If this is a way to treat depression, maybe dialing back the crap way we treat each other is preventative. I've been angry for a long time that I have to take medication because most of my life was full of people who seemed to get some sort of perverse pleasure out of making me feel bad for things I cannot control (like being female, nearsighted and unattractive). Somehow it's not possible to simply disagree with someone else and state your contrary opinion, but rather to escalate quickly to aggression and personal attacks. Somehow it's not possible that we can organize ourselves so that a greater number of people can have their physiological needs met, much less feel safe and heaven forbid we should feel love/belonging or have a modicum of self-esteem because how would advertisers ever sell anybody anything? And along comes the internet where anyone is entitled to say anything from a distance and not have to look into the eyes of the human being they're taking a scrap of dignity from.
Particularly family and close friends. I really don't give a damn what one-time acquaintances and Internet handles say, but when people who should know you better don't, that can be severely damaging. Ultimately I think depression is really chronic existential crisis along with alienation, and while I don't preclude treatment with drugs (as there could be associated physiological aspects that can be corrected and normalised), ultimately one has to 'find' the meaning and joy that can get you out of the rut oneself. But its not easy.
Chronic existential crisis can be accidental too. I'm barely out ot a clinical critical one and it was the sum very long time factors that just exploded at the same time in ways that were near impossible for me to predict.
Anyway, drug can be very helpful (coming from someone who refrained to use them) to smooth the bad peaks. It's impossible to fight that.. kinda like a bleeding. Then you can work on other aspects. Also depression has some absurd side, because as long as your brain is tilted nothing works, the day it starts to balance again, for no special reason, you'll start to have mental energy and pleasure you forgot you could have.
...I have to take medication because...of people who seemed to get some sort of perverse pleasure out of making me feel bad...
In my head I boiled your comment down to that, and it hit pretty hard. I have had people encourage me to take anti-depressants because of my reaction to the way they're treating me.
I think this is 100% spot on correct. Life is damn hard and cruel without our help as it is. We don't need to add to it, and yet we do. Thank you for posting this.
Being able to have a conversation with someone of differing opinion, and keeping it a conversation and not an assault, is immensely valuable for both parties.
>And along comes the internet where anyone is entitled to say anything from a distance and not have to look into the eyes of the human being they're taking a scrap of dignity from.
That's the wonderful thing about the Internet; it's not real life! Personally, I think it's a hoot, but you have to sublimate the pain with humor. :D
But the internet is real life. It isn't some alternate reality. Your actions online effect real people offline, and they also reflect you. I think a lot of people forget that.
Don't get me wrong, insulting people in any medium is fun, but it's less fun in real life because
- you're limited to insulting only those in physical proximity, and the logistics of traveling around and repeating insults for greater insult coverage are a hassle,
- your insults are easily traced to your identity, opening the possibility of social or legal consequences,
- and, unlike the Internet, physical harm is an option in real life, which is a very bad consequence!
That's why, for assholes or political dissidents alike, the Internet is so wonderful!
That crosses into personal attack. Please don't do this, regardless of how someone's comment lands with you; it breaks the site guidelines and eventually gets you banned.
There's a story Andrew Solomon tells that's not unlike the Southeast Asia anecdote. Andrew traveled the world trying to understand how other cultures experience depression as a way to deal with his own depression
In one African village, he asked the residents what they thought of western depression treatments. They said "why don't you bring people outside, so they can feel the sun on their skin? Why don't you dance with them, so they can feel energy of others? Why, instead, do you shut them in a dark room, alone with a stranger, to talk about things that make them sad?"
It's an interesting talk, and one that illustrates just how little we know about depression
> Why, instead, do you shut them in a dark room, alone with a stranger, to talk about things that make them sad?
FWIW, this isn't really how therapy goes. At least from my CBT experiences, its a few minutes of talking about what we're currently struggling with, then decoding those topics to learn how we distort our experiences and memories towards the negative / stressful.
Then usually the "homework" would be small actionable steps to build up habits to become aware of these distortions, as well as habits to make other healthy choices.
Not discounting Andrew's story one bit, just putting a bit more light on what modern therapy aims towards.
The general idea is true though. For a depressed person, we aim to isolate them with a clinician instead of surrounding them with friends. We even use "therapy" as a kind insult: "You should go to therapy!" as if mental illness is something to be shamed.
