I moved cities at 10 years old, and was bullied and isolated during the entirety of Middle School. Ever since then, I've always had negative and depressive thoughts lurking around. It's just my normal.

A psychiatrist helped me understand that those formative years are when your cortex is developing. The cortex learns through repetition, and during those years I was having constant sadness and suffering events. So, my emotional intelligence learned to be that way and that's why I've suffered ever since.

If I'm not pro active in thinking about being happy or doing active things, I default to being depressed. After almost 20 years, I'm still suffering.

A side effect of being isolated during those years is my social skills have taken longer to develop. I didn't have a true batch of friends until college, but now I've lost all of them.

Was bullied between ages 11-16. Grew a a social circle in high school, which started fragmenting once everyone went off to university. I rarely if ever see any of them anymore.

Before the bullying, I was aparently happy and excited for most things (according to siblings). After it I have always been the low energy serious guy.

20 years on I feel an intense need for human connection, but no matter how much I try I never seem to be able to cultivate any kind of lasting relationship with others.

I used to run a startup focused on this, here is what I learned:

Time. The answer is time. Research shows there are two ways long term bonds are formed, shared adversity[1], or lots of time spent together. General rule of thumb for relationship building:

1. 10 hours together is someone you know 2. 100 hours together is a good acquittance. 3. 1000 hours together is a good friend and a relationship that can now last a long time

This is why activities such as football watching (3*18, 54 hours a year, 2 years and you now have the beginnings of a good friends circle), or weekly poker matches (2 hours, almost 100 hours in a year) are so effective at building relationships.

Interpersonal hobbies with lots of down time, like rock climbing or playing in a band, accelerate this process greatly.

For people with kids, weekly play dates, or a weekly rotated dinner hosting.

Friendship is literally grinding hours, when we are young it is easy, studying and hanging out get those hours in, but when we get older, we have to be purposeful about it.

[1] Military boot camps are an example of this, so are the various culture wars. If you make people feel they are part of an oppressed group, preferably while isolating them from society at large, you will forms a cohesive group that acts together and one where everyone feels connected to each other. "Both sides" of the political spectrum do this, once you learn to spot it you start seeing it everywhere.

It's an easy place to meet 30-40 people in a day, everyone there has different interests and comes from different walks of life. If you attend for a few weeks you'll often start attending lunch together, meeting out at some activities, etc. Plus, all you have to do is show up. People at a church tend to be outgoing, at least some of them are. Someone is bound to reach out to you if you sit there and drink a coffee.

Everybody else "tolerated" the heck out of my gender-bewildered, 'spergie self from the messed up family, but it was the Catholics who finally showed me a love that would actually sacrifice something for my sake. Up until then, I sincerely believed "love" was like "Santa Claus" - a nice story you tell children, but nobody actually believes when they grow up.

Are there some Catholics who wouldn't know love if it came back from the dead? Absolutely. But there are others who stake their lives and well-being on the belief that love is at the center of everything, and wow are they worth meeting.

There are lots of suffering in the world caused by systemic factors. If you think all that matters is that God loves YOU and EVERYBODY then you will probably not spend much time thinking about the systemic causes of suffering, and how to alleviate them.

The thing about religion is it mostly advocates keeping the status quo as is. Religion doesn't demand that you use your brain does it? Whereas if you are serious about making the world a better place then you MUST use your brain.

I know, there is something called Liberation Theology:

https://www.religion-online.org/article/an-evangelical-theol...

"...central biblical doctrines is that God is on the side of the poor and the oppressed. Tragically, evangelical theology has largely ignored this doctrine"

Right...

As a note I went to church every sunday growing up - my parents (not religious) did it for exactly the reasons you described. Because we weren't religious there are some things that aren't a good fit even if its with other kids (confirmation meetings - I was very reasonably asked not to attend after asking questions because I was confused about the whole thing). There is a wide range of religious orthodoxy as well - plenty of mellower denominations.

lol really? Define evil. I view evil as anything that leads to disorder in the world (death, destruction, etc); churches do not do that - they often build people up, build in the community, etc.

> I find it difficult to believe that someone who is depressed needs to hear that they're a sinner heading to hell unless they accept whatever precepts the particular church is pushing.

I'm fairly certain 99% of them preach the opposite?

They'll say "here are all the bad things we do", "we are saved because we attempt to do good and believe in God [or if christian - Jesus sacrificed himself for all people, living and dead]"

Christians really preach self-reflection and atonement - aka be humble. Frankly, the world can use more of that.

While indeed time is important, it does not mean that merely spending time with somebody creates a friendship between you. It is more the quality of the time than time itself and, sadly, often our lives do not make quality easy to find. Especially regarding "hobbies and interests", personally I have found that relationships formed just through them tend to be more superficial and lasting less than relationships which are formed in a multitude of contexts and circumstances rather than simply spending time on one interest. They are good ways to meet new people, but for me an analogue of watching football together 2 or 10 hours per week and not other common context has never really worked out.

I like the approach of this blog post bellow on this. I think that especially the part of sharing life struggles together to be quite important.

https://billmei.net/blog/friendship

That blog's point to ask for help to create connections is a classic technique, super effective as well. Neighbors asking to borrow small things from each other is a great example of this bit of psychology in action.

Anyway, even though I only spent a couple of hours with my fellow passengers on that boat, I felt more bonded to them than most people I met in almost a year backpacking and stayed in touch with them for a long time on Facebook.

So interesting that that's some kind of inbuilt thing. Like the OP, I also struggle making friends otherwise like which makes this more curious to me.

Hockey is different but you still have a team working towards a goal, literally! With a good group of people, good as in nice people, not skilled, you win and lose as a team. Plus the on bench and locker room time means you get to know one another over time.

Cycling is different for me, it is a solo experience and as a result I don't have any friends in that world.

   Cycling is different for me, it is a solo experience and as a result I don't have any friends in that world.

I started cycling and was amazed at how social it was (albeit living in a town with a sizable cycling community). In my youth I was a swimmer, and although there is a lot of shared experience/adversity and friendship on any sports team, there's a lot less socializing that can be done while your head is underwater!

It's so lonely being a goalie sometimes. We never get any bench chat except for the short intermissions.

It was psychology applied to finding things to do, instead of meetup.com where you scrolled through a list of events and picked one weeks out from now, or a "friend making" site that had you swipe through faces, you instead selected from a list of events happening in the next 72 hours (immediacy). Personality matching[1], tuned for "will these people vibe", was used to arrange the groups. Groups were 4-6 people, small enough for real conversations to happen. You didn't get to see photos of people until you were at the event and ready to meet (avoiding the beauty contest problem).

Imagine a giant "I AM BORED, FIND ME SOMETHING TO DO RIGHT NOW" button. No endless scrolling, just a few choices, happening soon, presented to the user.

Investors weren't too pleased, two sided marketplace. Small businesses loved the idea, they only had to pay for people who actually showed up. Geo-fencing was used to track when people spent time at an event, basically a bill was only sent out if someone spent 30 minutes or so in the geo-fenced event area. (Phone privacy limitations and GPS throttling made that harder and harder).

Goal was to launch with local business partners at first and then migrate to letting individuals create events.

Stretch goal was to train an ML model up on creating a minimum viable set of questions to discover small groups that would vibe together, then license the ML model out to casinos, cruise ships, and such.

[1] test came from research in the EU, since American universities largely study friendships at work... ugh.

Do you have any references in mind?

Married the first girl who showed me positive attention. I didn't know what a friend for me was, so we're married but not friends.

The hope for you is that I found a group through a local running group. They posted on Facebook and we run weekly. They added me to the group chat last year and it's been amazing having people to chat with and go on runs with.

Going home to someone who you can't have a conversation with is hard though.

Trite advice that worked for me. Find a group of people who do the thing you like as a way to make friends. This group was started by someone just looking to not run alone in town.

I can picture in my head walking up to the running group meetup for the first time, it honestly feels like a new birth after being friendless from grade 7 til age 40+.

Same experiences with psychedelics, haha.

A significant amount of people damaged exactly like that run around. It‘s nothing noteworthy nor exceptional. And there is no recognized cure for us.

My pet theory is that through either nature or nurture, we are permanently damaged individuals that won‘t ever experience what we perceive as the normal, healthy social life and mental states. Our brains are permanently altered to our detriment.

Connecting to your anecdote: I am 30 and my mom still mentions what a lively and happy child I was. I wish she wouldn‘t, because it hurts to hear about the potential I squandered, lost or had stolen.

