For me it worked very well and I think the journey is an amazing one to go on. Building from the ground up and understanding all the foundations within. I always wonder about treatments which don't have this benefit, although the results in terms of lifestyle change sound extremely positive.

One of the hardest parts of therapy is diagnosis of what to work on. Even though an issue will be "presenting" itself clearly, it can often be a bit of a decoy. For example, a lack of self-esteem is often a useful derivative of an unconscious fear of upsetting others. Low self-esteem => avoid situations/behaviours that upset others.

During therapy I found dreams, when analysed outside of the "conventional" Freudian/Jungian frameworks provided a simple and accurate method of reaching the root diagnosis (the fear of upsetting others vs. the decoy issue of low self-esteem).

I got a bit obsessed by the topic and wrote a paper on it which can be downloaded here: https://psyarxiv.com/k6trz

And was discussed on HN here: https://news.ycombinator.com/item?id=19143590

I do take issue with the commonly parroted claim that depression can be a chemical imbalance. It's a notion arising from pharma marketing psyops, and is largely without utility. It even risks being an antipattern. The few pros include separating responsibility and thus alleviating some guilt, which often coexists with depression, and annoying spiritualists. Tell me if I missed any.

Analogy: if I told you an athlete is different to a couch potato because of chemical imbalance, you'd think I was obtuse. While technically correct on some level that explanation obfuscates useful relational information about training, motivation, routine, mindset, culture, and circumstance. Similarly if I told you to become an athlete by only taking supplements that augment the phospho creatinine ATP pathway, you'd think me a crook.

Oversimplifications sell pills and make for memorable catch phrases, but fall short of empowering us to become happy and well.

Let's try and move our collective understanding beyond chemical imbalance; it's a tired mantra with scant utility.

Disclosure: neuro psych doctor

So if depression is more about mental models, life choices, and drive and whatever, why do so many people suffer from depression in cycles? There is little change from one day to the next, and yet, many people with depression can feel great one day and terrible the next. Or pregnant women can feel great before giving birth and then give birth to a perfect baby and suddenly start feeling depressed soon after.

How do you use therapy to cure depression if the depressed person has no reason to feel depressed?

Your web app malfunctions, and a diagnostic sweep suggests the code is compromised. It's cloud hosted and open source. You're part of a team and see various recent revisions that could have exposed the app to malicious use. Furthermore your cloud provider is upgrading their hardware. Your app has to come offline whilst it's patched. Its a critical service for some clients who are hounding you.

You ask for help from a professional to get things back and working.

They say, "It is due to an electrical imbalance in the computers."

In psychiatry people are analogously doing just that.

We know sure that neurotransmitters have a role in mental health, in the same way as engine oil has a role in a car. Right amount in right place is necessary, but not sufficient, for good operating. If I brough you my faulty car and you jept harking on about engine oil, I'd be miffed.

Incidentally I'm a staunch monoist materialist and believe brain states and mind are facets of the same phenomena. My gripe is with pharma marketing penetrating our collective psychology. Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

To immediately jump to the "chemical imbalance" problem/solution is like if you have a web app that's performing really slow, so you hire a consultant to take a look.

They tell you that you need to horizontally scale your app in order for it to perform better. In many cases, this would actually work (for a while anyway), but it probably doesn't explain the real issue.

In reality, the problem could be that you wrote your app to do way too many things per request rather than picking and choosing which things are going to be treated as first-class. Perhaps there's even one little thing that's O(n^2) and it simply is going to take a lot of time to work out.

While they have a "role", differences in neurotransmitter levels do not predict mental health state.

My understanding is that "chemical imbalance" theory was a popular misunderstanding of a more limited and specific theory called the ”catecholamine hypothesis" which has itself been pretty much debunked.

For decades the explanatory psychiatric theory behind depression has been the the "bio-psycho-social" model. While we know that biology is an import part of the picture, that part can include a bunch of different factors besides neurochemi cals, such as possibly inflammation, neuron growth factors and more.

[0] https://www.psychiatrictimes.com/view/debunking-two-chemical...

> Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

I believe that theory has been mostly disproven, but that doesn't change solid evidence behind the efficacy antidepressants that were developed using that theory.

with your engine oil analogy, it seems like you are agreeing that brain chemistry is an important part of good mental health, just not the only one.

So if all the other parts of good mental health are in order, that leaves brain chemistry, hormones, etc. As the problem.

However I think there's some semantic issues with "chemical imbalance" that are worthy of examination. Depending on your basic philosophical views regarding materialism and the origin of consciousness, you might be of the view that all mental states are the result of brain states. This is a reasonable view. Considering what we know about brain function and the rather broad meaning of the words "chemical" and "imbalance" arguably all brain states are the result of "chemical imbalance" of some kind.

(I know the brain is also an electrical system but the electrical pathways are deeply entwined with the chemical ones)

* Trauma triggers and unprocessed/unconscious trauma. You'd be surprised how common this is. People who grew up in neglectful or abusive homes tend to believe there's something wrong with them and that their childhood was fine. So when life feels like shit, like there's no point, and it's only suffering every day, that somehow other people manage and they don't, they see no light at the end of the tunnel. It must be their fault, and for some reason they can't "get over it" or "Let it go".

* A person repressing stuff, which at some point reaches breaking point or saturation.

* Combination of (unlucky) factors - e.g. winter/less sun, less people around for some reason, had to sacrifice exercise for extra work, (...).

* Chemicals in the brain indeed, change from one day to another. And maybe the day they feel depressed is when they are seeing things more realistically and crash with that realization.

I don't buy this idea that it's part of the human condition that we're bound to have depression sometimes and that it's chemical imbalance. If we look at human history of psychiatry you'll see how coldly we've been treating patients. You'd be horrified at how we treated mentally ill people in the past. Why would you think we're doing any different now, just in a more mODeRn way - "They're sad because their brain is wrong. Give them a pill."

So, you think that chemical changes in the brain can affect how realistically one perceives their situation, but a chemical change that causes one to feel depressed is not something that happens? That doesn't seem like a logical conclusion.