The overall notion is that there's something wrong with people who are depressed, and that we'd rather wash our hands of it than help them. We have similar attitudes toward the homeless and the incarcerated. It's a very puritan/Calvinist attitude, that "certain people" are innately bad, but pervasive in even progressively minded Americans.
Friends/therapist is a false dichotomy, any good therapist encourages socializing.
Depressed people are not mentally healthy, it's a condition that can lead to suicide. Being sad is not bad, but when someone is diagnosed with depression, or any mental disorder, it's because it's affecting their lives negatively.
> We offer, and are offered, drugs as the first, and often last, recourse.
This is one of the many mental health memes I wish would die. I've lived my entire life with several close family members and friends who have severe mental illnesses. I have been to hundreds of appointments across dozens of providers. I have never NEVER seen a doctor give a patient a once over and then prescribe meds.
I understand there are bad psychiatrists out there. Just like there are bad mechanics, bad accountants and bad everythings. But I believe the vast majority of psychiatrists understand the limits psychoactive medications. I think it would be farely rare that a psychiatrist doesn't also discuss lifestyle changes and recommend some kind of talk therapy along with medication.
I think many psychiatrists prescribe first because people who are clinically depressed have such a high rate of suicide that it's better to first reduce the risk pf death before further treatment.
I'm not saying that applying that principle so broadly is a good thing, but I can see where they're coming from.
Sometimes antidepressants can increase the risk of suicide, however. This is a commonly enumerated side effect in their advice leaflets. One theory of depression is that it's evolved to take away our motivation to kill ourselves in the face of extreme adversity.
In no way do I want to diminish how serious these drugs are. They can have a profound effect on a person's behavior that occurs in a very short period.
Finding a medication regimen that works for a person is a serious undertaking. It often takes years. A person may have to taper on and off dozens of different regimens to find a good effect while minimizing side effects. The constant personal changes a person experiences through this process can strain relationships, ruin careers and much worse.
Also, at least here in Australia, it's way more expensive to see a psychiatrist than a psychologist. I imagine if you've made your way to a psychiatrist (someone that can prescribe meds) for depression then you've already had plenty of therapy, and things are still bad enough to warrant escalation. Which then ties in to your point. If someone is making it in front of a psychiatrist for depression, suicide is probably on the table.
Its very different in different countries, even different states. Are you in the US, UK, Australia, or Canada? Very, very different circumstances than France, Germany, Austria, etc.
It is true that there are generalizations; but the statistics of abuse of pharmaceuticals cannot be denied, nor is it safe - at all - to ignore the commercialization of mental illness by multi-national pharmaceutical corporations. In Germany, pharmaceutical corporations use sales agents to directly promote and sell their wares to doctors: and this is perfectly legal. In the US, they use conferences and junkets. You cannot ignore these things, given that pharmaceuticals are demonstrably over-prescribed in the West. It is very naive to ignore the drugging of society by corporate interests.
Caveat lector: Johann Hari, the author of this piece, was involved in a major integrity scandal in 2011. He resigned from his job at The Independent after being accused of habitual plagiarism and admitted to vandalising the Wikipedia articles of journalists who had criticised him.
His recent book Lost Connections, on which most of his recent articles about depression have been based, has faced widespread criticism for misrepresenting the evidence on depression and how it is treated.
We need to stop giving people reasons to be miserable then. I know too many millennials working two or three crappy service jobs for peanuts, never going to the doctor because being a server or Uber driver doesn't provide health insurance, and constantly ha-ha-only-seriously joking about becoming alcoholics for it to be just a coincidence that so many people are depressed. Oh, and I'm sure our disgusting sugar-laden diets aren't helping anything either. But maybe some basic social safety is necessary? I'd be pretty miserable too if I were afraid a single ambulance ride was going to bankrupt me (as it all too often does to Americans).
I think that the effects of food/digestion are still hugely overlooked as an underlying cause/catalyst of mental illness in general, and not the other way around. Here's a clinical psychologist and professor of psychology who discovered the same thing for both himself and his daughter [1]. They only eat meat now, basically.
Social Prescribing has only ever had a negative outcome on me, as well as most medications. Zoloft made me extremely suicidal, Lamotrigine for mood stabilization made me lose my hair. The only medication that's ever worked for me is addictive, and prone to abuse. It helps with my severe social anxiety, and prevents rumination. Because of the addictive nature of it, I do not take it.
I understand that things such as "social prescribing" may help some, but it is detrimental to me. I have no desire to be forced around a group of people that I have no known common interests, and may have none.