Pretty much all of the available evidence says otherwise. Look into neuroplasticity, developing healthy habits, and exposing yourself to people and situations that are far different than your comfort zone. I’m not the same person I was 20 years ago, and I’m not the person I was ten years ago. If you’re not busy growing, you’re busy dying. Change is the one thing we can count on to improve ourselves. But you have to accept it and get on with it. There are some people out there who have great difficulty changing and growing. Best to confront that now rather than later. Challenge yourself every day, and at the end of a year you’ll look back and laugh at your old self who said they were permanently damaged. Everyone has their unique way of doing this. For me, it’s going to nature and immersing myself in it every day and trying to find the beauty in all things. Find your own way.

I think this negative mentality doesn't help. The sooner you try to live life to the best of your abilities with the cards you've been dealt, the sooner you'll feel better about your present and future. We can't change the past, but we can choose to accept it and move on.

Maybe some other day.

Raves are fun enough as it is. You made the right choice.

As for relationships, the "one simple trick" for human connection and relationships is that there is no trick, you have to continuously put the work in. It helps if you find activities that you want to do and make friends there. A lot of people find satisfaction in helping other people, so volunteering can be one way to meet new people.

You might face constant rejection at first but you are not unlovable. But if you are nice and kind to others and help others people will value that and think of you in the future.

At some point you will reach critical mass and things will get easier.

It's a pretty messed up condition to deal with, especially because even the mere perception of potentially being rejected can cause disproportionate reactions.

More recently people after seeking specialists (not just general doctors) are getting diagnosed as ADHD (inattentive usually) and these meds are having positive impact whereas their previous diagnosis of borderline or bipolar weren't. Buzzfeed News did an article about it but I can't find the link.

This isn't to say ADHD and BPD can't co-exist! Their co-existence however would probably project itself in more extreme ways due to BPD being more consistent and overt in the display of instabilities and self-harm. BPD would sort of override a lot of ADHD symptoms due to not being extreme enough. Someone with ADHD might feel like their friends don't like them due to not replying to text messages, but will be fine if told otherwise. If the same happened to a BPD they would convince themselves that their friends are lying and deep down want to abandon them, and would likely take action in the form of either self-harm or being mean to those friends.

But you can see how there is a bit of overlap when it comes to self-image and how untreated ADHD that permeates can start looking a lot like BPD.

If you're struggling, I found graythorn's various assessment resources super helpful, as it systematizes aspects of relationship building that most people find intuitive. Things like "what level of friendship am I with this person" and "assessment on expressing needs and support" were helpful to me. Although these guides are specifically towards autistics, so keep that in mind when you try them.

Contexts to the links is the tiktok account https://www.tiktok.com/@graythornian

This is exactly right. I'm at the tail end of a long depressive journey that wasn't caused by self-beliefs, distorted thoughts, trauma, etc. Nearly every depression treatment I sought had zero effect.

My problems came about because I had undiagnosed and unappreciated neurological + genetic conditions that created stacking debuffs that made ordinary SWE jobs tax my executive function and deplete my neurotransmitters, eventually leaving me personally and professionally debilitated.

Because I suffered the symptoms for so long before identifying the causes, neurologically I seemed to have entered a new attractor (in dynamical systems terms). I couldn't recover by just discontinuing what brought me there; my neurology kept gravitating towards the new steady-state. (A good chunk of this is black-box reverse engineering what helped me recover)

I've only gotten better by radically changing my circumstances, identifying a crucial supplement, and undergoing a medical procedure.

The eye-opening part of the journey was understanding that because depression is defined by a set of symptoms, receiving a diagnosis doesn't tell you anything at all about what's wrong with you. It only confirms you have a problem at all.

Would you feel comfortable sharing some specifics on what these were for you?

The medical procedure was TMS - I spent ~6 weeks coming in every weekday, had my head strapped into a magnet helmet, and the magnets stimulate the parts of the brain associated with depression. I understand it to be vaguely like jump-starting an engine with a dead battery.

I just had my last session yesterday, and I see huge changes from December.

Crucially, I underwent TMS in 2019 and saw almost no change. At that time, I was still in the abrasive career situation, and wasn't on the supplement, so my hypothesis is TMS had very limited benefit because I didn't have sufficient quantities of neurotransmitters for stimulation to do anything, and any possible benefit was being immediately eroded by the circumstances that created my problems in the first place.

I also had undiagnosed autism (which came with hardcoded limitations I'd been treating as personal preferences or bad attitude), and ADHD (which I was diagnosed with as a kid, but didn't understand how it manifests as an adult). Both of these tax executive function (neurotransmitters) heavily, and the MTHFR mutation handicapped how much executive function I had to go around in the first place. My particular neurodiverse needs appear to be at odds with the typical SWE work environment, so every day I was powering through my special needs, until my brain couldn't take it anymore and simply gave out.

A big one for me is that staying focused on work responsibilities for 40 hours every week is really hard. Whatever my natural interest in the subject matter, it's exhausted much sooner than that. So I have to spend all day saying 'yes' to things I'm not interested in, while saying 'no' to everything else I'd rather be doing.

That sounds like a mundane attitude problem - ADHD problems can sound like ordinary problems (we're only human!), but the big difference is how unrealistic it is to "power through" problems, and what happens when we ignore them. We're fighting a brain that works differently at a physical level; your conscious mind can only do so much about that.

Choosing where your attention goes (either activating focus or breaking off focus) drains executive function, and the neurotransmitters that power it. ADHD brains are known to consume executive function more often, and to draw deeper from it. We have something like a 25% penalty towards available executive function. So an ADHD brain can easily run out of steam in circumstances a neurotypical person can sail through.

Brain scans show that ADHD brains use an inefficient subsystem to maintain focus, and also never stop daydreaming, so there's constant noise running in our heads. Maintaining focus is just plain harder for us. https://www.additudemag.com/current-research-on-adhd-breakdo...

Meds can help with this, but they don't "fix" ADHD; they only help us manage our symptoms to varying degrees.

In my childhood my ADHD was obvious because I was physically hyperactive - I was bouncing off the walls. When I got older and calmed down, I figured I'd somehow grown out of ADHD or something. I learned that you never grow out of it. Some of the symptoms were things I didn't know were ADHD, like my relationship with time. As for the hyperactivity, in adulthood turns from external to internal - your mind can't stop running.

For burnout symptoms specifically, ADHD can play its own role there. Online ADHD communities talk about "ADHD burnout". I haven't seen research about it, but its cousin, "autistic burnout" has early research, and they share the same root cause: "executive function depletion" caused by trying to power through neurological needs. Your brain just can't make chemicals as fast as you're using them up, and eventually you run out. An important distinction between burnout and depression: burnout tends to affect only work, while your mood is normal off-hours. Depression affects everything. Executive function depletion looks more like depression, despite the "burnout" moniker.

Executive function controls your ability to exercise willpower and take action, as well as your ability to regulate your emotions. If your brain runs out of the chemicals that make this work, these two things will fall apart. The only solution appears to be to remove yourself from the circumstance that overtaxes your executive function, then wait days / weeks for your neurology to recover. If it takes longer, you have additional factors in play.

Anecdotally, a lot of ADHD people find it challenging to keep normal jobs, and eventually find themselves in less traditional career paths where they can follow their mind's natural whims instead of struggling against them all day.

Another important ADHD thing for me is that ADHD brains often only have two ways of perceiving time: "now" and "not now". This is a component of time blindness, but I like to call it "the eternal now". Whatever I'm experiencing right now is the only thing that exists. If I'm happy, I'm happy with my whole being. Or sad. Or angry. I don't do well with delayed gratification because all I know is what this moment feels like - the future is irrelevant. Doing unpleasant work for "those moments that make it all worthwhile" - that doesn't exist for me. A brief moment in the past or future doesn't do anything for what I feel right now.

One more thing: ADHD people wind up relying heavily on routines and habits. Literally any amount of friction can stop you from initiating tasks, so any way to remove friction, avoid making decisions, or otherwise delegate willpower and memory to your environment becomes crucial just to function like a normal person. Three examples: 1) I reliably get my dishes into the dishwasher now that we have a clean/dirty sticker, because figuring out whether it's dirty was enough friction that I just left dishes on the counter. 2) I've heard several people say they actually vacuum once they got a cordless vacuum, because handling the cord was enough friction to discourage them from vacuuming at all. 3) I rely heavily on calendar/task reminders to get anything done. I can forget an important todo in seconds, so it has to make it into my phone.

It's worth noting that my ADHD won't be your ADHD experience. ADHD isn't a single, atomic condition - it's a collection of abnormalities that are so tightly intertwined that we can't tell where each starts and ends, so we have to treat them as one big lump of symptoms. There are six widely-recognized scientific models for what ADHD does to the mind, because that's the kind of complexity we're dealing with. That means each of us will have different limitations.

You may find it worth googling "spoon theory" - it's a mental model of how much energy you have that neurodiverse people find useful for understanding and planning their day-to-day experience. I also recommend the podcasts ADHD Nerds and Translating ADHD.

I love how you used "stacking debuffs" here. That made me smile.