If you happen to be a top athlete that’s just not getting enough vitamins, the supplements might help a bit (not as much as correcting the diet though). If you are a couch potato, you might have a Vitamine imbalance, and the supplements might correct it, but the supplements won’t turn the couch potato into a top athlete.

That would require a complete lifestyle change. From maybe new sport affine friends, to better diet, motivation, schedule, training routines, and a big time investment.

The analogy of the OP is that curing depression with pills “is like” trying to turn a couch potato into a top athlete using pills. The fact that the pills do something doesn’t mean that they achieve the goal.

We're all a product of our thoughts, our environment, and the mediating chemicals in our brains and guts. I'll throw in a different complex connection: the connection between hormones (estrogen and progesterone) and histamine. A woman can have seasonal allergies that wax and wane monthly due to the role estrogen plays in regulating mast cell release of histamine. The environment may stay the same over that month, but the chemical soup changes. This change may also be further mediated by what the person eats, as consuming high-histamine foods on top of that might be enough to really set off a physical reaction. Because we're talking about seasonal allergies here, few people would find this controversial.

So, let's move to the mind and emotions, which are certainly more controversial. All these factors are still there. Yes, CBT can be enormously helpful in getting you out of cognitive traps that decrease the quality of your life experience. At the same time, it can be true that you've been eating a diet that is not good for you and your stomach hurts all of the time not because of anxiety but because of your food. Let's take me for instance: I'm in grad school, I'm not feeling good, having trouble getting out of bed, I'm trying to drag myself through the thesis on caffeine and sugar, I keep beating myself up because I'm not as brilliant as Gauss or Kovalevskaya or even that guy who got that TT job at Virginia Tech and I have writer's block, I see the psych person at the health center 'cause why not. She says I have stress-induced stomach problems. Mindfulness doesn't help. What finally helps? An elimination diet that allows me to discover that one simple trick (eliminating a type of food) makes my stomach not hurt, means I don't wake up tired and hurting in the mornings, etc! Amazing to sleep and then wake up rested! Suddenly I have half the problems I had before and have more energy to deal with them. I'm still not Gauss, and that takes another 10 years of life progress to acknowledge. Whatever.

There are many ways to attack problems. Change the input, change the process, change the environment, decide the desired output isn't actually desired. Childhood experiences, diet and exercise (physical upkeep), the "shit life" phenomenon another poster mentions, hormones and chemical imbalances. Therapy is not the cure to everything. Neither is medication. Neither is diet. Sometimes we actually need reform so that people aren't stalked by medical debt or huge bills for having their kids put into foster care or whatever (lots of literature on the connection between financial instability and depression).

I spent years suffering with really severe symptoms and I was so desperate for relief I tried all sorts of treatments. The main thing I really learned during that time is that approaching mental health requires a holistic approach, but even armed with that knowledge my life was still seriously impacted by my mental disorder. For me, I had spent years in talk therapy and different behavioral therapies. I had also tried various medications which did not help me and/or had side effects that were unbearable long term. I was on lamictal for a while which seemed to help but I also stopped seeing improvements and eventually that was also not good enough and my function declined. I also tried meditation, spiritualism, self medication, yoga, exercise, different diets, journaling. I took class after class on psychology and I instituted all sorts of different systems to try to fix myself. My therapist told me over and over that I was doing the work but that the improvements we were seeing weren't what she would expect, then I was referred to TMS. Once again, I was desperate and I was willing to do or try pretty much anything because I was a wreck of a person that was spiraling dangerously. So I went, and for the first time about three weeks in... I started to see a small difference. It changed my life, and I'm still so much better. The thing about how well it worked for me though is this: the idea of TMS is that it targets the part of your brain that is damaged by depression. Whatever this means- I've come to imagine it as neurons that have formed hard wired patterns of depression that are nearly impossible to rewire through sheer force of will. So chemical imbalance- probably (even demonstrably)false. Physical patterns in the brain formed while you suffered from depression being very difficult to rewire without outer interference? Is that possible? I'm mostly thinking out loud and I don't really expect someone to just have the answer but I really want to know and it's something I wonder about constantly.

Additionally, we're generally told quite a lot of lies and made to believe fantasies from the earliest ages about - the world, who we are, and our place in the world. I have a theory and it's just a theory when we get misaligned with certain, let's call them, cosmic truths - there's a mind and body reaction, often outside of our conscious ability to recognize the problem.

I agree. The fact that depression and mental illnesses highly correlate with lack of religion and rise of the secular nation is something that should be investigated more.

I forgot who i saw recently that said we have a strong mirroring need in our brain, which means our happiness is extremely relative, if you suffer while people don't .. it hurts more; if people are in the same boat the pain gets softer.

Oh and yeah unconscious fears are often the root of so many mental issues.. abandoning (to) fears is often a massive trick.

Often as infants we develop legitimate fears in the context of our vulnerable position and extreme dependency on maintaining the parental relationship. These fears made sense then and helped us keep our parents calm, but interrupt our adult lives. These fears are also extremely powerful as our infant brain associates breaking them with a risk of death (typically through abandonment).

However, the brain seems to be remarkably fast at unlearning these fears when it realises they no longer are needed (I will not die/risk death by doing the "forbidden action"). So my experience was that pinpointing the fear, facing it in my life (perhaps initially in the context of the safe relationship with my therapist, and then outside in the "real world"), and watching my anxious reactions which were previously flared up in situations where I was avoiding the forbidden behaviour fade away. It leads to a calmer mind with fewer and fewer situations in daily life which cause anxiety to arise.

Background: after a difficult childhood, I did a therapy, discovered self improvement and lived a few years where I faced fears regularly and expanded massively. However, multiple debatable decisions built up to a point where everything broke down. Lost my job, hoped on 3 jobs even worse afterwards, was morally harassed, and the resulting bad mood and general negativity made me lose friends, and be even more vulnerable. Loss of confidence made me sabotage more or less voluntarily other aspects of my health, balance and projects. Therapists, SSRI, etc. no way to get out of it (just lots of money taken away => even more pressure/problems). It felt like death since I had to go through these many years, helpless, hopeless. It was worth than any experience in my childhood, and still traumatizing.

