressants are ideally combined with CBT or other therapies that help people change their mindset.
Weird article. It tries very hard uo front to defend modern depression drugs until midway down, where the lede gets buried:
Research suggests antidepressants work only a bit better than placebos (dummy drugs people are told could be the real thing). There are debates among researchers about how significant this difference is.
And this bit has been known for a good deal longer than the more current news that the shakiness of the whole premise of brain chemical imbalance.
> The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision.
> Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”.
> (please note that “clinically insignificant” is very different from “statistically insignificant” aka “has a p-value less than 0.05.” Nearly everyone agrees antidepressants have a statistically significant effect – they do something. The dispute is over whether they have a clinically significant effect – the something they do is enough to make a real difference to real people)
It's anecdotal, but anti-depressants certainly had a positive effect on my depression. However, a large component of my depression was caused by a co-existing anxiety disorder.
I often feel the anti-depressants cured some kind of physical imbalance that led to my anxiety disorder, and thus the ensuing 'curative' notions of anti-depressants might not be directly attributable to any physiological aspect of my depression, but the cause of a large component of my depression...an anxiety disorder.
Anxiety and depression have a close relationship and both represent a chemical imbalance in the brain. When you have an issue like this to the point of disorder, it's unlikely to be the only problem. Psychiatric labels like PTSD, GAD, OCD, BPD, serve to categorize the behavioural manifestation of the imbalance.
I don't claim to have a cure for depression. However, meditation has been a significant help in balancing my emotions and achieving calm. I am convinced poor diet and sleep hygiene are major contributors to mood disorders. Work on those in tandem with practicing meditation. If that doesn't work for you after a few weeks, the medication will still be available.
One of the episodes of the BBC's "Billion Dollar Deals" series talked about how the anti-depressants were pushed on to the masses by the drug companies, even to people who did not require it.
I imagine depression is a multi-faceted problem and not singularly a chemical imbalance problem. On a holistic level it could also mean you’re spiritually broken and don’t have the right tools to navigate life and its many hurdles. People need the right tools to navigate life.
Everything in your brain is made up of chemicals though. Even if one’s depression is caused by external factors (as opposed to some kind of inherent or congenital chemical imbalance), modifying the chemical state of your brain can still possibly address the depression.
I’ve been on SSRIs for years — I’ve bounced back and forth on my view of depression. I think my brain is likely prone to respond to certain stressors in a depressive way, due to a combination of genetics and years of conditioning/“practice”. It seems possible to me that I could learn, via a combination of things like therapy and meditation, to notice and control my brain’s reaction to those stressors. But at the same time, “chemical interventions” like SSRIs have also seemed to help.
Musing some more while I'm here (a bunch of armchair psychology to follow):
Everything in your brain is chemicals, but beyond that, external influences can I think cause very deep, "low-level" changes in your brain, that end up feeling more like chemical imbalances than they do like being upset about some particular thing. Like, the thought "I'm sad my partner left me" is made of chemicals, but I think depression operates on a much lower level than that of conscious thoughts like those, even when induced by some external stressor.
When I pay attention to my own mood, I can sometimes notice specific things that trigger feelings of depression. Something stressful happens, I'm worried about something, etc., and I'll react by getting depressed. But the depression doesn't feel like it's tied to whatever just happened. I'm not sitting there being like "omg I'm so sad about X" -- I just feel depressed: I'm not getting much joy out of anything, nothing seems interesting or exciting, I'm not looking forward to anything, etc.
It's only when I force myself to take a step back and ask "what might have happened recently to cause me to feel depressed?" that I'll realize "ah yes, X just happened, that's probably why I'm feeling depressed right now". But even after that realization, the depression _still_ feels disconnected from the stressor. My conscious brain knows that the depression was probably caused by X, but my subjective experience of the depression is still disconnected from X.
I guess this is kind of analogous to waking up with back pain, wondering "what did I do to my back?", and realizing "ah yeah, it was X". Realizing what caused your back pain doesn't somehow alleviate the back pain -- the damage is already done. You can maybe try to do X more carefully in the future, but even that is no guarantee that X won't cause you back pain again.
I think we like to think that because our brain is where our consciousness and ego and thoughts are, that we can control it in a way we couldn't control other body parts, like our backs. And that we ought to be able to "will away" mental pain in a way we couldn't just "will away" back pain. But that's not always the case; the brain's just another organ.
This 100%. Framing mental health as a purely individual or chemical issue distracts from the societal/cultural level problems you're hinting at.