(Not everyone with an MTHFR mutation experiences symptoms. For a long time I didn't. Best guess is my body changed after a period of intense stress.)

I take L-Methylfolate 15mg, which bypasses my digestion and provides my body with the processed materials directly.

The brand name for this is Deplin, which requires a prescription. I just switched to over-the-counter L-Methylfolate - it remains to be seen if it's as effective.

Fun fact: once I started taking Deplin, I had to come off of all my traditional antidepressants. They were at max dosage and having no effect, but once my brain was flooded with neurotransmitters, all the antidepressant side effects kicked in, including (perversely) amplifying depression symptoms.

Over the counter should be identical. I only prefer the prescription because it’s regulated and less likely to be fake. :)

Having a concrete scientific explanation for the empirical result I was seeing was a great confidence booster, bolstered some hypotheses I had, and helped me identify next steps in my journey.

I know that I personally still suffer the effects of bullying some 40 to 50 years later - for example, I tend to withdraw from any conflict/confrontation in the work setting misinterpreting even constructive conflict/criticism as being directed at me personally. When I was a kid playing with other kids I tended to withdraw and disappear even in situations where there was no bullying because I came to expect it would happen. And I see that I withdraw similarly in the workplace. In that sense the bullying from many years ago has negatively impacted my career and mental health (anxiety, panic attacks and a bit of paranoia as I'm always expecting the worst from other people).

It's nothing but lip service. Bullying is largely the result of several quite obvious system design flaws. 30 kids to one adult is going to result in a Lord of the Flies culture, and that culture will get worse as you scale to additional 30+ classrooms.

Further, actually paying attention to the emotional state of a child and nurturing it carefully at the times it needs that would be hard to pull off in a group of _five_ kids.

But at all costs, we need every mom and dad in the country working all the time to maximize the size of our economy (and help the rich keep getting richer). We need conforming, beaten down worker bees who've been trained to drag out of bed and go where dictated all day long to fill all the jobs that keep the economy humming.

So any changes in the favor of nurturing kids reasonably (not even optimally, just reasonably) just aren't in the cards. But we can make some nice posters about it.

You might have come to believe, for instance, that you're fundamentally "different" or "unlovable", and that you can't expect to be socially accepted or loved.

These core beliefs, these schemata, are difficult but possible to change. Schema Therapy has had empirical success at doing so.

The subjective experience of changing a maladaptive schema is like teleporting from a miserable planet to a strange but much happier, more loving planet. You can be (much) happier than you think; you're just stranded on a miserable planet, one that would make anybody sad.

I'd suggest checking out Reinventing Your Life by Jeffrey Young: it provides the tools you need to get to that happier planet, where you can feel safer and loved and accepted.

This is ~equivocally~ unequivocally false. The portion of the brain that develops emotional intelligence forms during your formative years and can learn to be put in a depressive mindset.

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984129/

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132040/

> Humans are likely the most emotionally regulated creatures on earth. Compared to other animal species, we can modulate and modify emotional reactions and experiences, even very intense ones, through a large and sophisticated emotion regulation repertoire that includes skills of distraction, reappraisal, language, prediction, social interaction, suppression, and more.1–5 At times, these skills require effort, and at other times, they seem reflexive and automatic. But what are some of the variables in this sophisticated emotion regulation repertoire? The parent of any toddler or even adolescent can attest to the very slow development of emotion regulation processes. This slow development has been documented in empirical research, which also notes the large individual differences from one person’s ability or style of emotion regulation to another’s. Evolutionarily speaking, this slow development of emotion regulation ability in childhood that culminates in an exquisite ability in adulthood points to the benefits of a slow-maturing emotion regulation system. Indeed, humans are not only a highly emotionally regulated species, but they are slowly developing in general, relative to other species, 6 with a prolonged period of immaturity. Phylogenetically, slow development may confer benefits through an extended period of neural plasticity—a feature of a developing neural system that heightens its ability to learn from the environment. If so, then humans may owe their sophisticated emotion regulation skills to the “extension” of childhood that has evolved in us. The nature, chronicity, and quality of environmental inputs during these periods of plasticity, in particular those from close relationships (e.g., parents, friends, teachers), in large part determine emotion regulation functioning in adulthood.7 Thus, adult brain and behavioral function in this regard can be conceptualized as a historical reflection of what was experienced during development. To fully appreciate individual differences in adult emotion regulation skills, then, it is helpful to understand how the brain develops.

There's also a difference between traumatic experiences (such as you moving somewhere new at 10 and struggling with isolation and being bullied) and how you may have psychologically adapted to these situations. But nothing you've mentioned implies that your brain can "learn to be put into a depressive mindset" -- it's more the case that strenuous challenges that haven't been addressed, or moved past, or evolved from, will continue to cause problems until work is gradually done to address them.

I have always felt it's similar to musculoskeletal issues. You can do a lot of damage to your lower back by sitting at a desk all day, or to your wrists by typing at an angle that causes repetitive strain. That damage can be "mitigated" in different ways -- medication, surgery, physical rehabilitation. While the last one is most difficult, it's also the most effective because you're training the mind-muscle connection at the point where it's fragility is causing and compounding structural damage.

Even as people get older, until they reach very old age, it's rare for these kinds of MSK problems to occur in ways that cannot be unwound by adherence to physical therapy and a good exercise regimen. I think the same is true for our minds. As you mention in an earlier comment, if you do something that makes you happy, you feel happy for that time before drifting back to depression. But that in and of itself may be the point -- if you are constantly doing things which make you happy, it may not be immediate, but eventually you can re-orient your brain you being default-happy with depressive episodes rather than the other way around. That doesn't make it easy, of course, nor is there a one time fix.

What is the practical difference between saying "learnt to be put in a depressive mindset" and "psychologically adapted to these situations"? Psychiatrists don't need to be so technical when explaining the differences to people. I'm only framing the conversation in a colloquial manner such that non-psych majors will understand them. In some manner I've "learned" to be in a depressive mindset. And, through repetition, I can "un-learn" it.

> Even as people get older, until they reach very old age, it's rare for these kinds of MSK problems to occur in ways that cannot be unwound by adherence to physical therapy and a good exercise regimen... if you are constantly doing things which make you happy, it may not be immediate, but eventually you can re-orient your brain you being default-happy with depressive episodes rather than the other way around.

I'm not disputing this. The times where I am the happiest is when I'm in my routine of working out and playing tennis. But when I get out of my routine, I fall back into the depressive habits. It's hard to stay consistent. Maybe if I stay consistent for long enough, my default will not be depressed. But I have yet to be consistent for long enough to reach that point.

I had to lookup "formidable" in case it was a specialized term, but I think it's a typo. Nevertheless, I like it better this way.

I turned into a depressed, "emo", grumpy kid around 8-12 and that became an angry, misunderstood kid after the second move. It has been decades since that time, but I am doing better now.

Being depressed, moody, overly serious, is my default now. I've learned to work past it like you've described, change my outlook. It still sucks having a default downer attitude in my head though. Still more work to go.

My parents and siblings were always perplexed by this. To this day, they still think nothing is wrong with how it all went down. I was just a "problem kid". That worked for them, problem kid was a convenient scape-goat for all the other familial difficulties we had going on.

If I ever have kids, I'll do my best to not disrupt their lives the way mine was. Hopefully, I'll be a lot more attuned to make sure they're dealing with social pressures better than I did. No one needs to live the way I lived, it's not mentally healthy.

I wouldn’t put this all on your experiences from a two year period from decades ago. It’s probably just who you are.

I think it’s important to frame it this way in order to empower yourself. If it’s just who you are, then you can accept it, adjust the way you live, and even alter your perspective enough where you don’t feel weighed down anymore.

But if it’s an injustice that happened to you far in the past then you’re a victim and you just have to deal with it because you didn’t get lucky.

Many people don’t want to take my perspective because it sort of sounds like I’m saying that some people deserve to be bullied. I do think it’s true in a way, but then I’m not one who thinks life should be fair.

Maybe there is truth to both, and the brain is plastic, so we can also change who we are.

My neurologist once said to me "any time you see the phrase 'multiple mechanisms of X' in a medical journal, that's code for 'we have no fucking clue'".

Once I left school behind me and met people who respected me, I managed to let all of that past behind me and become a very happy person with (so far) zero depressive tendencies. There is still some trauma left when I see my kid being teased or teasing somebody (to a much smaller scale than what I went through), but aside of that I'm very glad my brain managed to escape hell unscathed.

I had a strange life due to pre-wired issues, until 30 when a few traumatic event (including a first relationship that was as positive as negative) completely altered my reality. I was very surprising to say the least how one day you cannot exist socially (total shut-in with obsessive painful thoughts on a daily basis), and the next one you see colors and friendliness everywhere. Deep in your guts, something that really lifts your mind, imagination and heart solidly, not just a philosophical understanding.