Now, the absence of "death" at an instant t when doing a "dangerous" action doesn't mean that death can't come later as a consequence (ex. tell your opinion at work -> doesn't kill you but if it leads to be fired later and start a cycle like above, it can be dangerous). Therefore there's never validation that my actions don't kill, they're just written on a list, with consequences pending, and the fear of the ultimate judgment is impossible to confront, unless it all happens again and this time I manage it. How would you confront this kind of fears?

A bed room theory is live small and grow through tiny risks. Small means your life is easier to secure and you can try stuff and fallback as soon as something goes wrong.

It's only a theory, that came up through the realization that a lot of pain comes from bad obligations. Too much mortgage, obligation to stay in a toxic job. Also contexts too large to really know if what you can do or not (such as politics at work).

I was saying almost the same thing as your last line to a colleague, taking many responsibilities in parallel before waiting for full closure, can lead to failing something that you would normally be able to do, just because you were stressed out by the other things you had to do in parallel.

- being able to recognize what are too large obligations, with time your nose becomes better at avoiding them quick

- being able to recognize how much I want to bear

- learning to say no thanks

There's a tendency to avoid seeking reality and stay in fearful predictions based on limited data that we gathered.

All this is probably close (if not same as) CBT. And Yoda :)

That said I often fail to do so. But I used to never try at all.

Indeed, one of those is the 'chemical imbalance' theory of depression, which in itself can lead to a person believing there is no hope because they just are a bag of chemicals.

The way out of this particular conundrum is as the OP stated - therapy which addresses the cause of the imbalance, which has every indication of being an effect of the depression, rather than the direct cause. Change your mind through therapy and non-physical means, then watch the bag of chemicals transform...

If the "theory" that depression can be caused by chemical or hormonal imbalances is wrong, then what externality is causing such severe depressive swings on such a regular basis, like clockwork?

What "mindset" should a pregnant mother with a history of post partum depression put herself in so that she doesn't feel depressed even after everything goes great and she has a perfect baby and all the support she needs?

I'd expect the opposite effect. If we are bags of chemicals, we can change ourselves by altering the composition of chemicals. The hard part is finding the proper balance.

I'm still not convinced this is true. I think it is just as probable that any apparent "chemical imbalance" is actually a symptom, not the cause, and while treating the symptoms can alleviate some of the suffering it is not a cure.

Therapy helps cultivate self awareness which in turn strengthens inner dialog and allows you to reflect on yourself, almost in third person.

It’s a shame our society stigmatizes therapy to such an extent but it really is a miracle cure for many mental health issues if you put the work in.

Serious question: are these typical signs of depression? Now I'm wondering if I have depression.

Think of that little "kick" you get when you think of something you want to do. Maybe you like eating ice cream, maybe you like playing tennis, whatever it is... that feeling, that subconscious little mental boost that gets you up off your ass, and moving... is completely absent in the depressed mind.

That spark that initiates and sustains action, is simply not there. Tasks, even small ones, are giant and the future is hopeless.

Ending it today will stop having to do x today, tomorrow and rest of my life.

So it's not just the homework of the day.

But due to my thinking I would also not just go without consuming my money and doing only what I want as long as possible as it also freed me from certain social boundaries.

Like suicide is bad, you need to work, lifing as long as possible is good etc.

One problem might also be that in my opinion lifing as long as possible is not the right answer. I'm not life positive like independent how shitty your life is as long as you are alive is good.

Now the question arrives what is a good time to leave.having already seen and done more than any other human who lived 50 years ago already puts me ahead on a experience level .

So determine this answer is open for me to decide.

Not having kids and not planning some right now also makes me more 'flexible'

One has to work 9-5 whole life that slowly kills their health and die horribly. That's normal, but if one does not want to continue that, it's illness. One must suffer. There is no other way whatever people here says, the real world does not work in any other way.

That’s as much a solution to everyday problems as nuking the entire planet and the human race out of a existence is a solution to, say, Covid or hunger.

I agree, but what you're saying is not how the world see it. Many things that make humans exists are not necessary or makes life difficult now anyway. Like phobias, vomiting while travelling by car, allergies etc.

Homework isn't a great example, but you can substitute anything that causes you suffering. For me, a lot of it is about my weight. I went through more suffering than most people can imagine to lose more than half of my bodyweight, and I was pretty happy with the result... until I started letting myself do the things I'd had to give up to get there: eating out with friends (or even attending any event with food), not doing intense workouts more than 3 days a week, having the occasional snack, eating something other than protein bars every meal, etc. My weight started increasing, naturally, and I realized: I never get to stop going through all that suffering if I want to maintain my weight. Ever. Ever. And without being able to maintain that weight I instead get to feel like a fat piece of shit for the rest of my life instead. Given those two options, the idea of just ending my life here and now doesn't seem so bad.

Life is constant struggle for most humans (not talking about privileged here). In the end we all die horribly going through all that trauma, so peaceful suicide like hypoxia may be a solution to stop the suffering.

There are others with me but they are walking along the banks telling me to “just get out of the water.”

But instead of extending a hand in help, they just move on and leave me behind.

Every once in a while I find a rock that is strong enough for me to lean on, And I can rest for a bit.

But the rocks always get tired of holding me up, and when they let go, I’m left drowning, thrown 50 feet back again.

And nothing is harder than standing up in that current when everything in you is telling you how much easier things would be if you just let yourself get dragged under."

—Unknown

I don't really like shopping for groceries, but I'd rather do that, than order take out that's expensive and probably not very healthy.

If I'm going to cook something, I'd rather cook something with a different taste than eat pasta again.

I don't really want to do laundry, but I do want to have clean clothes that don't smell.

If I could afford to do so I wouldn't work, but until I retire that's not possible, so I might as well make the most of it and increase my earnings/time ratio.

I don't really want to go see my family, but I feel I have a duty to do so.