I've come to the conclusion that a lot of what we call the mental health epidemic is really just late capitalism being fundamentally unable to meet human needs of spirituality and emotional belonging.
There's nothing inherently wrong with capitalism as a means to an end in an economic sense, but as an ideology and identity (as is especially pervasive in the US), it's extremely toxic. Capitalism in this sense dehumanizes people, and rewards and encourages lack of empathy and sociopathy. We're taught that it's OK to let people be homeless, starve, and die preventable deaths from lack of healthcare because it's their fault for not being able to succeed in a system that is designed to profit off their failures. We're told we can't fix these because of insufficient means, but in actuality it's a question of prorities and not wanting to midly inconvenience wealthy people to share small portions of their wealth to support the society from which they extract their wealth.
Being in constant fear for your survival because your wages haven't increased in years while the cost of healthcare, food, housing and education keep increasing is disastrous for mental health, that shouldn't be surprising at all. If you're in that position you might be told that your employer can't afford to pay you enough to survive, when in actuality they likely still have healthy profits that are redistributed only to senior management and shareholders.
Learning about the concept of internalized capitalism was a game changer for me. Once you decouple your self-worth from your perceived productivity for the economy/society (aka your value to wealthy elites), it's a lot easier for you to accept yourself and stop blaming yourself for something that's totally outside your control that you perceive to be as a personal failure.
I definitely think there are broad societal trends contributing a lot to mental health issues, but I'm less convinced it's capitalism exactly (depending on what you mean by "capitalism" of course[0]). Two societal trends that seem significant to me and my own depression are a) emphasis on individualism over community, and b) rejection of religion.
That's fair, everyone's mental health journey is unique, and you deserve a lot of credit for working on yourself and figuring out what's contributing to your depression.
When I say capitalism, I'm mainly referring to it in the sense of "internalized capitalism", as an ideology. It's the idea that your self-worth is only as valuable as your income or economic output and that if you aren't capable of that, you aren't worthy of basic things like shelter, food, and healthcare and therefore don't deserve to live since you are a burden on hardworking people with money. I'd really encourage you to research that since it can help untangle assumptions you might have about yourself, based on what society has been teaching you is the "right" way to live and what expectations you should have of yourself.
I think the things we think of as societal trends contributing to social decay have capitalist ideology and assumptions as the underlying thing that ties them together. Capitalism promotes individuality over communities sharing resources because that increases consumption, since then everyone needs to buy their own instance of something. You're expected to leave home at 18 because that's just what you're supposed to do to be a "normal" young adult, even if you're not financially or emotionally ready, and that also means that you have to consume more to support yourself instead of your parents continuing to share with you. We're taught that "greed is good" and hoarding individual wealth and power is better than making small sacrifices to ensure the well-being of everyone in the community.
Personally, rejection of religion was a positive for me, since at a young age I recognized the hypocrisy of Christianity as it was being practiced versus how it was presented in the gospels. This article written by a priest articulates this feeling that I've had for a really long time, that most of what is called Christianity in the US barely resembles it:
> Inasmuch as the two major political parties in America are both “liberal” in the classical sense—the one devoted a bit more to something like John Stuart Mill’s economic philosophy, the other a bit more to something like his social philosophy, and neither of them to the communal ethics of Christian tradition—it is hard for most Americans to make sense of such views. Contrary to conventional wisdom, Christianity has never really taken deep root in America or had any success in forming American consciousness; in its place, we have invented a kind of Orphic mystery religion of personal liberation, fecundated and sustained by a cult of Mammon.
My self-esteem improved immensely once I became an atheist and stopped guilting myself and tried to stop living up to others' expectations of how I should think and act, and this helped me become a more open-minded and empathetic person. Though, I will admit that although there's a lot to be gained from rejecting organized religion (as a human institution), there's also a void of community and spirituality that's left.
Anyway, thanks for being open about your struggles.
> Research suggests antidepressants work only a bit better than placebos
That really undermine the credibility of that article. They work extremely well for some people. Others might need to try several before they find one that works. And a minority might not be able to find one that works (I don't know, I'm not a professional).
Another anecdotal evidence: I started taking anti-depressants 1.5 months ago, and after the acclimating period (which was hell for me, I wish I had been better warned, I had to take a week off), it's a night and day difference on how my brain works.
My SO had the exact same experience: it changed her life, from a miserable struggle every day to a life she can enjoy.
If this article makes you reconsider taking anti-depressants or not, please talk to a healthcare professional instead.
> Within that average is a group of people who experience much better results on antidepressants - doctors just don't have a good way of knowing who those people are when prescribing.
