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

- PsychOLOGIST: therapy, talk, feelings

- PsychIATRIST: drugs, neurotransmitters, ECT, TMS, etc.

If your neurological chemistry isn't working right in the first place, no amount of therapy is ever going to help you. That's when you go for the drugs through a qualified psychiatrist. Once that's in place, THEN you go see a psychologist for therapy on a regular basis, both to mend the damage long-term and hopefully help you establish the tools necessary to prevent it happening again. But if your brain is fundamentally jacked up because it doesn't have the right balance of neurotransmitters in there, nothing that therapist does is going to matter. So if you tried therapy and nothing's moving the needle, talk to a pschiatrist to see if medication is a good option in your case.

Above all, remember that his is medical science, not witchcraft. We're still learning about how the brain works, but it isn't casting bones or shaking a magic 8 ball either. There's a surprisingly strong amount of science backing this stuff, especially when you consider the human brain as a quantum computing device that is both affected by, and can affect, its own neurotransmitters on an internal and external basis simultaneously. (And that's just the tip of the neurological complexity iceberg...)

> UPDATE: Since you're worried about the drugs, talk to your psychiatrist about TMS. Short for "transcranial magnetic stimulation", it's an evidence-based treatment that is usually reserved for when the drugs don't work, but if your insurance covers it (assuming you're in the US like me, hope you're better off than that though!), it's a non-drug based therapy that can help. Not guaranteed because everybody's different, but it's worth a discussion at the very least. > > There's also ECT (electroconvulsive therapy). Yes, electro-shock. No it's not AT ALL like you see in the movies. It's remarkably safe and effective according to what I've read, though not without some risk. You don't want average run-of-the-mill idiots doing it either, and you sure as hell don't want med school students learning on you. But with the supervision of a skilled physician and team, it's helped people where nothing else has. Also worth a discussion with your doctor, though I honestly advise SSRIs first (I'm not a doctor though so take that with a grain of salt). > > Neither of the above relies on medication whatsoever. Both use external energy sources to influence neurological electrical transmission and (hopefully) stimulate production of the same.

The depression was so bad it profoundly effected my vocabulary and cognitive function.

We're talking a 20 point drop in IQ. I was so deep in the well I no longer had depression but depression had me. I was fortunate to be going to a therapist at the time who recommended I go on anti-depressants and I agreed but I made a deal with him first.

The starting dose he was going to prescribe was something I saw had similar impact to vigorous exercise so I asked if I could try biking every day for the next 4 weeks and if I wasn't better I would start taking anti-depressants.

Because my fathers depression severely negatively and permanently impacted my life I had a pathological talisman to always get out of bed everyday.

I rode a bike every day in the Texas 100 degree heat, a minimum of 16 miles and usually 20, I would drink over a gallon of water on each ride.

I would sing songs from my childhood and pray out loud (I was ~religous at the time) as I rode and talked to myself and about what was happening in my life almost the whole time... while absolutely flogging myself on the bike every day.

There was no affect the first week, no lifting of depression.

On the 8th day I had ~one hour where my mind seemed normal before the veil dropped again.

By the time I went back to the therapist I was myself for all but an hour a day.

If you cannot do such extreme exercise you MUST go on medication (you should almost definitely go on medication, it's nothing to be scared of, many people are on them only short term), regardless you should see a therapist and follow their advice, you must talk through how you got to your current situation and take practical, physical steps to alter your environment. If you try exercise you must make a time gated deal with your therapist then hold yourself strictly to it.

Medication need not be permanent, if you are inside of depression you must get a mental toe hold out through any means necessary so your operating mindset isn't coming from helplessness and emotional poverty.

In addition to medication I would also practice the entire list below:

Non Pharmacological Cognitive Enhancers – Current Perspectives https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573018/

The one caution I have with medication is that in almost all cases it must accompany working/talking through underlying issues with an engaged therapist, otherwise you're cutting your gains way short. Depression in individuals without clear disorders is like anger, your body and mind are telling you that practical things must change.

I went through a couple different psychiatrists and multiple combinations of meds before I found something that was mostly effective and without major side effects for me. Along the way I went through times where I was severely overmedicated and couldn't really function but quickly recognized that and worked with my psychiatrist to move onto another treatment. You have to give stuff a shot and see how it goes for you, chances are the first thing you try is not the thing that's going to work.

The psychiatrist that I stuck with was the one that suggested I should also see a therapist. My take is you need both. I went through a few different therapists before I found one that worked for me. They helped me develop the tools I needed to break out of the cycle and take control of the anxiety and depression.

Ultimately starting to take care of myself physically was the biggest impact and the thing that really got me off the meds and "graduated" from therapy. But I wouldn't have been able to get started on that without the meds and the therapy.

I tried exercise, read Feeling Good book, took different vitamins etc. None of this really helped.

What finally worked was giving into my depression. I would come back from work, listen to sad songs, cry like a child, pray, and drink until I passed out. Within a few days, I would wake up without pit in my stomach. Hangover was another story. Within a couple of weeks, I was not depressed. Depression turned into anxiety. And anxiety was a lot easier to deal with than depression.

Once depression was mostly gone, then I was able to use CBT methods to deal with my anxiety.

It is really hard for people who never experienced depression to understand what it feels like. It is worse than hell. I am sorry you are going through it. Just take one day at a time.