For some folks: This is the reason for a shower becoming a monumental victory in one's day: Sometimes just getting out of bed is a struggle for folks. I'm in a few cooking subreddits, and often get folks looking for "depression food": Food that takes no effort (cooking at all can be too much effort) yet is still a bit healthy. At this point, you probably aren't enjoying food anyway. I've known someone that literally bought new underwear because laundry was the more difficult option.

Not everyone has all of this, and folks are pretty good at hiding it from others and putting on a happy face.

(Of course, that doesn't mean that putting up a facade means that you are depressed.

Also going out and doing stuff is probably better for you than sitting at home, no matter if you are depressed or not. And if that drive to make you go grocery shopping or meet people is less than healthy, that's still better than losing all motivation for everything, I guess?)

Have you tried a delivery service? Walmart as an example charges $100 or so a year. And then you pay a tip to the delivery person. I think it's worth it to avoid shopping in person, and cheaper than ordering delivery from restaurants.

Some examples - Going groceries. Used to hate it. Stressful. Too many people, I'd get social anxiety. Now, I smoke some weed, put on Michael Jackson on my headphones, cruise through the store with a smile on my face and a dance in my step. They say Mediterranean cuisine is one of the healthiest diets. OK. So I bought the best Turkish cookbook (https://www.amazon.com/gp/product/0714878154/ref=ppx_yo_dt_b...), and decided this is my new food bible. "Good luck, me! You're gonna need to figure out Eggplant." I've been eating grape-leaf wrapped rice, humus, pita bread, and that kind of thing all week - have never felt healthier. The recipes are easier than you think, and are good for leftovers, meaning you can food-prep and still eat healthily.

Laundry - You might laugh, but I find that on the days where I imagine I'm going to go on a hot date (LOL one day), or meet an important client, or honestly - when I feel most badass (and comfortable!), those days - cool stuff happens. I make a cool connection, have a good conversation, experience something different... So, doing laundry has been a positive way to ensure that my favorite shirts/outfits remain ready for duty, instead of uselessly in a basket.

Work - I was in a bad work situation a couple years back. Failing in-place, in slow motion. I tried to be honest during a review with ny boss, and listed all the things I felt I needed to work on (honestly, coming clean on what I was failing at). My boss took me aside and told me, "Why not get better at what you're already good at, rather than improving on what you're not". It kinda blew my mind... I honestly took a look at one of those "find your dream career" Ven diagrams. What is the intersection of your Passion, What You're Good at, What People Pay for (https://www.authentic.com.au/wp-content/uploads/2015/08/pros...). I broke the seal, asked my friends, "Hey. I'm looking to make some career changes, and could use the perspective. You know me. What do you come to me for?" I was surprised what kind of great answers I got. I'm quite self critical, so hearing this type of feedback was very encouraging.

I find t fulfilling to identify the people in my life whom I truly admire, learn about their life goals, and help them achieve them. It's a really great feeling, and leads to getting to know your friends at such a different level.

Family - Lately, I have been calling my grandmother on the phone. She's 95. I asked her, what gets you up in the morning? Without missing a beat, she told me: "Music." She loves Singing, playing piano, dancing. I decided to learn to make music. I'm not going crazy with it, but I bought a MIDI keyboard, plugged it into Garageband, and have been learning chords to songs I like, taking lessons. I'm telling you - it's such a wonderful soul feeling. I've since found out that many of my family members - some I had "written off" - are into so music. We've truly been able to connect in ways that excite us both. One of my cousins, we've gone from a "I see you once a decade" to the the true feeling of "family"- sharing each other's cool songs we've discovered, favorite bands & albums, to even video clips of our playing music attempts, telling stories, etc. If you haven't given it a try before, piano is pretty fun & easy to pick up (Trust me, I never in a million years believed I could play any instrument). Now I can sit down at a piano and kinda play something that at least makes MY ears smile :) Check it out if you haven't. Thanks for listening to my Ted talk...

I am the same way. My depression isn’t severe enough that I CANT do the things that need to be done, but rather, they take immense effort and personal discipline.

Of course everyone (even non depressed people) sometimes struggle to do things they have to do, but don’t want to do. It’s all about how severe that struggle is, not whether or not that struggle exists at all.

Years ago I was recommended a book written by a Dutch psychiatrist who had developed depression himself. The tagline was sort of "here's a professional who suffers from it, this will be insightful."

I couldn't relate to his condition for one iota (let alone finish the book); as he had mostly feelings of guilt and shame, and dark, weird mental images.

I guess depression is a sort of blanket term by now for many things, which probably complicates diagnosis and most of all, treatment.

Plus, I recently discovered the term "sh*t life syndrome", which is apparently getting to be known as a well-known term in the US/UK psychiatrics system (at least it has a Wikipedia page claiming that). It describes people who are poor or lonely because of the system surrounding them (prime example: they live in an area with raging unemployment). In that case, it's argued, symptoms of depression might actually be the logical response to an outside stimulus (or lack thereof). Yet, it appears many of these people are referred to psychological treatment because, well, society doesn't come up with any better option.

But what rubicon33 describes is certainly one way of depression, and I think a common one. But I'd go one step further even: Yes, people lack that little "kick" to get them going and do something entirely. But I don't think that's the root cause.

The root cause, to me, is that this kick has been subconciously "unlearned". Because when people with this sort of depression DO force themselves to do some of these things (and man, do they need to force themselves, with rational arguments and all sorts of tricks), they are not enjoying it. To stick with the example of playing tennis: Non-depressed people come back and say: "That was fun! I powered myself out on the tennis court, maybe I even won, I feel good.". People with this particular sort of depression come back and say: "That was physically, but mostly mentally exhausting. I want to sleep or procrastinate now and reset my thoughts to the baseline of being emotionless."

Disclaimer: Yes, I think I can also kind of speak on this subject. I've been repeatedly diagnosed with childhood PTSD and depression possibly ever since that (which makes it 30+ years); which doesn't mean that I'm not questioning this all the time, because the biggest trick played by depression is to make you think that everything may be just normal sadness/exhaustion/"not trying hard enough" ...).