I had a year of socially vibrant emotions but gradually went back to my old self (avoidant) but I still remember that my reality is somehow altered and very far from what others can experience or what is healthy.

If anybody has resources to read or places to monitor I'll be glad to know.

ps: I have a ton of questions regarding the neurology of the perception of "the self" and others for the lack of better terms. if any neuroscientist has time to waste, my email is in my profile, feel free to spam.

Interestingly, I'm convinced depressive state accumulates during a sleep cycle. Missing a single dose of mirtazapine and then sleeping feels exactly like an alcohol hangover. I'm also convinced alcohol is a CNS depressant and abuse of it induces depression.

Edit: Similar experience. Chaotic home life with fighting parents with high anxiety levels. Emotional problems, speech issues, out-of-norm appearance and intellect, bullying, and intense untreated depression and ADHD-PI for many years. Too many factors to control for. I suspect genes and epigenetics.

I think it's probably impossible to treat with drugs because what people really need are friends, hope and a good outlook on life (which often comes from hope). I'm sure drugs can improve people with imbalances and I'm also sure it's not just one thing that causes depression. That said, it seems like it can often be solved with more traditional means -- finding community and purpose.

No need for an “imbalance” as justification to get help through medication. This attitude is a form of ableism that can ultimately be deadly for the people it’s targeted at if they buy into it.

Coming from a spiritual and community oriented background people aren’t doing well. “medicine bad” and constant implicit and explicit messages they get - that they must not be doing it right, doesn’t help at all.

I think losing college friends is inevitable. People get jobs, move, marry, change, etc. Clutching to the friends when life was much simpler might not work now.

The solution would be making more social ties with neighbors, family, acquaintances, hobbyists, etc., and try to find new friendships/relationships within them.

Not to mention, exercise is "too hard" for most, the food supply is weaponized with sugar and FUD, everyone is so tired at the end of their "BS job" workday, so hit the couch and stream the streams. And now you have a vicious flywheel that quickly turns people into candidates for the latest big-pharma "cure"

HN Disclaimer: I'm in the US and making generalizations based on my observations. Not saying that there aren't needs for pharma / pills / afflictions that aren't solvable by the above, etc...

For what it's worth, exercise, diet, sleep, social engagement, and lifestyle changes are well-known inputs to addressing depression. Therapists will explore and encourage improvements in all of these areas. Good psychiatrists will as well, given enough time and a patient who is open to listening.

One of the difficult issues is that many depressed patients often don't want to hear any suggestions that depression might be due to anything other than external factors. This is why the pop-science version of the "chemical imbalance" theory became so popular in the mainstream: It gives a plausible explanation that depression is just something that happens to you due to no fault of your own, which is weirdly easier to accept for many people.

There are similar treatment problems with a host of health issues, such as obesity. The trend on social media and pop culture is to explain obesity away as a chemical or societal problem, minimizing the input of personal choice and actions. It's very popular to propose theories that "counting calories doesn't work" or hear anecdotes about people who claim to only eat less than 1000 calories per day but never lose weight (which isn't possible, even 100% sedentary coma patients need more calories than that).

Or rather, it is about choice, but the choice for some is "obsess over it and suffer a lot more than the people around you for the rest of your life", not to mention generally being treated like not being able to fight your body's compulsions is a personal failing by people who don't have to fucking do that.

P.S.: And before you go shoving your fad bullshit advice of the week at me, it should be noted that at one point I had lost half my body weight and am still over 100lbs down. I have been doing this for over a decade, I have tried every trick anyone has yet devised to make this easier and none of the work for this kind of weight.

Any diet will work for 10-15lbs. Like, literally any diet. This has been shown multiple times. Losing real, serious, obesity-level weight takes significant effort and suffering continuously and anyone who says differently is full of shit.

...unless there's a drug involved. Amphetamines and the new class of diabetes drugs seem to actually work wonders. The former is obviously problematic and ill-advised.

[0] which I find hilarious because their definition is skipping one meal a day, not skipping entire days at a time the way I did when I was trying it. Skipping a single meal is not, nor will it ever be, "fasting" as far as I'm concerned.

Why is it so hard for people to get adequate sleep, exercise, a good diet and social interaction? Even most non-depressed people I know don't do these things well (except maybe the last one), so this isn't something unique to depression.

As an individual, yes, do what you can (which might mean changing to a less “sick” culture or subculture so you’re not fighting a sisyphean battle). And also, we should do better as a society.

For example, If people lack meaningful social and don't want to socialize with their neighbors, call friends, or have dialogue with their partners, you can't legislate solution to that problem.

Maybe we fundamentally agree, but I was pointing out that society IS the individuals. doing (1) is how you do (2).

Maybe this is pedantic or my own bias, but I think it is important to keep in mind. Some people use "society" as a substitute for "other people but not me".

When some people talk about changing social norms, they mean forcing other people to act opposed to leading by example.

At the end of the day, I think I agree with you that we do live in a sick society. The best remedy is to cure the sickness in ourselves.

People are resistant to those things because they are being told - do all these things and make all these hard changes and you will feel better and have motivation and energy. While they are thinking, “but to do all those things will require a lot of motivation and energy”. So patients are being told to get the things they want, they need to already have them.

It doesn’t matter if depression is a chemical imbalance or whatever. The reality is people get stuck and medication is a very easy initial step that can get them moving. It’s well established that executive control varies among people. It’s not a moral deficit to be on the lower end of that spectrum and be unable to spontaneously will yourself out of a depressive apathy.

It pissed me to no end that the couple people who got to know about it basically told me to "just exercise more and do volunteer work and it will go away", even when I told them that it was caused by work-related stress.

Yes, and "chemical imbalance" is totally legit but not like its predominantly being marketed. The chemicals (dopamine, seratonin, whatever) are already present in our bodies - they just aren't consistently expressed across the population. For many people, these chemicals aren't released as regularly or in sufficient quantities for a given time period. Often due to lifestyle, but also just differs from person to person. But hey, put in 45 minutes of Z2-Z3 cardio and it can be amazing how the cobwebs get cleared.

> The trend on social media and pop culture is to explain obesity away as a chemical or societal problem

The somewhat recent corporate opportunism targeting obesity and marketing it as completely normal and healthy, almost something to strive for, is incredibly concerning.

If you think about it in an evolutionary timescale, the way most of us live in the West these days is horrendously incompatible with the sort of life we evolved to live. Thousands and thousands of years were spent out in nature, in small communities, eating certain types of foods, engaging in physical activities, etc.

The sit-on-a-chair-all-day, look-at-screens-all-day lifestyle is a comparatively new development, and neither our minds nor our bodies are suited for such an existence. That's enough to cause us a fair amount of trouble. Add all the socioeconomic issues you mention into the mix, and it all starts to make perfect sense to me.

I’ve had situational-depression badly enough that I would easily have been diagnosed as clinically depressed (more than one person said so, and if I had gone to a doctor I am sure I would have been given a label and some pills). When the cause was resolved, I immediately switched out of the funk and all symptoms of “depression” were gone. I don’t believe it was correlation, that is I don’t believe depression lifting caused me to fix my bad circumstance: I don’t think I had any influence over the actual date the underlying cause was “fixed”. Chronic clinical depression is not usually fixed in a day.

Indeed. What's worse is that we, as individuals, know this. But we, as in the western society at large, seem to be utterly unwilling or incapable of addressing this.

Long working hours to make ends meet. The shittiest food is the most convenient option. There's a metric fuckton of light- and sound pollution which messes with our sleep. 10% of folks suffer from sleep apnea for a variety of reasons. So many things are messing with us. At some point, we're going to have to start dealing with these things.

Being around people reduces cognitive decline in old age.

Being around people reduces depression levels.

Being in a supportive community reduces the severity of symptoms from schizophrenia.

The 2+2 nuclear family concept is an abomination, we are supposed to live in a multigenerational community, surrounded by friends and family.

The modern American lifestyle destroys psychological health. Without large social circles, finding romantic partners is hard, which leads to all sorts of negative life outcomes.

Raising kids is hard, friends of mine who have nearby extended family have a much easier time raising kids (and are more likely to have more kids!) Heck my sister had kids 20 years before I did (bit of an age difference), 2 sets of grand parents, lots of free baby sitting, and aunts and uncles to help out with homework. It was also useful for me, I got to learn a lot about babies early on.

> gross imbalance of exercise, diet, sleep, and social connection

Yeah lots of these are solved with a large social group. I have some good friends (who sadly now live a bit aways from me) who host dinner parties 3 or 4 nights a week. People come over and help cook and clean up, so everyone eats healthy meals all the time.