Perhaps I could have been more precise: the article answers the title and big question "So do antidepressants work?" with "Research suggests antidepressants work only a bit better than placebos", then bury the actual detail you outlined later.
That's at least misleading if not downright a lie. "a group of people who experience much better results on antidepressants" is, in my opinion, simply not compatible with "work only a bit better than placebos".
If you tell me the later, I'll probably forgo the treatment. If told the former, I'm willing to give it a try to see if it works. (luckily for me, it did)
I don't think it's possible to tell if your or your partner's acclimatisation period and subsequent improvements were caused by the effect of the antidepressants or by a placebo effect
1. Indeed, there were serious trials before those were made available and prescribed. Those trials have to demonstrate that the medicine is better than placebo effect. I personally don't like to hand-wave away those trials to "big pharma bought them".
2. Yes, I inadvertently forgot to take a pill one day and only realized the next day. Coincidentally I felt depressed that day. It could only be a coincidence but I'm firmly convinced it's not. I'm not going to try to replicate the experiment though (especially since doing it on purpose could induce a placebo effect).
On your number 2: SSRIs have to build up in the system before they are effective and take a lot of time to ween off when you stop them. If you only missed one day, any change should be considered psychosomatic.
> This latest research looked at 17 studies and found people with depression didn't appear to have different levels of serotonin in their brains to those without.
I think we are going no to look back in this and laugh and cry at how big of a mistake SSRIs were..
I think the body will find homeostasis. Artificially changing serotonin levels may have an effect for a while - but with continued administration the body will just create less naturally and become dependent on the drug for the remaining amount. So then after a while - everything went back to normal and in effect the only clinical result was a placebo effect, like the research suggests it’s efficacy is comparable to.
If there is some effect it is probably short term, which as the article points out, drug companies only like to study the short term effects (which still have debatable efficacy compared to placebo)
And what would this mean for the industry. They spent decades giving us the equivalent of sugar pills making billions of dollars. While we have already been in health care crisis.
Explanatory power is good if you're trying to understand where depression comes from. It's not helpful as a guide for clinical treatment of a person suffering depression right now.
> Some psychiatrists raise the concern that evolutionary psychologists seek to explain hidden adaptive advantages without engaging the rigorous empirical testing required to back up such claims.
That's putting it very mildly. Not that it's impossible that depression is an evolutionary trait, but that whole page is a bunch of highly contradicting, unprovable "this is deep" philosophy. It isn't even clear how to diagnose depression, what the underlying causes are, and if people were depressed 50,000 years ago. They all assume there has to be some benefit. There isn't a theory that argues it's just a negative effect of some other beneficial development. They don't even tell how developing depression could possibly positively affect procreation.
I feel like depression is the result of some people's life situation. They work a lot, have little to no friends or family, come home to a depressing little apartment and play video games, etc. Of course life is going to be unmotivating. I think the disparity between the "antidepressants work" and "don't work" crowd may be explained by this. Some percentage have a chemical imbalance, the others just have a life that is depressing.
They will give you antidepressants if your spouse dies, but can you really say that person is mentally ill beacuse they are sad? You'd be mentally ill if you weren't sad.
A very sweeping statement generalising a very broad set of people.
Have you ever helped a close loved one during their battle with depression? If you have some experience with this you'll know that a lot of your sweeping generalisation is easily falsifiable.
SSRIs (lexapro) saved my life. 6 years of depression effectively gone in 2 weeks of starting. Literally night and day and I tried every non-medicinal intervention that you could imagine before taking the plunge.
I don’t care how it works but I will never stop taking it.
There is a lot of suffering and misery in the world, with so many people displaced and torn from a community they can call home. When SSRIs were promoted with big science on the front cover of Scientific American with every doctor prescribing them, the world was still under that cloud of the Cold War. The world was as doomed then as it is now.
This also came with powerlessness and de-industrialisation. Job prospects were fine for the entrepreneur or for those willing to sell their soul, but it was not so easy to find a job where you would be doing positive to the world.
At the same time there was a lot to be cheerful about. For example there was the awesome rave scene that really did bring people together rather than atomise society. Progress in tech was also great. So much else.
The SSRIs were supposed to just dull down the spectrum of allowed emotion and thought. You could not let the state of the world depress you. Hence take the pills, be normal. But this would also turn down the dial at the other end of the scale, you could not live the time of your life, just go through the motions.