If you're experiencing those, it might be worth talking to a psychologist or your doctor (to get a referral): you don't have to tough it out. But people who don't have clinical depression also have those issues too, which is why the diagnostic criteria is a little more involved.

For me, a short 3-4 month course of a particular SSRI lets me beat back the worst of it, and Cognitive Behavioural Therapy keeps it at bay. I haven't had an episode in years now

Screws up your sleep cycle, is time consuming, causes you to not leave the house, makes other hobbies fall by the wayside.

That said, it does also exacerbate clinical depression, so this gets confusing quickly!

I have on many occasions beaten back total anhedonia and a desire to die with a few drinks. It's not an optimal solution obviously, but when your options are limited it is sometimes quite preferable to not drinking.

As someone who has suffered major depression, I agree totally that recreational drug use can be helpful in managing some symptoms of mental disorder. I do however feel like moderation is a very important aspect of this which can be harder for folks when they are already feeling down

otherwise most of them wouldn’t want to socialise at all.

Can you elaborate which one are you using? I was prescribed Wellbutrin/bupropion (along with some therapy sessions) about a month ago and I seem to notice no changes. I'm going to continue to be hopeful but it seems like this wasn't the one for me so just wondering what you were using.

"There is research to support common factors theory. One common factor is the client–therapist interaction, also known as the therapeutic alliance. A 1992 paper by Lambert showed that nearly 40 percent of the improvement in psychotherapy is from these client–therapist variables."

Quote from https://en.m.wikipedia.org/wiki/Dodo_bird_verdict

A second remote but local(because of covid) therapist was assigned to me as part of this Wellbutrin trial. A total of 10 sessions are to be done with this trial. So far she has only told me what I already know: that I should keep trying little steps every day like increasing my exercise. She gives me little goals but I don't like the fact that since these sessions are 45 mins with no way to extend, there always seems to be a time crunch.

There are tons of therapists in my area with no way to evaluate the differences. This is an expensive proposition as it stands and so I don't know how I will find the perfect one without evaluating each and every different therapist in my area. :/

This has been my experience as well, both personally and through friends.

An important point is that a therapist which works for someone might not work for you, it's rather personal.

I will say that the effect is permanent. It's rewiring your brain when you use it.

If it's helping you to spend some time on harder but more important self-improvement, then great.

If not, you should consider switching drugs.

I currently take ADHD medicine, which is helping in many ways, but a mixed bag in others.

All the drugs are going to grease the wheels in some way, but you'll have to experiment to find the one for you.

That would be a miracle if it did that. My doctor put me on this precisely because it is less strong than other drugs like Adderal. He does not want me going down an addicting road unless necessary. (my summary of what he told me)

So far I have been taking it for about a month although I have missed days here and there and while I try to take it at the same time, sometimes the window varies by +/- 1-3 hrs. I am on the 150mg XR version. What is typical time frame we are talking about before we notice changes? 1 month? 6 months? How long did it take you?

The fact that I am on HN/Reddit/youtube for a couple hrs each day instead of exercising/coding/tidying up/working on my life seem to indicate that no reward loops have been broken thus far. In fact I am slowly sinking in the other direction(but i'm not sure if buproprion is causing it). I have broken another all time record for weight gain despite increasing my exercise regime somewhat.

Was considering stopping treatment after a month if no changes are noticed and wait some time to clear it out of my system before trying something like ayahuasca or psilocybin.

I'm currently on Adderall. If you have ADHD, it has more benefits than drawbacks in my opinion, and the effects are not as subtle. It does give you focus for tedious tasks, though it's up to you to assure that those tedious tasks are actually important and not a rabbit hole.

Neither drug is going to make you stop browsing Reddit or HN. If you want to reduce browsing Reddit, turn off all the default subs and then subscribe to specialized subs catered to real, specific interests of yours. You will not miss the default subs. HN is only good for about 1 page usually, then it's scraping the bottom of the barrel.

If you want to do more exercise/coding/tidying up/etc. set a 5 minute timer, do at least that much work on that, then reward yourself with some HN. You'll find that starting the activity is the hardest part.

Re: weight loss, you can't outrun your own fork. All the fad diets have a kernel of truth to them, a lesson to apply or discard in your own life. Intermittent fasting is quite effective IME. Besides calorie reduction, it also resets your hunger signals. For me, it got me over this irrational fear of being hungry that I had, and also revealed just how much I was eating out of boredom rather than hunger. Also, you have to pick a problem and focus on it. Mitigate the weight situation, but don't force yourself to fight a 2 or 3 front war.

If you have ADHD, you should be on an ADHD med, unless you literally can't trust yourself to take only one pill a day.

If you have treatment-resistant depression, you can also look into ketamine, either intravenous or now intra-nasal. Pay the price to have it administered professionally, as it's not a good idea to develop a black-market hookup for something so addictive.

It took me months to find the right one for me though. Worth talking to your doctor about it if it’s not helping much!

Unfortunately, the side effects were so bad I gave up after a week. Horrible nausea all the time. Such extreme fatigue that i'd sleep 16 hours and still feel exhausted. Not to mention other side effects that are not appropriate to discuss here.

I am considering trying this nightmare of a drug again because I still remember that productivity but man that first experience literally felt like poison was seeping into all areas of my body.

But the side effects (and primary effects!) are also why I only ever stay on it for 3 to 4 months. The sexual side effects alone are enough to impede my recovery, let alone some of the other ones.

So I use it like a bandage to get through the worst parts, rather than a “take every day for years” drug. The “take every day” bit for me is CBT exercises to rewrite my mind, and it’s worked :)

The physical sides for Lexapro at least for me disappeared. I also got the nausea initially. It’s rough, I know.

There are other more modern SSRIs that might be worth trying too, but if escitalopram seemed to work then it might be worth trying to stick it out to see if the sides get better. They usually do

I gave up after the Lexapro until this year where I am trying to tackle this issue again with the Welbutrin. I keep reading that maybe ayahuasca or psilocybin might be the miracle key that solves the underlying issues.

Imagine Einstein. He can't figure it out and solve the constant problem. Somethings not right. He's not happy, not sleeping well. He's thinking hard.