Friends who have lots of family nearby, just rotate whose house they go to on different nights, all the kids and adults after school/work get together to do child care and cooking. Healthy food for everyone, less work.

Lots of modern life scales up really well. 2 parents will get exhausted taking care of 1 baby, between cooking, cleaning, and watching the child.

4 parents, 3 kids? Much easier. Seriously, piece of cake.

3 grand parents, 4 parents, a young auntie, 5 kids? No problem at all.

Society has seriously screwed the pooch.

If I had some insane amount of capitol I'd try to start some sort of shared housing for families, do intense interviews to match people up (see: My last failed startup) people cook together, raise kids together, support each other. Put 3-5 new/young families in a mid size housing complex with a shared yard. Put a support network in place, house chaperone (cough RA cough) to help out now and then.

Extended Family as a Service. Dystopian, maybe, but possibly it'd do a lot of good in the world.

(If any investors want to get in touch, please do, :-D )

I noticed that my depression spiked when I started to become more isolated. I was getting older, long time friends are now scattered about the country/world, difficult to make new ones. Family members are isolated and scattered doing their own thing in their nuclear units. Parents are divoced and fending for themselves too. Finding a romantic partner under these circumstances is difficult ... having no friends can be seen as a "red flag". It snowballs.

I have also thought of the concept of shared housing for adults. I LOVE this idea.

They share the responsibilities much like a multi-generational family would, they just happen to be strangers.

Pretty much all available data says as much, but we refuse to do anything about it. Hell, most refuse to recognize there's even a problem.

SSRIs are extremely dangerous if tryptophan intake is also increased (with supplements, for example), even moreso if niacin is also consumed to encourage the tryptophan -> serotonin pathway.

https://selfhacked.com/blog/serotonin-syndrome/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184959/

Isn't a quick, effortless fix the ideal goal? Wouldn't that be better than a slow, difficult one?

Lifestyle changes are a lot harder and more time-consuming than taking a pill; if the latter were equally effective and low-risk for all people, it would obviously be the better choice.

Having been close to a few people with psychotic disorders (I'm not misusing that term, I mean paranoid delusions, hallucinations, ...), this rubs me the wrong way. A mild case of depression may be safe to approach this way but with serious psychiatric problems that is dangerous.

The author wrote a book saying schizophrenia doesn't exist, and was made up by psychiatrists. While it's probably true that it's a blanket term for what are probably multiple causes or possibly more of a spectrum disorder, I have seen schizophrenia up close. It would be foolish to say it doesn't exist, in that there are millions of suffering people in existence who fit the symptom criteria and benefit from treatment.

You also need to be careful about people who advocate this position because some of them are affiliated with cults.

Do you think you would have been able to make the lifestyle changes without medication first? If so then why?

It may be easy after the fact when the depression is lower and you have side effects to look back and judge the value that way. But it may be hard to imagine what did not happen or how life may have trended if not for it.

Obviously I have my own bias. I don’t think I would have been able to start and stick to exercise if not for the kickstart from medication

> Disclaimer: I'm in the US

These are related. This is largely from car dependence. In a lot of places you can get daily exercise through walking.

In a modern day society it really isn’t acceptable. Give people access to low cost housing. Reduce the cost of education so no one is priced out of it or forced into massive debts. Subsidise healthy food and tax junk. Subsidise gym memberships and sports clubs for the poorest. Increase the amount of therapists being trained and make them more accessible. Pay people proper wages. Watch depression plummet. The solutions are there - why is there no political will to enact them?

Edit:

I have no idea why but people are reading “subsidise” and seeing “free”. That is not what I said. Subsidise the things you want to encourage so it is cheaper for the consumer at the point of sale and do the opposite for the things you want to discourage. The cost you pay as a society ends up being less in the long run. Less people ill and ending up in hospital means more people working and paying taxes etc.

It is a state of disconnect from one's own life and the World At Large. This is symptomatic of a loss of individual agency and ability to interact with their environment in a personally meaningful way.

All the free gym memberships and free food in the world is useless if individuals don't want to go to the gym or cook the food. In reality, there are opportunities for free recreation and cheap healthy food readily available, but that isn't the bottleneck.

Bottleneck is trained helplessness which leads people to self medicate and watch an average of 40 plus hours of Television a week instead of doing something that actually Sparks Joy.

Also, I realize all of this is great, but the opposite side is true too. We also live in an era with the most amount of obstacles and vices people can fall into. Yes, there are amazing lectures on YouTube, but there are also millions of addicting cute cat videos.

I state all this to say depression and improving people lives is not as easy as providing them access. They need to want to put in the work themselves.

I’d also argue that there are some social programs but:

- we’re drowning in information overload so people don’t necessarily know how to access them. For example, a lot of the poorest households in the Uk did not claim the money they were entitled to from the government for energy payments this winter.

- We don’t really have policies that are addressing the root causes of poverty which are unaffordable housing, unaffordable and/or poor quality education and low wages.

This idea that just throwing free things at people will give them any amount of deeper happiness is typically proven false. I also don't find therapists all that useful but I guess that's a personal subjective take... maybe for the right people they can be. The healthy food thing is a cultural issue and no amount of subsidizing it to make it cheaper will get people to eat healthier. The percentage of obese people is too high to place all the obesity blame on food pricing.

The issue is simply that modern day life is typically TOO easy for most people and gives back very little deep meaning. We've created a culture that gives zero meaning to anyone and promotes nihilism. You will not fix that with welfare. Some of the most depressed mentally ill people you find will be very well off financially.

You need to reduce friction for good habits and increase friction for bad ones. At the minute, our societies do the exact opposite. Unhealthy food and Netflix and cheap. Healthy food and education are expensive.

It doesn’t matter how it happened, once someone is in the hole, the negative feedback loop makes it very hard for them to escape. If you are worked to the bone on minimum wage to keep an overpriced roof over your head you will likely fall into the trap of eating shit food and binging on Netflix because summoning the energy to cook, teach yourself skills and exercise is going to be difficult. And the more you give in to doing that the deeper into the hole you fall. People at the bottom need breathing space. Reduce the amount of money they have to spend to survive which means they don’t have to work themselves to the bone to survive and they can actually focus on improving themselves. I’ve literally seen it happen with my own eyes.

And yes, for some people life can be too easy and that can also cause depression. Which is why I believe we need finer grained categories to narrows down the root causes and provide more tailored solutions than just handing out happy pills willy nilly to everyone.

I would argue the opposite. healthy food is already dirt cheap, and education is free.

One hour at minimum wage can buy enough clean healthy food to last an adult most of a week.[1] Free education as available at online and at libraries, ranging all the way from simple tasks to Phd courses from Stanford.

My point isn't to minimize the hardship of the depressed, but point out that friction isn't the issue. If 5 minutes of cooking, picking up a book, or typing an educational topic into youtube is too much effort, there is a different problem.

Why does reading a book, cooking, or learning seem like work, and not fun? It certainly isn't because it is too hard in reality, especially when the same depressed person found pleasure and relaxation in doing these things before they were depressed.

[1] I was at the store yesterday and pork was 88 cents/lb, frozen vegetables ~ $1/lb, and rice and beans ~$1/lb.

I also agree that you can teach yourself stuff online for free. However it doesn't change the fact that you don't have the piece of paper saying you've got a degree which is one of the societal structures that holds a lot of people back. If you want the certification for an online program, you have to pay a similar amount of money to what you would have if you'd attended in person. There are lots of immigrants working in Western countries as taxi drivers who are scientists, doctors and the like back in their home countries but can't practice here for whatever reason, normally to do with the paperwork. IT/Dev is an outlier in that they will hire people without degrees in ways that don't happen in other industries. Something like 'Good Will Hunting' where a self taught janitor makes it into a white collar career is pretty rare.

> My point isn't to minimize the hardship of the depressed, but point out that friction isn't the issue. If 5 minutes of cooking, picking up a book, or typing an educational topic into youtube is too much effort, there is a different problem.

I still believe friction is a key component. Say you're on the minimum wage and you have to work as many hours as you possibly can to keep a roof over your head. Plus you have a lengthy commute. When you return home you are physically and mentally depleted, particularly if you are an ill fit for whatever job you've had to take on to survive. You want to turn your life around, but you've only got limited time available outside of work to do it. So you start looking for ways to save time. Maybe you'll cut back on exercise, or start eating more junk food so you don't have to cook as much and you can study. Or maybe you'll cut back on sleep. You keep this up for a while but eventually the physical and mental effects start to become overwhelming and you become more and more ill and eventually you burn out. You've worked hard, you've studied and you've still gotten nowhere. And your body and mind are a mess. Maybe you end up losing your job as a result. You lose faith that anything will ever pay off and you stop studying. You fall into depression and the cycle gets even worse. Maybe you even turn to alcohol and drugs to numb the pain. What that person needs is less friction in their life and a bit of help. Maybe it's work from home, maybe it's cheap and healthy takeaway food and probably a higher wage.