Parents could get worried if their teenagers were not taking their pills. They could also call their kids mentally unwell. Yet never have a sensible conversation about how bizarre the world is and why there has to be so much misery. There would also be expectations for the kids to pull themselves up by their bootstraps getting on the housing ladder by working hard and saving up. All of this with no acceptance that times have changed, the population is twice what it was and how property has become a speculative bubble.
Put together, it was one generation who had trashed the planet and let thousands of nuclear weapons proliferate telling the younger generation to shut up and take the pills. The whole thing was one of those society wide lies with very dubious science, even if they used big words for it to make it sound legit in Scientific American.
If there are similar numbers in all counties. That means locations with different cultures, religions, and social structures all suffer from it. Identify a commonality?
It's literally how western medicine works. (Exaggeration incoming) You have diabetes? Never mind the fact that you eat unhealthy and live a sedentary life. We're just gonna give you insulin so that you can keep surfing on your high-sugar diet. The human body did not evolve to eat so much sugar and sit all day. The body needs to move just as much as it needs good nutrients.
You have to meet your meds half way -- meaning you must do the work i.e. sleep hygiene, physical activity, diet, challenging negative thinking patterns, etc...
This was all made very clear to me when I began addressing my mental health about 4 years when I was first hospitalized during a manic episode.
During 2 years of outpatient treatment at the clinic for the Neurosciences at the Univ. of TX -- it was stressed meds are no panacea. For mood disorders they were big proponents of interpersonal and social rhythm therapy[0]. I believe the approach was similar for those with unipolar depression as well.
Some steps that have worked for me, and many of my associates over the years:
1. Turn off the TV. Seriously, just don't watch it. Instead, get your news source from print media - the Web, or newspapers. Or, just forget about the news for a while, and catch up occasionally. Daily news intake is guaranteed depression. Remove that source for immediate relief.
2. Leave the city. Most modern cities are designed to keep their occupants trapped in a hell-hole of epic proportions. They're not designed to make you happy - they're designed to keep the economics of the society in motion.
3. Plant trees. Over a few years, the trees I have planted have become a daily reminder of why life is worth living. I eat fruit from these trees every year, and they are delicious. (Pears, plums, peaches, apricots, quince..) Fresh fruit from a tree you planted yourself and watched grow, is a guaranteed pick-up.
4. Get more exercise. Everyones body is different, but we are all the product of hundreds of thousands of years of evolution of muscle systems that promote distance running. You might not feel like it, because your immediate ancestors probably never left the city, but the more sport you get, the happier you will be - and it takes time, also! Don't think this is an instant-fix, because it isn't. Doesn't have to be running - could also be swimming or kayaking, or indeed dancing. Just: do something that is not what your body is normally doing in order to satisfy your contemporary cravings. Get outside that box.
5. Stop listening to 'professionals' telling you what you should think/feel about yourself. You don't need that. You need real friends who are willing to commit to experiencing lifes ills and its greats, right alongside you. A heavy reliance on the instant-fix culture of psychiatry and other disciplines is a sure-fire path to depression. Those industries depend on you, remember - they are not altruistic, and will do whatever serves their shareholders. That includes selling snake-oil drugs to generations of gullible instant-fix addicts. You will never get the level of care you need from a paid-for professional. Work on those friendships and relationships instead. A good friend who knows you well and is willing to listen is often the best therapist. Don't have someone like that in your life? Work on that. Its important. Be a good friend, too.
6. Do things for others. Seriously, this one is key. If all you ever do is focus on your own life, you are headed for major depressive episodes. Humans are a hive species, we absolutely need to do things for other people, or we go crazy. This can be as simple as being more inclined to help others at work, or it could be something like volunteering for a scout group or soup kitchen - up to you, just do something for other people. A person who feels they cannot help others, in any way, becomes helpless themselves - almost overnight. That will change the moment you see the smiles of the people whose lives you have enhanced by your efforts, whatever they may be.
7. Find a job that you truly, absolutely like, and get into it. So many peoples depression is as a result of being forced into a career - by others, usurping your agency - that it really is simple. Find a way to make your career out of the things you love doing - and if those things don't involved active engagement in point 6 (helping others), then you'll probably have to keep looking until you get it right. Personal happiness, and the happiness of others, is entwined no matter how you resist this cold hard fact. Your own happiness is important, too - never mind that Mom or Aunty wanted you to be a lawyer, so thats what you did. Find your own way.
8. Eat well, and sleep well, and hydrate well. Yes, this is obvious. No, not everyone remembers that ones' metabolism is a key factor in mood management. You're probably not getting the nutrients your body needs - not many of us do. It can help depression, immensely, to learn to cook for yourself and satisfy your bodies needs. If all you do is shop and order out, you're heading towards the key factors of depression. Nutrition drives metabolism, and metabolism is a founding element of mood. Not feeling great today? Go back to bed, wake up when you're fresh, and make yourself a decent breakfast.