But then, he takes a pill. Suddenly, no more thinking during bike rides. "I'm just looking around and dopamine rushes in, it's great".

(I'm not discouraging treatment if you have a problem !! Positive feedback loop of negativity can kill you.)

I just mean that if you have high standards you may be less easily satisfied. I do think it's good to be able to step back and really enjoy a walk or music without a care in the world, but I also don't think there's something wrong with people who don't, and instead just focus on their problem. Or even are just looking for a problem or a puzzle interesting enough to solve.

It's all in the context. Sleep is important, you should sleep well. But maybe if you are lunching a rocket tomorrow it's fine to have a problem sleeping. Respect to others is the most basic thing, but maybe if they keep distracting you from work which can improve everybody's life it's ok to say something harsh but effective. And so on.

I don't think you can truly change the world if you sincerely enjoy its current state.

In all cases above it's not the brain chemistry that you probably want to fix. But you probably can do just that..

Of course you can change yourself, all problems are within you, they are created by your optimization function. Apocalypse is not a problem unless you don't want it to happen. Without people who don't make themself content with the state of things right now it's not a nice place to be. But without people who are not content and are trying to fix it it's not getting better.

Just to be too verbose because of sensitive topic: it may be you, it may be chemical imbalance, I'm not saying it's a happy pill and long story short if you haven't experienced happiness in a long time go see a doctor yada yada.

You can be happy during apocalypse when you are making progress towards ending it, you can not like things and accept it. I'm just making a case for unhappiness being the sane reaction in specific contexts.

It's really hard to have a meaningful discussion about this topic without being seen as a murderer while providing a decent information density. Even on HN.

If you weren't susceptible to depression these spirals wouldn't take hold, you might just say, "huh, now that I've learned more, I realize this is a harder problem than I first thought" and you just carry on.

Imagine a kid drowning in front of you (that somewhat happens but on the other side of the world so you can't see directly). You can be unhappy about it, but that's within you. If you don't care about the kid you have no reason to be upset.

Most probably would agree that maybe doing something to yourself to make you less upset about the kid drowning is not optimal. Reality is somewhere between this and somebody living a perfect life and wanting to kill himself.

The PHQ-9 is a pretty standard depression screening questionnaire that you can complete in a minute or two. https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

It is very difficult to properly assess 2020-2021 survey data both because the "you should be depressed" messaging is very strong in the media and the bias in who responds to surveys is complicated by the pandemic.

I am a Canadian and we saw an enormous drop in suicides, 30+%, in 2020 despite survey data (and wacky conspiracies) to the contrary.

I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue.

Many people have lost family members and been pushed into poverty. It is incredibly callous to think mental health can be discretely measured without accounting for the environment.

Suicide is not a quantitative measure of mental health.

I don't know who said you can measure mental health without accounting for the environment, I never made that claim! I literally said "I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue."

I'd say a population with high suicide rates is more afflicted by mental health issues than one with lower rates. What would you say?

Simply put: I could purposely crash my car and it would not be counted as a suicide or homicide.

While there are a lot of reasons for that to be the case, my point is the numbers are not representative of our current position.

A more holistic approach measuring alcohol and drug abuse, domestic violence, social media sentiment, and workforce participation.

Unfortunately, all of which are indicating that the majority are collectively suffering.

"Lottery winners and accident victims: Is happiness relative?"(1978) https://psycnet.apa.org/record/1980-01001-001

Additionally, there seems to be a stigma attached to not caring about a particular event, especially if doesn't affect you, all because of the slippery slope argument which is a fallacy.

How did you come to think depressions' cause must be internal ?

going to bring this up with my therapist tomorrow

How do you deal with the trust issues posed by that questionnaire? I have suicidal thoughts most days, but I'm concerned that revealing this to an NHS doctor would quickly result in my freedom of choice on what happens next being taken from me. Seems like one of the few cases where US healthcare (where you are explicitly a customer as well as a patient) has some advantages.

Really though, seek help. It is unlikely you'd lose choices (eg be sectioned) if you're asking for help and engaging with that help.

I pick at this stuff in my own head all the time, and just don't have enough confidence in doctors to believe they could tell me anything new. Being able to skip straight to pharmaceutical or other non-talking solutions via a disclaimer would probably mean a lot more people like me would seek help.

Antidepressants are strong stuff. Some years ago I hit a bit of a snag and went to a doctor and got just this, a prescription after five minutes of talking with helpful advice like "get a girlfriend" or "study something else". Stuff really worked... except in the wrong direction. Not an exception either, common enough they put "suicide" as a side effect in the fine print. I think if you're gonna take something like that you need some kind of feedback/monitoring and test different drugs until you might find something that works right. A hands off fire and forget prescription like I got likely won't work for most people.

GPs have been enormously helpful to me with this stuff. Most are very understanding. If you can do an online appointment booking that might help too - so the immediacy isn't an issue so you can write the appointment reason very clearly and revise it as much as you want before hitting the button. Otherwise, tell the receptionist you'd like a phone appointment (for the distance that gives psychologically) and that it is for a mental health issue. The diagnostic criteria for depression are fairly easy to satisfy - it is mostly about low mood for 4+ weeks. Keep details to a minimum you need to get a prescription but be cooperative if they probe.

Whatever you do though, don't just suffer. Tell your spouse how you feel too. Get some help.

I have kinda the same problem. I've had depression for a very long time - stable, but consistently declining. I get the "... or I could just kill myself" xapata mentioned a couple times per week and the reasons I don't are basically "that sounds like work" and "that would make my mother sad". Which aren't exactly good reasons, I know, but so far I've done very little actual self-harm and I very much don't want to get involuntarily admitted. I really would like to get help to deal with depression. I've battled it out alone with it for 15+ years and I'm not exactly winning that fight. But- anyone that's qualified to offer that help is pretty much legally required to admit me if I answer their screening questions somewhat truthfully.

Damned if you do, damned if you don't.

Depression is surprisingly common. Most people kick it after a month or so of meds (the individual in the article clearly has chronic depression).