> Why does reading a book, cooking, or learning seem like work, and not fun? It certainly isn't because it is too hard in reality, especially when the same depressed person found pleasure and relaxation in doing these things before they were depressed.

Because the person is engaged in a fight for survival. They are not necessarily studying a topic because they want to but because it's the only thing that will help them get a job in their current location. They can't move away because they have no savings. Whatever they have to learn becomes high stakes. You can't afford to mess up or fail because if you do then you're toast. And learning requires failure so it's a stressful experience on top of your already stressful life. You've got society telling you you're worthless due to paying you barely enough to survive and now you've got a compiler error or a textbook you can't decipher saying the same thing. It takes a large amount of strength to hold fast and have faith that you will eventually come out the other side victorious, especially if this kind of thing goes on for years.

[1] https://www.theguardian.com/society/2018/oct/12/more-than-a-...

When I talk about access to learning, I am not talking about obtaining a piece of paper increasing economic mobility. I am talking about learning for the sake of personal enjoyment.

Most poor people are not depressed, so you have to ask what sets the depressed apart from the rest. Why can one person find joy in learning, and not another?

I think this points to something greater than money= happiness. Im not saying it doesnt matter, just that I don't think is accurate simplification.

You constructed an elaborate and plausible narrative why someone is depressed because of their economic situation. However, it ignores the person in identical situation who is happy. What is different between them?

I think we are too.

> You constructed an elaborate and plausible narrative why someone is depressed because of their economic situation. However, it ignores the person in identical situation who is happy. What is different between them?

From my viewpoint, there are four components:

- Personality

- Expectation

- Perception

- Resilience

Starting with the first, imagine you’re really, really into the arts. Maybe you’re really into musical theatre or something like that because you saw them on TV. Now imagine you’re stuck living in an isolated town in Alaska.

Now we can move on to expectation. Maybe you grew up as kid and thought one day I’ll make it out of this town and move to a city where I can work in musical theatre. Or maybe you don’t even have that high expectations, you just want to live in a city where you can watch musical theatre. You think you’ll grow up and earn the money and get out of the town. But it doesn’t go to plan. Maybe you struggle to find a job because you don’t have the skills needed in the area. You’re working as a bartender and don’t seem to have any money left over at the end of the week to put towards your new life. Years go by and you’ve not made any progress. Your dream is fading further and further into the distance.

Which moves on to perception. So many years have gone by that you no longer see any possible way of achieving your expectations and living somewhere that matches your personality. You know what you’re doing isn’t working but you can’t think of anything that will. You fall into a depression. You let your body and mind go to shit.

A year or two goes by and maybe your perception changes and you think “maybe if I train as a lumberjack then I can earn more money and then I’ll be able to save and get out of here.” So you go to college to train as a lumberjack. But you’ve been out of school for a while and you’ve forgotten how long it takes to learn a new skill. You fuck up a lot. You’re not really a lumberjack type so the other students take the piss out of you and you become the butt of the jokes. You try and start running for your mental health but you’re that out of shape that you can’t even run a mile. You give up on both because you haven’t built up enough resilience through previous challenges to make it through.

That last part is absolute key. When you’re exercising, the total stress the body endures needs to be appropriate for it to have the intended effect. If you push someone too hard who is out of shape you risk injuring them. Even if you’re a seasoned athlete and overtrain, your fitness decreases. Similarly if you don’t work hard enough to trigger growth, your fitness won’t increase.

It is the exact same thing with depression and why some people on here are saying depression is caused because life is too hard and others are saying it’s caused because life is too easy. The stress stimulus needs to be tailored for the individual. For a lot of people the stress is either too high or too low and it is causing major, major problems. We’re calling both of these polar opposite cause and effects “depression” and it means everyone is shouting at each other rather than coming together and helping each other.

Going back to our original scenario, you might have another poor person who lives in that small Alaska town. Maybe he loved musical theatre too. But maybe his personality extended to other interests so he was happy. Or maybe he never expected much out of life so he was happy. Or maybe he could perceive different opportunities to escape. Or maybe he took the same lumberjack and running route but he knew that it was going to take a long, long time to get good at either and he was going to have suffer and persevere for a long long time.

It doesn’t matter how someone got in the hole, when they decide that they’re ready to get out, society needs to rally around them to offer support. That doesn’t mean to completely molly coddle them but it means that, just like a good coach or physio, you’ve got to realistically evaluate how much stress and damages they’ve endured and how much they can currently tolerate and then gradually increase their ability to handle more over time until they’re back on their feet again. At the minute, in my opinion, society is far too much Led Tasso and not enough Ted Lasso.

I think you personally just might not be engaging with people who aren't well off financially. The rate of mental illness among the homeless and the jailed populations is way, way higher than the rate of mental illness among the wealthy.

Is this statistically true? otherwise this is worthless.

See: Study Finds Strong Relation Between Income and Happiness, Does Not Max Out at $75k. Turns out that famous study that everyone loved to quote isn't exactly truth. https://www.nysscpa.org/news/publications/nextgen/nextgen-ar...

Any references that people were less depressed when things were more difficult?

The idea isn't that you're "giving" or "providing" or "subsidizing" with welfare - the point is that the subsidization has already occurred, just in a non-human focused way. Factory farming has been subsidized so processed sugars and unhealthy food are the norm. Companies are effectively subsidized by allowing minimum wage scheduling without providing healthcare.

This all has knock on effects. Healthy food isn't just a cultural issue, many people simply don't have the time or access to be able to cook healthy natural food. For the vast majority of people, they have no possible access to a therapist, even if they wanted to or were able to afford it (unlikely in the case of the US healthcare system). And of course, since there's minimal insurance support for general therapy, there's a much smaller market for people to go into it. The negative feedback loop continues.

I agree with your general point that life gives back very little meaning in our society, but its important to understand that this doesn't just occur because life is too easy. For many people, life is hard. And there isn't a visible path out of the situation they're currently in. Checking out/dropping out/giving up is honestly a reasonable response.

TLDR: Try not to think of Welfare as a handout. See it as a signal of a broken society that needs fixing.

That is about accurate for USA. People can start a garden or put a pepper plant under a CFL bulb. Grow some food to get some appreciation for how life has become easier.

[0]: It would be interesting to have a discussion about "depression" without actually using the word, since it's so overloaded.

If politics is being blamed for depression, it is because people voluntarily consume media about politics. Just say no. Refuse to be sucked in to that pattern.

If the main cause of poverty is unaffordable housing and low wages and poverty is one of the leading causes of depression then the people who have the ability to tackle the housing crisis and low wages but instead choose to do nothing are also responsible for the causation of a lot of depression. The people who are able to do something about the housing crisis are politicians. I do agree with you though if you think political media is pretty toxic.

So, I won't blame society for depression, it looks like mentally healthy people are pretty resilient, and if put in extreme situations (ex: torture) to beyond breaking point, the result is usually more anxiety than depression. I know a few people with depression, treated and followed by psychiatrists. And while the trigger can be some hardship, which can be related to society, or can be a simple breakup, it is just that, a trigger, most people would have just moved on.

And one trait I notice the most is apathy, not sadness. And it is really unsettling. At least, when people are sad, they react to your sollicitations, they may cry, get angry, complain, attempts to get them out will be warmly welcome or they will oppose resistance. For the depressive people I know, there is no reaction, it is not catatonia, their intelligence is unaffected, but it looks like they can't have emotions of their own. They may get good support from friends, family, and even society, but it all seem to go down in a black hole, I really think it helps, but it doesn't show. Drugs seem to be the most effective treatment, unfortunately, because these things induce tolerance and are addictive.

Depression is a disease, and we don't know the cause. We know heredity is important, being healthy and well supported is certainly better than sick and alone, but we are not sure about the details, and therefore what society can do. Quoting scientists favorite phrase: "more research is needed".

As for what society can do to promote healthy habits, this is really a complex thing. You may not realize but that's what Hitler tried to do (for their own people), in fact Hitler could have seriously tackled depression, though eugenics, healthy labor and campaigning against unhealthy habits like smoking. And yet, it would be an absolutely terrible society to live in.

So, I don't think a better, more equal society, as good as it is, is the ultimate solution to depression. Still nice to have though.

This seems analogous to Stockholm Syndrome. The “kidnappers aren’t that bad, if they were really bad they would have taped our mouths shut rather than just tying us up and locking us in this room”.

> While I didn't experience it first hand, a common thing I see when people visit really shitty places is how happy people are, from North Korean farmers to women of Saudi Arabia.

So if the people there are that happy, why are some of them risking their lives to flee?