Just anecdotal steps that I have, personally over and over again, seen help with depression in myself, my family and my friends and associates. But you know what, life does take work. A quick-fix instant-happiness pill may seem like a 'solution', but you're just kicking the can down the road if none of these other rudimentary factors are not properly managed. Seriously!
Skills before pills, I agree with you fully. However, cynics would retort: "yeah sure, walk and exercise more, thanks I'm cured"
And I think there is something to that in the sense that when you are in that hole, when just pulling yourself out of bed seems like a monumental task akin to moving a mountain -- these adages ring hollow and seem beyond reach. I know what I need to do when in despair, making it all the more frustrating.
At that point I think the most important skills are to challenge negative thought patterns, and work towards tiny victories (showering, eating, getting dressed for the day). Once I have some momentum, going for a run or walk no longer seems impossible.
Point being, I feel telling those who are in the midst of a low its so simple can be counter-productive... Its kind of simple, muddled by our cognitive distortions.
I have been diagnosed with Major Depressive Disorder.
I have been struggling with depression for 35+ years.
I have attempted to kill myself. [Yes I failed at that too! =)]
I thought about (and planned) killing myself several times a day.
I have had 6+ Psychiatrists.
I have tried EVERY drug available.
Electric Shock Therapy was going to be next, but I have avoided it.
The best drugs only work for 6'ish months for me.
Then my doctor offered an experimental Ketamine treatment.
I've had 3 rounds of treatment over the last 6 years.
I didn't obsess about killing myself any longer.
It's almost like I forgot to dwell on it.
I still have some bad days, but my bad days now are better then my best days used to be. So that's an improvement.
I'm very happy you found something that works for you. What method of ketamine treatment have you been taking? I just stopped after 2 months of troches, which didn't seem to bring significant, if any, benefit.
Interestingly, I found myself abnormally susceptible to the psychedelic effects. When taking ketamine orally, the expectation is that most of the medicine is absorbed while you hold the troch in your mouth for 30+ minutes. After a lot of experimentation, I found that I barely absorb any medicine through my mouth, but once I swallow it I absorb it very rapidly. This made it difficult to control the delivery speed, and likely hindered my treatment.
I haven't been dealing with depression for anywhere near as long as you, but I do speak from experience about how terrible it is to not find anything that works. I've gone through ~13 of the most commonly prescribed drugs for depression, anxiety, and sleep, and none brought any relief. I've now tried and failed out of ketamine, which I was really hopeful for. Now I'm just back to sitting around trying to get _any_ doctor to actually see me and maybe get tested for various neurodivergent conditions.
Every treatment had slightly different results, but only 1 offered me any kind of significant moments.
The most commonly repeated imagery was usually geometric patterns (usually in a glowing neon, accompanied with an EDM auditory hallucination as well), and old-fashioned TV static.
I refer to these sessions as 'brain rewiring'.
The singular significant moment was a quiet nothingness. All the voices stopped. All the inner talk stopped. I can best describe it as:
cat BRAIN >/dev/null
It was incredible, and the only true inner peace I have ever felt.
I once went down the rabbit hole of anti-antidepressant “science research” (due to some internet argument), and what I got from it is that a) research papers often have “comments” in the form of other scientists answering them. The bad ones I read were answered in a very enlightening way! b) studies showing no or little effect may have bad methodology.
One prominent error is that the often used Hamilton test is only an ordinal value, its value should not be used to quantify improvement. The other thing I saw (and have some anecdotal experience agreeing with it) is that around half of the patients react very well to anti-depressants, while the other half doesn’t. It may be misdiagnoses in the latter’s case (or as someone mentioned in the comments, there might be another illness subtype under depression which has a different underlying cause), but I assume the bad name of anti-depressants come from the large number of people in the second group.
Sigh, why does HN keep picking these editorialized articles up? I honestly expect the community to flag this as clickbait.
We have new evidence that invalidates our previous hypotheses, so we adjust course and keep going. “We all” didn’t believe a “myth about depression.” We believed that scientific findings combined with some relevant studies, experiments and feedback loops would yield a step in the right direction. We accept that the scientific method isn’t infallible.
I don’t understand what people are after. The further along we get in our exploration the more hypotheses we’ll invalidate. Which is to be expected. I would rather be outraged at ignorance than outraged at new knowledge that contradicts the old.
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