See for example https://www.medscape.com/answers/286759-14692/what-are-the-d...

And consider “ Diminished interest or loss of pleasure in almost all activities (anhedonia) “

— his ability to enjoy guitar for its own sake is a great sign.

And “ Sleep disturbance (insomnia or hypersomnia) “

…he addresses that directly.

But the presence of those symptoms doesn’t by itself mean that a major depressive episode is the best or only diagnosis.

But having some of those symptoms is enough to indicate you should talk to a medical professional, as they are very troubling symptoms.

I’m just conscious of this because I’ve seen this argument used to justify delaying actual treatment in favour of ‘alternative medicine’.

Basically the counselling/therapy part of the process would be identifying if there's a "real world" root cause to address ahead of going the pharma route and facing potential side effects, and/or the reality of having to go off it later and immediately regressing because the root cause hasn't been fixed.

In any case, I'm obviously not a doctor; neither this post nor the GP should be construed as medical advice.

Also the "just do it" mentality is very damaging to admitting people can be depressed.

> “Twenty-nine people with treatment-resistant depression participated in the study: About half received SAINT, and the rest underwent a placebo procedure that mimicked the real treatment. After five days of treatment, 78.6% of the participants in the treatment group were no longer depressed, according to several standard methods of evaluation. “It’s quite a dramatic effect, and it’s quite sustained,” said Alan Schatzberg, MD, the Kenneth T. Norris, Jr. Professor in Psychiatry and Behavioral Sciences, who was a co-author of the study.”

Makes me wonder what percentage of the placebo group improved?

> The transcranial magnetic stimulation treatment currently approved by the Food and Drug Administration requires six weeks of once-daily sessions. Only about half of patients who undergo the treatment improve, and only about a third experience remission from depression.

From the article further on.

But what about other chemicals, Glycine contributes to an increase in 5alpha Reductase which helps reduce Cortisol one of the stress hormones. It can be used in place of sugar in hot beverages and food, how much does stress contribute to depression? https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conv...

And then there is Glutathione which increases light sensitivity, could this help reduce Seasonally Affect Disorder (SAD) also known as the winter blues, knowing that it also helps management of ROS, peroxides, lipid peroxides and heavy metals? Glutamine, N-Acetyl Cysteine and Glycine help to increase Glutathione in the body.

I wonder if fMRI has a similar effect on the brain to homogenising milk, namely it softens the fat walls in milk. Is fMRI having an effect in the brain or in the vascular system with plaques that contribute to atherosclerosis, because induction hobs or magnetic induction reduces inflammation https://peerj.com/articles/929.pdf does this demonstrate that depression is caused by a variety of factors not just one's linked to serotonin even though serotonin plays a part with the immune system?

Who says it won't last? Most depressions actually do get better by themselves.

How do you think humanity has survived so far?

(Most, but not all. And even if it eventually gets better without meds, there was still a lot of suffering.)

No clue whether it's the depression itself, or whether that's just a side-effect of something else that's useful.

Empirically, most clinical depressions get better by themselves today.

Similarly, most alcoholics improve by themselves.

(Of course, effective treatment is still useful!)

How happy would you choose be if you could consciously decide how happy to be?

I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it.

Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.

It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.

The FDA approved treatment is "aim at the middle of the dorsolateral prefrontal cortex". Getting more activity and connectedness improves its regulation of overall emotional activity.

This research implies that aiming instead slightly differently and a different dosing regimen may be more effective.

This is no different from any other medical treatment, where we find refinements in how and where to apply basically the same treatment to get better results.

To get some perspective on iterations of treatment, read this account of the work of August Bier.

He pioneered spinal anesthesia, something used all of the time today for epidurals during childbirth.

His experimental treatments he both performed and had performed on him by his assistant will, at the very least, raise your eyebrows.

https://en.wikipedia.org/wiki/August_Bier#Spinal_anesthesia

That’s what gives me pause.

Then again, the stuff shows benefits in trial, and presumably we get most practitioners trained up and doing the thing that's the standard of care well enough...

But in practice people just take two 500mg tablets and call it a day. Works well enough most of the time, even though it might be 'wrong' in some platonic sense of the word. (Eg you might have been helped enough with a slightly lower dose. Or perhaps 1250mg would have been better and suppressed slightly more of the pain. Who knows?)

I'm just not sure what the margin for error is, the failure modes for this magnetic therapy, or what makes a good magnetic therapist.

Not a reason to stop developing it though.

Eg. "We'll poke this red hot poker into you 10 times to cure your depression"... Many painful screams later... "So, is the depression any better now, or should we do more treatment?".. "Yes, yes, I'm pretty much cured!".

How can we be sure that this 'torture effect' isn't whats being measured here? Especially when the treatment appears to have unpleasent side effects, and the success of the treatment is measured with patient feedback...

Part of being depressed is you don't even have the will to resist being treated in a way that you don't like.

In fact, I'd say that feeling powerless against conditions that you don't like is the core of what depression is.

It's why someone who is depressed doesn't feel like doing anything, because they feel like no matter what they do nothing will ever change so nothing they do is ever worth the effort.

Just mildly uncomfortable .. for a period of time longer than one would be willing to tolerate.

Something like being at the dentist when you have many cavities in your teeth.

You can tolerate one or two sessions. But the idea of doing it every day for two weeks straight is unbearable enough that you decide on the third day to report feeling well.

For future reference, assuming this is a clinical trial, data from clinical trials is available online. This is the kind of statistic that you'd be able to find.

It was interesting to talk to the technicians/clinicians about how they came to be working at a TMS clinic. Several told me they'd been working in mental healthcare for decades, and were excited to work with TMS because it was the only thing they'd ever seen be truly effective in treating severe and persistent depression. One told me she had been helping patients through the 6 week program for three years and had not seen it fail to help a single person.

When I read the paper for this study it brought tears to my eyes. To think that it's possible to apply a lasting treatment to someone stuck in their own personal hell over the course of five days, and to have the effects persist for six months, is practically a miracle.

My treatment was over two years ago and I have not relapsed. There is hardly a day that passes where I do not feel deep gratitude for that burden to be lifted.

