Ask HN: How do you deal with suicidal thoughts ?

"The trouble is we don't really know the root cause of major depression."

That's not really true. There are several different purely biological things that have been identified as root causes of depression: chronic illnesses, inflammation, nutritional imbalances, alcohol abuse, etc. These alone probably account for more than half of all cases of depression. (IIRC just inflammation is thought to account for 30% of cases.)

Similarly, there are many more lifestyle choices that clearly contribute: stressful work/family situation, lack of exercise, poor diet, poor social life, chronic sleep deprivation, etc.

Certainly there are individuals who are doing everything right and still end up suffering from a bout of depression that lasts more than two years even with therapy. However, these are fairly rare, as in almost certainly less than 5%.

As for treating the symptoms, it's not pointless but it can be extremely damaging. It can lead to more more severe mental illness (bipolar, schizophrenia), chronic depression, psychosis, suicide, violent behavior, sexual disfunction, etc.

There definitely are times when drugs are appropriate. But telling someone who has had suicidal ideations to look into drugs as a first line treatment is extremely irresponsible. It's like telling a 13 year old kid with a pimple to look into accutane.

Please do seek out a therapist. Specifically I would recommend one trained in Acceptance and Commitment Therapy, a mindfulness-based cognitive behavioral therapy. If you can't find one, you can still explore it on your own with whatever therapy you happen to choose. Here are a couple resources explaining ACT:

http://contextualpsychology.org/act_for_the_public

http://www.thehappinesstrap.com/

I agree that you need to make sure there are people in your life who know clearly (ie, you tell them honestly and openly) what you're going through, who can stand by your side as you go through several attempts at coping with this.

I can assure you right now that if you ever went through with it, there would be several (if not dozens) of devastated people going "If I had only known...!"

As for how to involve other people while still "saving face" and not being too much of a burden, I always liked Jane McGonigal's "recovery game" idea, maybe this can give you some ideas: http://blog.avantgame.com/2009/09/super-better-or-how-to-tur...

I wish you all the best!

Hey man- You're getting a lot of advice. I'd even say some of it's good :) Here's my two bits - but only you can find out what'll work for you.

Around the time I turned 20 I started having bouts of serious depression that lasted from 2-5 days. And then I'd get better and be OK for a week or two. This was pretty debilitating, and left me more or less emotionally unstable until I sought professional help around the time I was 25. I frequently entertained suicidal thoughts in this period.

Around 25 I found a therapist I could trust, and a psychiatrist. I have a family history of alcoholism and bipolar disorder, and my psychiatrist diagnosed me as bipolar pretty quickly. For the past 5 years I've been taking an anti-depressant (celexa) and a mood stabilizer (lithium) every day. That, combined with weekly therapy, has made me 100% more functional in daily life.

Above all else, find a therapist. I'm on my 4th, have been seeing him weekly for 5 years, and I like him a lot. The first few you try might suck - I had one therapist who actually belittled my problems. I ditched her. My current therapist has helped me excavate and talk about the ugliest stuff in my head. Turns out it's a lot easier to live with if you can hold it, turn it over, and talk about it. I know for a fact that I'm a better person because of therapy.

Pharmaceuticals probably aren't for everybody. But they sure as hell helped me. I credit them in part with the healthy marriage, productive professional life, and happy social life I have now. I'm going to have a freakin' baby next month, and I'm psyched about it. You can work through this.

Good luck. You're already drowning in advice, but here's my story. Cheers!

I mentioned that depression is possibly an evolved mechanism. The mechanism is: depression makes you ruminate which leads to insights. Meanwhile, you feel bad so you have an incentive to make a positive change in your life as a result of these insights.

Here is a NYT article about this: http://www.nytimes.com/2010/02/28/magazine/28depression-t.ht...

This really changed the way I think about depression. I now think about depression as a signal to ruminate, have insights, and make change.

However, don't try this at home, kids. I mean, it makes a lot of sense to work with a therapist/doctor, if you can find an effective one.