> On the other hand, Scandinavian countries are often a model when it comes to a "good" society, topping all the "happiness" charts, and yet, they are in the worst quartile when it comes to suicide rate. So, I won't blame society for depression,

This argument doesn’t make sense. You seem to be saying:

- autocracies and democracies are societies

- some poor people in autocracies are happy

- some people in well regarded democracies kill themselves

- therefore societal factors do not play a leading role in depression.

> it looks like mentally healthy people are pretty resilient, and if put in extreme situations (ex: torture) to beyond breaking point, the result is usually more anxiety than depression.

not sure on this. PTSD correlates pretty strongly with both anxiety and depression.

> I know a few people with depression, treated and followed by psychiatrists. And while the trigger can be some hardship, which can be related to society, or can be a simple breakup, it is just that, a trigger, most people would have just moved on.

> And one trait I notice the most is apathy, not sadness. And it is really unsettling. At least, when people are sad, they react to your sollicitations, they may cry, get angry, complain, attempts to get them out will be warmly welcome or they will oppose resistance. For the depressive people I know, there is no reaction, it is not catatonia, their intelligence is unaffected, but it looks like they can't have emotions of their own. They may get good support from friends, family, and even society, but it all seem to go down in a black hole, I really think it helps, but it doesn't show. Drugs seem to be the most effective treatment, unfortunately, because these things induce tolerance and are addictive.

I agree with the apathy part. But I think it has varying levels of severity, and at its most severe is when it leads to a catatonic state. I agree that these people are the most likely to need medical treatment. I think this illustrates the first point I’m making though which is that we need to either do away with “depression” as a term or that people need to get more specific with it. Also just because drugs are the cure for the disease, doesn’t rule out the fact that the social triggers may have been responsible for causing the biological issues.

> Depression is a disease, and we don't know the cause.

Well if this thread is anything to go by, people can’t even agree on what the term ‘depression’ is meant to represent. You’re making a bold claim here stating it is a disease, which implies that the cause is purely biological. Most medical definitions state it is a mood disorder.

> We know heredity is important, being healthy and well supported is certainly better than sick and alone, but we are not sure about the details, and therefore what society can do. Quoting scientists favorite phrase: "more research is needed".

Quoting https://www.science.org/doi/10.1126/science.aay0214

> Rates of depression, anxiety, and suicide correlate negatively with income (4–7) and employment (5, 8). Those with the lowest incomes in a community suffer 1.5 to 3 times more frequently from depression, anxiety, and other common mental illnesses than those with the highest incomes.

It would seem that actually yes, as a society we do know what to do to alleviate depression. We can help these people out of poverty.

> As for what society can do to promote healthy habits, this is really a complex thing.

Well yes but also no. We seem to have reduced smoking very effectively. Sugar taxes work well. It seems that in general, if you tax unhealthy things and subsidise healthy things, it tends to have the intended effect.

> You may not realize but that's what Hitler tried to do (for their own people), in fact Hitler could have seriously tackled depression, though eugenics, healthy labor and campaigning against unhealthy habits like smoking. And yet, it would be an absolutely terrible society to live in.

You seem to be trying to make the point that any societal attempts aimed at boosting physical and mental wellbeing should be avoided because Hitler also ran societal programs so any such initiatives are destined to lead to fascist societies. This does not appear to be the case.

> So, I don't think a better, more equal society, as good as it is, is the ultimate solution to depression. Still nice to have though.

No, it is not the “ultimate solution” (ironic choice of words given the contents of the last paragraph) to depression but it is a giant leap in the right direction.

It is also founded on the premise that the government is in a position to remove any and all risk from people's lives. Indeed, it would be obligated to do this. It is extending a guarantee it has no way of fulfilling.

So you are trying to call everybody out for earnestly bringing relevant opinions and other points and just having a good discussion on an important topic. Is this not what comments are for? this isn’t Reddit where all the comment threads have to devolve into pithy jokes.

Maybe more people are anxious and depressed than in the past because modern life really sucks for a lot of people. I'm not saying that's a simple thing to fix, and certainly there is a biological component for some people...but the idea that societal changes are increasing rates of anxiety and depression seems way more plausible than there being some sudden and mysterious shift in the biology of a significant percentage of the population that needs correcting via medication.

It's been a while since I've seen it, but I recall his evidence including some rather striking non-behavioral symptoms, like changes in sleep cycles.

To address your specific thoughts on it, his position (paraphrased from memory) is that social stressors like you describe cause elevated cortisol, which causes depression - such that your position that "modern life really sucks" is not incompatible with a biological cause.

It's extraordinarily interesting in a lot of other ways - definitely worth a watch in spite of the length.

Of course that question is an oversimplification since the answer is certainly some of both; but the prevailing wisdom seems to be that it's mostly/all biological changes leading to feeling depressed, whereas I'm not convinced the scales don't lean more in the other direction, at least on average.

EDIT: but as to your point about stress leading to elevated cortisol levels, to me that's clearly not a biological cause. The cause is stress, and the elevated cortisol levels are an effect of the stress. It's not like the hormone levels just went up all by themselves due to some genetic abnormality or something; if they did, then yeah maybe that's a biological disease that warrants some kind of chemical correction, but that's not at all what we're talking about.

"Recent findings in the field of neuroscience have, however, demonstrated that a single functional circuit, incorporated inside the broader dopaminergic mesocorticolimbic system, seems to be involved in the various experiences of pleasure"

https://www.frontiersin.org/articles/10.3389/fnhum.2018.0035...

Going back to your accusation of "faulty logic": an interruption in the ability to experience pleasure, which is established to be controlled by biological processes, having a basis in a biological process would be deductively valid logic. Anhedonia is an inability to experience pleasure.

https://en.wikipedia.org/wiki/Deductive_reasoning

Well of course on a certain level your ability to feel anything is the result of biological processes, but that doesn't mean that the specific things you feel aren't a result of the specific experiences you've had.

Nobody in this thread is arguing that feelings happen completely independently of biological processes, but there's a hugely important difference between "I had a bad experience that altered my feelings, and that's reflected in my biology" vs "my biology just did something of its own accord that had nothing to do with my life circumstances, and that change altered the way I feel".

You seem to be arguing that because anhedonia correlates with certain biological changes, that it must be caused by those changes. That could be true (and probably is true in some cases) but it does not necessarily follow that it is always true, or even true the majority of the time; the causation could could flow in a different direction.

There was a funny study about crayfish changing behaviour when exposed to SSRI, where they became bolder to the point of endangering their life.

https://www.theguardian.com/environment/2021/jun/15/crayfish...

It’s on the other hand disturbing that there’s talk of broadening the term “depression”, when it really needs narrowing. There’s such a thing as a medical condition “depression” that one might as well define as “responds to antidepressants” and then there’s everything else — the invisible boundary accounting for how little effectiveness antidepressants have at large. It’s a damn shame that we don’t have the means of diagnosing it (whereasw Kraepelin developed the bipolar/schizophrenia differential diagnosis before Freud even arrived on the scene).

Overall this article does nothing to inform or educate.

I think the big problem is we probably have a lot of recent societal/cultural changes which at least contribute to depression and anxiety, but are very hard to detect because of near universal adoption + too many confounding variables when examining holdout populations. Thinking of things like diet (and trace chemicals, pesticides), sleep habits, screen usage (internet, social media, porn, passive media, games), caffeine, etc. Somewhere in those areas, IMO, likely lie very large causal contributors to all of the reportedly increasing mental health problems we are seeing.

I can also speak from personal experience that I had very debilitating depression/anxiety as an adolescent which has since greatly leveled off but not quite cleared. While I could likely still be diagnosed with depression now, to me the two states comparing now vs then are so wildly, qualitatively different that I am convinced they represent different underlying pathologies. What I have now feels more like the same thing that most other malcontents seem to have.

Now, some are saying that gut flora might also be involved. And possible genetic markers. This would create a gigantic number of permutations.

I doubt we can ever "fix" depression with just drugs / chemical imbalance. We may help it along.

Current treatment for depression, in so far as drugs are concerned, is a doctor throwing an "anti depression" pill at you and askinf you to try it for a while and see how you feel.

If you feel worse, or no better, you get to try another.

The loop repeats until something works better or until you are out of alternatives.

In which case, if you have severe depression, options like electrocution of the brain (forget proper English term) becomes an option.

It is often successful, but usually must be repeated and it is not a good thing for the brains other functionality.

And one reason is because we just don’t know enough exactly as you say.

Maybe one reason electroshock “works” (if it does and I’m speculating here and I feel like it sounds like a barbaric torturous medieval treatment) but maybe one reason is because it throws enough entropy into the brain to allow it to reset out of the local “optima” that it had settled into. And obviously there’s multiple you know assumptions going into that statement and I’m just speculating.