Was it expensive?

Are there any downsides?

Do you think TMS is, like psychedelic therapy, potentially useful for people without depression (i.e. the "betterment of well people")?

Here is a great comparison of noninvasive brain stimulation techniques for depression treatment: https://www.bmj.com/content/364/bmj.l1079

A company that offers tDCS as a home treatment for depression can be found here: https://flowneuroscience.com/

The main downside of TMS is simply that you have to be fully dedicated to the treatment. For six weeks I had to go Monday through Friday to a special clinic that was a half an hour drive from my house. This was a point that they brought up repeatedly in my interviews to get the treatment, so I think it must be common that people decide that it is too much dedication. For me though, by the time I was interviewing to receive TMS I had really tried everything and I was absolutely desperate to follow any path that would offer relief from my symptoms. I had gone through multiple medications, had been in talk therapy for several years, tried CBT, DBT, self medication, meditation, yoga, exercising three times or more a week, different diets, spiritualism... Really the works. I could sometimes stave off my symptoms but eventually I would suffer a huge crash and totally burn out again.

One of the other possible side effects is also seizure during treatment(very rare) and because of this they ask that you abstain totally from substance use during the time as it can lower your seizure threshold, which I agreed to happily. While the idea of having a seizure was scary, I had already experienced so many horrible side effects from medications that didn't even alleviate my symptoms I was willing to try anything.

I am not an expert in the field but I do think that there is a lot of use that could be gained for any person who decided to try TMS, for me some of the things I noticed was that my brain fog started to lift and suddenly I was able to learn much more quickly. I started practicing languages and instruments to really help foster this growth in my brain. The TMS helped me break the patterns of my mental illness and start forming healthier ones...I really do credit it with saving my life.

I have been to a neurologists in the past multiple times and completed multiple courses of medicine. But those medicines I took had really bad side effects. And I realised the more I used them the more I was dependent on them for a normal mood. Also my brain felt foggy while working when I took them.

I do take time off after a few days of working but that alone does not help. This is a cycle. Planning on going out daily and exercising, eating more healthy and having a schedule with less screen time. Let us see how it goes. These things seem trivial, but I have never them for more than a month continuously. I want to give them a try this time like my life depends on it.

Writting about myself and what seems to have helped me.

Have been on medications for two years (getting off of them now), and in therapy for a year. Likewise, I had (or have) troubles with feeling stagnated/unmotivated after bursts of productivity and motivation.

The key insight was that creativity and productivity does not come without cost. I used to overwork myself and my body. After "feeding" the intellectual part of me, the other parts became "hungry".

The solution for me is to have breaks, even when I am in the state of flow while doing something productive, and use that energy to work on the dull activities that are required to keep me healthy - physically and psychologically. The stream of consciousness style of journaling helps me as well - it helps the root cause of my bad feelings show themselves, sometimes in a subtle way.

What you may want to have a look at is Active Imagination[1], it comes from Jungian analytical psychology. I find it really helpful.

Good luck!

[1] https://en.wikipedia.org/wiki/Active_imagination

A well put metaphore I've heard is that you got a set of forks which you use daily. Make sure you don't run out of them. The problem is that it feels so great just using them all when you get a new clean batch after a couple of days of downtime..

Good for you that you are aiming for stability. Setting a structure and planning for mentally tough parts of the day (like social events) and never parting from that can make a total difference in life quality. It would for anyone obviously, but with living on some spectrum it's a life ingredient. Yeah, it's tough, and yes your life (as in with great life quality) depends on it.

A quick google pulls pack a couple of interesting links: A subreddit https://old.reddit.com/r/tDCS/ and an article https://www.wired.com/2014/05/diy-brain-stimulation/

[1] https://www.youtube.com/watch?v=NOAgplgTxfc

Not to mention the personal suffering.

That's a good bargain for people who pay out of pocket as well.

Here is a great comparison of noninvasive brain stimulation techniques for depression treatment: https://www.bmj.com/content/364/bmj.l1079

A company that offers tDCS as a home treatment for depression can be found here: https://flowneuroscience.com/

Makes you wonder whether they'll go into remission for a while and then slip back into depression if the environmental factors are still there. I guess if it can knock you out of a depression where the trigger is no longer present but the trauma persists, that's incredibly valuable, even if the mechanism seems very strange.

Actually being depressed can worsen environmental factors. Depression can make it hard (or impossible) to maintain work, relationships, hygiene, sleep, diet, and exercise. Losing the things can make the depression worse.

Anyway Doctor was explaining the damage to lungs and odds of survival, but I was totally chill about it thanks to Prozac.

Plus side doctors finally believed me that I wasn’t making up stroke symptoms.

Sometimes depression has a real cause that needs dealing with.

Every mind issue is also a brain issue, and so there is no actually boundary between the "real you" and an ailment --- it's an arbitrary division influenced by social norms.

I am no expert but I understand medical ethics is more trolley problem type stuff than issues like this. Similarly is the fact the many psycological ailments are highly culturally specific but the DSM just sort of assumes American context and doesn't go into this.

I also think middlebrow dismissals are discouraged on HN: http://www.byrnehobart.com/blog/why-are-middlebrow-dismissal...

Trials cost money. Even if this is a lucky outlier and it turns out to be no better than the placebo in a larger trial, having a decently strong positive result can hugely improve your chances of getting the money (and interest) needed to run a larger trial.

tl;dr yeah, but everyone knows that / science journalism is terrible.

Having tried TMS pretty extensively, I do not think this will help me, but I am hopeful that it might prove useful for others.

[1] - https://news.ycombinator.com/item?id=29562785

[1] https://www.uptodate.com/contents/unipolar-depression-in-adu...

Here is a great comparison between different noninvasive brain stimulation techniques for depression: https://www.bmj.com/content/364/bmj.l1079

There are also a few antipsychotic-like drugs that are used at low doses for antidepressant effects along with other antidepressants, but I'm not sure if the newer ones are indicated for depression, or if the newer ones are just reformulations of existing medications. It looks like there's a newer olanzapine combination on the market.