I feel that reading the majority of discussions to treat depression fall short in my case, as a lot of them involve other people or outdoor activity. My general disregard for other people and existence as a whole tends to be an issue.
I'm sure this can help some, but it seems to just be what most people understand already.
I don't think it's so well understood as you say. I believe your personal position and experience makes it quite obvious for you, but not necessarily so much for others, it could be helpful to them...
I agree that for some people the situation is much more complicated. In the article they mention endogenous depression. Even if it does not really exist, and it's "just" you needing much more than you have... how are you even supposed to begin to tackle that? If the society you live in is so unhelpful, if you can't even imagine one where you'd want to live, if social interaction is tedious or extremely exhausting and unrewarding even when you are with people you like? Or a thousand more. When even without any other problem and at your best, after regularly trying to put yourself in different positions and meet different people, life feels meaningless, exhausting and always unrewarding, what do you do?
Just trying to get the point across. It's great that people are trying to come up with better treatments, but as you say, sometimes it seems like many of those trying to help just keep walking in circles, and many of those who suffer still have the same unanswered questions. It's really unsettling. And maybe it will be hard to get to the next step unless we start helping more ourselves with the insight from the inside. Or maybe I'm just clueless.
I can see how it's less obvious for people, and it is important to bring these things up. They will inevitably help someone.
Also man, that second point really hits home. I've had a total of 8 'friends' over the past 10 or more years. Of that, I would consider two of them to be close, intimate friends. And they're both located hundreds of miles from me. One of them is NC with me, as we both accentuate the depressive nature of one another.
The only really rewarding thing I experience is video games, because I enjoy competition, and regularly hold top positions over others. It's also the major distraction from depressive thoughts I have. I also have hallucinations / extreme paranoia when away from a computer for too long.
The only real release from my depression I feel is being free enough to feel what I please at any time, which is impossible, or to achieve the un-achievable.
To put it into a very high-level form, I enjoy learning about anything under the sun, so much so that I wish I could solely dedicate my life to it. However the nature of our world leads to complications: money, family, jobs, etc. That's just something that you have to expect. These things are manageable. What chance within those constraints of society, humanity, and more can you expect to discover or create something that transcends history, to be remembered forever? What about affecting the world in a positive way enough to affect the coming generations into a mindset where knowledge comes first, with no border to access it, with the same plan to better the universe?
Such things aren't possible. No single human can have such an effect on the world. So personally I have to make a choice to attempt the impossible every day, trying to work on projects that might some day better our existence, or just give up.
I feel a good cutoff age for me is 29. If I don't like the direction my life is going by then, I'll probably take steps to make it not exist, or I'll continue.
I don't want to push my views on anyone, and would urge anyone that has the same ideas as me or has felt this way before to seek some form of treatment. It does help, and can get you out of a slump.
I've lost friends, family, jobs and more due to the way that I feel. I've spent days not eating or drinking laying in bed crying, waiting for it to end. If you think you need to seek help, do so.
>I feel a good cutoff age for me is 29. If I don't like the direction my life is going by then, I'll probably take steps to make it not exist, or I'll continue.
I don't know how old you are - but I am 30 and just came out of a depression. I have stuff I'd like to do every day, so I think I'm alright. Even when I was not alright, I was still far from wanting it to end.
There's a tough period with anti-depressants where people are on an upswing to a more positive position. They haven't yet broke free of overwhelming suicidal thoughts and low mood, but now have energy and motivation to actually do things. Unfortunately, that means suicidal thoughts that seemed too difficult now appear possible.
It's a really interesting and tough situation. Being suicidal can actually indicate things are working properly, but will still need 4 to 6 weeks to get you to a more positive place.
I was actually quite low. I didn't want to put it as harshly as I explain it to people close to me, but it took me from a position of "I want to die, and probably will kill myself semi-soon." to "My shotgun is loaded, 41 steps away from me. In a flash the world could be gone, and my thoughts would vanish and I would be at peace."
The prior thought process was accompanied with self-destructive methods. Abandoning friends, work, hobbies, etc. My real emotional escape has always been video games. They keep my thoughts from wandering, and I pour everything in to them. I believe my use of them in that way accompanies my skill at them. (Top 10 PUBG 2 seasons ago, A+ ESEA, Global Elite in CS, top 50 crusader D3 S13, etc.) My accomplishments in video games really help my suicidal tendencies, but they also hamper them. My depression seems to sway between a desire for success, freedom, skill, and a general over-arching hate of the meaningless-ness of existence. On a downswing it can depress me, on an upswing it can inspire me. I don't know enough about the topic from a professional perspective to determine how common that is for people.