Riffing on that comment I think it’s interesting to consider that the depressive response may actually be an adaptive evolutionarily response of the brain, the nervous system, the body, the endocrine system, whatever and I think it’s interesting to consider what that adaptation might be trying to achieve.

Maybe depression is not the cause of unhappiness, but its result. The collection of symptoms is the result of unhappiness and a response by the body to try to slow somebody down when they’re sort of in a situation that the body brain system whatever has judged is dangerous or not good for them.

And that danger may be to mental health or some thing so it’s basically a way to try to take somebody out of circulation to protect them. It’s the self trying to protect itself from a dangerous environment, whatever the parameters of that environment may be: social, environmental, work whatever.

I was going to add my personal experience. I might be a bit of an anomaly. I have the full range of emotions, intensely experienced, and all kinds of crazy deep experiences in my life so far but I’ve never been depressed. And I always felt it was some thing I wasn’t gonna let happened to me: I was gonna Always find a way through and to keep moving through whatever situation. So I think in my case I mean riffing on what I previously said the depression response never came up because I always kept moving through whatever I was in and my body didn’t have to take me out of circulation, because I was always finding a way like actively to just keep going and doing what I want.

I'd go further and say that most things we class as "mental illness" is just a way of categorizing our ignorance.

Even drugs that purport to help with "mental illness" at best treat some of the symptoms of the unknown causes of such symptoms often have side effects that can be worse than the symptoms.

While significant advances in neuroscience have given us more knowledge about how our brains/mental states work, most attempts at treatment are at the level of trepanning[0] to release evil spirits.

Hopefully that will change as we learn more. I'm not holding my breath.

[0] https://en.wikipedia.org/wiki/Trepanning

"Different genetic variations can affect whether individuals respond to certain types of stress, such as sleep deprivation, physical or emotional abuse, and lack of social contact, by becoming depressed."

I see the value in analyzing genetics for depressive genes, but I also consider that how the genes interact with our environment that play a role. For example, if the state of women's rights around the world returned to where it was 200 years ago, it would likely appear a genetic cause of depression is related to having two X chromosomes. To wit - is the issue with the genes themselves, or is it that those with the genes are somehow repressed by the way society works?

That being said, there's a lot to the genetic compotent of disease risk beyond just changes to the sequence of protein coding genes. How much protein that gene produces can be affected by a number of factors, such as the presence of singe nucleotide polymorphisms (changes to one site in the DNA) that may be well outside the gene region in the genome, but are a binding region for a transcription factor or an enhancer that drives expression of that gene and therefore dramatically lowers (or increases) the protein produced. You can also have epigenetic changes that similarly effect gene expression, but these are not reflected anywhere in the genomic sequence since these represent changes to the proteins that package DNA in the nucleus, not to the DNA itself.

I think we overestimate the impact of external factors on our internal mental states. That's why the typical treatment for depression is CBT (literally changing your thoughts and behaviors) and not "improve your external situation".

That's interesting. I would have thought men would have it more since it's an abnormality, and with only 1 X chromosome, men are much more frequently abnormal.

When I said "If the state of women's rights around the world returned to where it was 200 years ago," I meant if women who currently had normal human rights lost them. In that case we would see a major increase in depression among women, the point being that depression would be explained much more clearly by genetic factors, even though the genes didn't change; the interaction between the genes and the world changed.

> I think we overestimate the impact of external factors on our internal mental states.

We definitely do. And the external factors that affect our happiness the most are often the least controllable.

It takes about 24 hours of sobriety for me to begin to feel normal again, and at least 48 to feel I am at my normal baseline.

I always assumed the alcohol was depleting my serotonin.

Beyond that, most of my depression seems to be due to my heroic and idealistic self raging and wallowing in the chasm between my ideals and hard realities that I cannot defeat.

Someone experiences too much sadness and other negative emotions, so the brain tries to stop the negative emotions by shutting down all emotion processing. Then you do not feel so many negative emotions anymore, but also no more positive emotions. You just do not feel anything. Since motivation comes from emotions, you also lose all motivation to do stuff

Jesus...hard to imagine volunteering for that study

There's probably genetics involved as well. Sun light exposure modulates hormones and Vit D.

I wonder if there's a correlation with caesarean section births and depression as well. The hypothesis would be that the infant is born into a sterile environment and does not get populated by the moms microbiome.

Exercise probably plays a role as well since it boosts resilence.

This article is promising that it seems science is rethinking this challenge one small step at a time. I’ve always been fascinated with stories where previously depressed people found the right combination of change to turn their lives around. Sometimes it feels like it is cyclical in life. Being able to treat it with a kitchen sink of tools could really help outside of a single drug solution.

Been depressed and unhappy for ages. But I find it gets exacerbated when people are assholes.

You don't feel like you have a community that can help you achieve your goals, or even set goals that are attainable that will put you in the social role that you think you should be filling.

The interplay between your self concept and societal expectations for you individually determine your mood stability

Now, certain people (me) have behavioral contributors from childhood like massive trauma that makes it easier to feel low self worth. I would argue everyone has some trauma, but those with big trauma deal with it chronically.

My Parents moved when I was 5, and divorced when I was 14, ever since I've moved about every 5 years or so - it's a restless life.

I've been bullied and beaten when before I was 5, bullied by a teacher in elementary school, and when I left there my parents divorced.

Depression probably has been with me since I was 6 or 7. Nothing matters, and I don't want to do anything. At the age of about 31 I got diagnosed with heavy depression and adhd (I'm female and probably authistic as well).

With 35 the last thing I hadn't tried yet was ketogenic diet. Within a Week my energy levels rose dramatically, and it took another year to pull it together, but my life is normal now (at 40 years old).

I haven't found a definitive answer, but my guess is that I've ruined my gut when I first moved. Can't digest plants and they ferment in the belly. It takes about 4 days to have effects. Any effect stays for a few days and then leaves when I go back to Meat and Butter.

Either that or the brain/immune system just connects carbs and veggies with violence/danger (mum used to beat me over food I didn't want to eat)

I've been to gastro enterologist - no diagnosis, allergy testing - no allergies, general practicioner - no diagnosis, psychologist - no diagnosis except for the depression and adhd part (which are much much lighter on a meat based diet)

Ketogenic diets have also been used for a century to treat epilepsy in children, so effects might not be limited to the gut. Maybe it’s ketone bodies as an alternative fuel for the brain that is doing the trick.

There's anecdotal evidence that cocos fat helps with dementia and alzheimers as well. It already has MCT which can be forwarded by the liver to wherever it's needed.

I actually get migraines from most plant-fats, but not from cocos!

We don't even really know what depression is. Is it a disease or a symptom or both? Is it actually multiple different diseases all presenting similarly?

One look at how regularly professionals change the name/definition/diagnostic criteria for this shows you we are still in very early days for mental health...

Of course there are many things in medicine that have no known cause so it's not exactly unique to depression or even mental illness. For example some large % of chronic pain is idiopathic (no known cause), and there are a host of physical conditions that we similarly have no idea about (fibromyalgia, IBS, etc.).

It's like in the dark ages when people just had "fever" and died.

There are 14 known serotonin receptors in 7 families

https://en.wikipedia.org/wiki/5-HT_receptor

not to mention other targets such as the serotonin transporter which is a target of many antidepressants.

Serotonin pharmacology includes antidepressant and antianxiety medication, psychedelic drugs such as LSD and mescaline, the nearly unique drug MDMA (aka Ecstacy), drugs to suppress vomiting, part of the action of some antipsychotic drugs, anti-migraine, and drugs that increase gastric and intestinal motility.

Platelets, your gut, and heart valves are just a few tissues that are full of serotonin receptors: some serotonin-active drugs can seriously damage your heart valves, see

https://en.wikipedia.org/wiki/Fenfluramine/phentermine

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The conclusions that people made about free serotonin in spinal taps of psychiatric patients in the 1960s have been long used in a facile manner in psych med marketing and the chickens seem to finally be coming home to roost on that one.

I'd almost call the SSRIs "antineurotic" drugs in that they are helpful for both anxiety and depression in many people. There has been a lot of negativity about them in the news in the last months or so, particularly reports of bad efficacy which I think draw the wrong conclusion.

Basically if you try "X mg of fluoxetine vs a placebo" you are going to have poor response and a lot of side effects. In good clinical practice you see your doc, fill a script, talk to your doc in three weeks, maybe increase the dose, maybe try a different med if you don't get a response or if you are bothered by side effects. If you do that you get much better results that the average clinical trial of a single antidepressant but you are going to talk to your doc (maybe sometimes to the nurse over the phone) several times over 6 months or so.

The basic idea of CBT is that our thoughts are a result of our actions, and by changing our actions we can change our thoughts. I'm not going to say it's super easy, but it definitely does work.

Robert Butler

https://blog.goruck.com/rucking-training/the-rucking-white-p...

It helped me get through a depressing period in my life.