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

If you did not take meds, do it asap. I regret not taking them sooner enough.

I would like to focus on two things you wrote:

> Beating depression with or without anti-depressants?

Depression is never really beaten, it's controlled, mitigated, kept at bay, and sometimes resurges and you start again. In my case, I haven't had a severe depressive episode in years, but have had minor ones most years since my late teens with several year and multi-year episodes. I haven't had suicidal ideation in over a decade, but I know that it's something that could happen again. I don't fear it, I just acknowledge it at this point and keep vigilant for the signs of a depressive episode. I don't use medication, I primarily use therapy (specifically cognitive behavioral therapy) and found ways to restructure my life which seem to have helped. But a lot of it is fragile, a move right before COVID restrictions left me in a very bad state 2 years ago (though not my worst, it was not good). Fortunately I have learned to recognize the onset of these episodes and my wife also helped by calling me out and I went back to therapy and I restarted the process. But it's never really "beaten".

> Life has taken me on ups and downs but as far as I can can tell I'm fairly lucky, well-off and have every reason to be happy.

This is a self-judgement, and when I am dealing with depression one I often make about myself. I'm married, have a house, relatively little debt (the mortgage itself), a job that pays well and likely won't get laid off from ever (if I choose to stay), I have my health, friends, and family. And then one of my best friends lost his mother last year and will likely lose his father this year and... I start to feel guilt and shame about my depression.

There are two ideas of depression that often get conflated because we use the same term:

1. Depression the emotion. This is what a grieving person feels, or the way someone who got skipped over for promotion describes their feelings (too extremely different feelings!). This is a valid way to describe how you feel, but is mostly a temporary thing (though "temporary" can be very long for something like grief). The advice to toughen up or "just be happy" is not helpful here, but it's not as harmful. Often it's usually "just" obnoxious and may end a friendship, at least for a time, but won't send you spiraling. But, importantly, this kind of depression often has at least one obvious causal factor. The loss, the humiliation, the pain, etc. It can be explained by circumstances.

2. Depression the disorder. This is what you are describing, what I have experienced (and will likely experience again). That sort of statement, "Look at your life, you have it good, you should be happy" is more likely to cause a downward spiral than "just" annoyance. It becomes an earworm, nagging at you and eating away at what willpower you have and what positive mood you may occasionally be able to muster until you're stuck in the hole. It's not the only thing that does it, but one of many. Some come from outside, some from inside. The painful element here is that this sort of depression has no obvious causal factors (though it may have exacerbating ones, grief from losing all my grandparents in just a couple years certainly made my college-era depression far worse, but it was not the cause).

This is one of the things that CBT, in particular, helped me with. I learned to recognize both the cause of these thoughts (in particular the self-generated ones, versus someone trying to be helpful but failing) and my reaction to them (and how they spiraled). Sometimes you can't find a cause, but you can still examine the reaction. This has helped me to stop the downward spiral (not always, and not usually immediately, but it's helped) so that I can at least still function well enough to acknowledge the need for help and get it. In some cases, those thoughts now just disappear almost as soon as they appear in my mind. This is the ideal (well, the ideal is that they never pop up again, but from my experience that hasn't happened yet). It's not easy, it's a process, but it's something to think about and work towards.

I also have learned over the years what things elevate my mood, and break the spiral. I'm an introvert (in a general sense), but thrive with friends and family (in small groups). I took up sports and athletics as an adult and found being outside and the kinds of activities being fit enabled to be helpful to me. Team sports gave me some camaraderie that I was missing, too.

Like I said, though, it's not perfect, I have not "beaten" depression. I was doing great in my old town, old job, and pre-COVID. I was doing fine here before COVID, and then just got slammed by the isolation and stress of it all. Many of my coping mechanisms weren't available. But I still had enough awareness of myself, how I was feeling, the sense of the downward spiral, and the openness with my wife about my feelings, that we cut it short in 2020 (compared to some of my prior episodes) and I went straight to therapy. Learned new skills, found new ways to cope despite the isolation, etc. I still had "every reason to be happy" at that point during COVID. I still had my health, no one in my family had caught COVID (at least not immediate family, several "x's in-laws' in-laws' nephew died last week" kind of things though), still had my job (no risk of being laid off, the work still needed to be done and was still making money). But depression the disorder does not care about the reasons, it's a thing we have to deal with (healthy coping mechanisms, therapy, and medication being the better ways).

Learning to accept that idea, that it's not my fault that I'm depressed, that it's not a moral failing that I'm depressed, that it's just a fact of life that I (with some frequency and to varying degrees) become depressed, has itself been immensely helpful in getting the help that I need, recognizing (because I stopped being in denial, for one reason) when I am in a depressive episode, and getting through them and out of them more effectively.

I second this. Foods affect your depression levels. Foods high in Omega 3 fight depression. Eat those foods regularly, you should notice the change in your mood.

> CBT

It seriously isn't a good idea to self-prescribe cannabinoids for depression. While it may work great for people experiencing a temporary bout of the condition, it can make things significantly worse for people with life-long depression.

I don't know why you were downvoted, but I will say that for me caffeine has not directly impacted my depressive episodes. The closest is when it impacts my sleep. I've learned that poor sleep quality and insomnia are my first obvious signs of a depressive episode, but the causal direction is not always straightforward (depression -> insomnia, insomnia -> depression? Both have happened, they feed on each other). So keeping caffeine to the morning and early afternoon is sufficient in my case.

However, caffeine does heighten my anxiety (with or without the impact on sleep). Maybe I should quit caffeine, but I like my morning coffee ritual so have no plan to right now. Instead, I take periodic breaks from caffeine to make sure I'm not addicted again. If I can go a few days without caffeine and without getting a headache, then I'm good. If I can't, then I'm probably consuming too much and it will (or already has) exacerbate my anxiety.