This is exactly where the "suicide warning" on anti-depressants come from.
The "I want to die" thought and the "my shotgun is loaded" thought are at their core, the same "I don't want to live". However, the later has motive and intent behind it.
The whole goal of anti-depressants is basically to give you motive and intent. In many cases, that can be really good but it also means you have motive for the suicidal thoughts that still linger around.
> Yes, but also some anti depressant medication causes suicidal thoughts and actions in some people.
I'm not arguing that. I'm arguing why it occurs as it's a really interesting reason.
When you're super down in the dumps, you simply don't have energy for anything. Even thinking about suicide is a chore so you simply don't do it.
When you start on an anti-depressant, it doesn't literally cause to become more depressed or suicidal.It causes suicidal thoughts by giving you the energy to actually have difficult thoughts and actions - including suicidal thoughts.
> I'm not arguing that. I'm arguing why it occurs as it's a really interesting reason.
And I'm saying that's an incomplete picture. It only accounts for some but not all suicidal action in people taking anti-depressant medication.
You make it sound like your mechanism is widely accepted. It isn't. For one thing it doesn't account for age differences in suicidality in people taking medication.
Very interesting question. I wouldn't say it's a problem with the approach itself, but i'm not quite sure how effective matchmaking could even become. For the majority of cases, probably very.
Speaking from experience, I can rarely closely associate with people. In the span of 10 years, from a friend perspective, I've kept approximately 8 people around. None of them are from my geographic region, either. If I lived in a large area, it might be different. All of my friends are 'online' friends. We rarely stray from our group of people either, and we all are quite similar. (It's also probably worth mentioning, solely for interests sake, that we all have some form of diagnosed mental illness, which I find quite interesting.)
I've been saying it for years - depressed? One-way plane ticket to another culture, preferably completely foreign: solved.
And I've seen it work, time and again. So many times, I cannot be swayed: if you're depressed, you need to move. The deeper the depression, the more convinced you are that there is no solution: the further you need to fly, friend.
No, its not easy. (Except it is). Yes, you will have to learn a new language (except that is fun and very rewarding once you do it). No, your culture is not important, you can shed it in an instant - all it takes is that boarding pass, man.
This story is by Johann Hari who has an interesting TED talk about addiction [0]. He put addiction down to the amount of connections that people have and seems to be arguing something similar in this article too. Googling bought up this criticism of the video [1] for some perspective (with Hari, to his credit, answering the criticisms).
I can not talk about how things is done in other countries... but everyone who reads Psychology (and/or psychiatry) in grade school knows about Aaron Antonovsky and the "sense of coherance" theory. Everyone in health care who study assistant nurse and up knows about this theory.
So this is not something new or unknown about. It is not biology or social.. it is biology and social. Both play a part.
I live in a Scandinavian country and we are very aware that loneliness is an important cause for depression. The problem is.. you can't force people to be social. Family might be the problem. So drugs can be a solution until you find a more permanent solution.
Not a mention of plant-based medicines and psychedelic, spirit-centric treatments of depression? There's enough data at this point that this seems willfully obtuse. We need new ways, yes, and they're out there. These new ways need champions.
Ayahuasca changed my life and banished two decades of born-into depression. I have seen dozens of people transform thanks to this medicine. I've seen similar, incredible transformations from Psilocybin. Daily meditation keeps me in balance and singing tunes of contentedness. They're out there!
I have doubts about the authors intentions: Look up the wikipedia article and in the past he has done things of questionable integrity to be popular. He is a good storyteller and there is strong criticism from the medical professionals about his skewed views about ineffectiveness of current treatment methods. He does not cite enough references for such a hevayweight topic. I have no problem in him presenting a new perspective, but this is more of getting into the bestseller book list by telling you what you wish to hear.
Ancient wisdom and modern science support the idea that exercise and nurturing are highly effecting in fighting depression. I once spent a day in a log cabin splitting wood, dancing and baking bread and thought to myself if everyone in the world could do one of these things every day most of the world's problems wound evaporate. My specific favorite prescription for the slings and arrow of outrageous fortune is an aerobic, geometric, tribal form of dancing that is challenging but easy to learn with a subculture that welcomes and celebrates beginners - contradancing [1]. I also recommend listening to uplifting music such as Stan Roger's Mary Ellen Carter [2]
