Ask HN: Beating depression with or without anti-depressants?

All the people telling you not to take antidepressants are not doctors. No doctor would give you medical advice through an HN thread.

I can only speak to my personal experience, but my personal experience is that SSRIs saved my life. Please talk to a doctor and be frank about your fear of treatment.

Depression is a bitch, but it’s also surmountable. And there’s nothing wrong with using every tool at your disposal to surmount it.

If you haven't tried cognitive behavioral therapy (CBT) make sure to check it out given your unfounded as far as I can tell terror of anti-depressants. Cognitive therapy (long before the "behavioral" bit was added) was very useful for me, and in 20/20 hindsight made further talking therapy useless.

I'm not a standard case, have a inherited combined anxiety and depression problem that behaves somewhat like bipolar disorder without ever going manic (see below for exception), it's "refractory" but I've found the two last out of three generations of anti-depressants to be very helpful, although far from cures.

I have no idea whatsoever what convinced you "SSRIs and other anti-depressants" "have really bad side-effects for most people that take them." That was certainly true for the first generation MAO inhibitors and I knew someone on one who had the usual food problem, but is much less true for the second generation of tricylics, and not at all true for the third which started with the SSRI PROZAC/fluoxetine.

If after all you've gone through you're still literally willing to live a miserable life without at least trying a third generation anti-depressant I don't see what we can say that will convince you. You certainly might have a bad reaction to one or more members of this class of drugs as I and a friend have had (PAXIL/paroxetine made me hypomanic, a friend had suicidal ideation which she simply recognized and fixed by stopping taking the drug), and perhaps as others note you may have to try several to see if one works.

Note one of the biggest mistakes made in prescribing them is not moving to a high enough dose quickly enough if a smaller one is tolerated but doesn't have much of an effect. Everything else you need to know about them is well documented, although you'll have to find better sources than whatever has convinced you these drugs are simply too dangerous to even try.

Of course. I think this stems from my point about not having a good partner. I don't think that sleeping around will help depression.

Your utter terror of these drugs is not warranted. Yes, some of them have intolerable side effects. Some of them will just be ineffective. But there are lots and lots of different antidepressants and there is probably one that will work for you without intolerable side effects. If there isn't, then there are other options (ketamine or TMS for example - but you can't start with these, you have to try antidepressants first). It will take time to figure out, and it will be a lot of work, but you owe it to yourself to at least try, especially if therapy alone hasn't worked.

My advice is to get an actual psychiatrist. Your PCP will prescribe antidepressants, but in my experience you'll be way better off relying on the expertise of a specialist, especially if you need to sort through which medication is best for you personally.

If you should be in utter terror of anything, it's depression. It is a potentially fatal illness.

Also, seriously, don't get medical advice on the internet. Would you ask a random sample of strangers on the street to direct your medical care? I'm guessing no, but that's exactly what you've done here.

First off, I'm sorry you are in pain OP. I hope you can find some help by asking this question.

Back pain is fascinating. Rarely, there is an immediate and obvious cause and obvious treatment that will work, wham bam, lickety split. Far more often, there isn't.

Intense pain starts in your spine. So you go see a doctor. Doctor says, "Here is some Vicodin, take this and rest up." Fixed!

Nope. It helps for a while, but you still have pain. This happens to the vast majority of people with back pain. It's the normal doctor first step.

So you go see a back surgeon. How do surgeons fix things? With surgery. So the surgeon does an MRI, finds a herniation (which is, after all, a source of pain!), and performs surgery and cleans out the herniation. Fixed!

(Mostly) wrong. A small — something like 30% — percentage of people find relief. The remaining people continue to have pain. They also now have a lengthy recovery, ~$10,000 less dollars, and a growing hopelessness. (These aren't fake examples, feel free to look them up or ask a doctor friend.)

These options seems to be attractive because they fit the standard Western model of disease, and also of care. Our (Western) minds tend to like this model and expect that it works. Diagnose obvious thing, do seemingly normal surgery or just take this pill, problem solved. Except not.

Had the back pain person asked an orthopedist, the orthopedist might have prescribed conservative care. Chiropractic, physical therapy, Pilates, yoga, strength training, massage, ice, heat, anti-inflammatories, etc. A surprisingly larger number of people find relief from that.

However, this approach is more annoying. It takes time and effort. It admits that maybe we don't know the exact cause, but maybe here are some things that work for a lot of people. With enough effort and time, they might work, slowly.

Had they seen a somatic or functional practitioner, the practitioner might have started looking at what else is going on with the person. What kind of psychological trauma might they have in their past? What is their desk setup? How stressful is their job? What is their diet like? What is the connection between the patient's mind and their body, and how does that relate to pain? They would then prescribe a course of treatment that might be modifications to lifestyle, healing trauma, etc.

Depression is very similar to back pain. It is complex, and is a mind-body problem. You may have an immediately obvious cause and thus an immediately obvious solution. And even then, that first solution has a fairly good chance of not working.

Moreover, you can predict with a fairly high degree of accuracy the solution you are going to be prescribed based on who you ask. Ask a general doctor or a psychiatrist, either get a pill or a referral to a talk therapist. Ask a talk therapist, get a lot of talk sessions. Ask an Eastern medicine practitioner, get some herbs, a change in diet, and acupuncture. Ask a shaman, get ayahuasca. Etc.

Depression happens for a whole bunch of reasons. What works for one person almost certainly won't work for the immediate next one, at least entirely. It often has to be addressed by looking at the individual as a whole and unique person, and using a multi-pronged mind-body approach.

If you have tried most of the normal stuff, then it's time for some not normal stuff. You have to be your own advocate in this, and keep track of what has worked and what hasn't, and move on when you have exhausted your options. I know that can be hard in the midst of severe depression, but at the end of the day it is really the only option. If what you are doing isn't working, don't just keep doing it. Find another competent professional, do your research, have your conversations, take a leap of faith if necessary, and try something new.

Again, I really hope you find healing, OP. Whatever it is that atheists do instead of praying, I'm doing that for you.