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

> I realize this is somewhat of a taboo topic

Unfortunately true; I opened up a few times to different friends, and it never went well. But more people talking about it is the only way to change that, so thanks for posting!

I was in a similar situation as you; I remember once leaving work at noon claiming to feel sick, but actually it was because I couldn't think of anything except how I wanted to kill myself.

A couple years later, I'm still around, and here's what helped me:

* Bupropion, 150mg XL * Some basic understanding of CBT * Adderall

> The obvious solution to these problems are SSRIs and other anti-depressants. These drugs are very powerful but have really bad side-effects for most people that take them.

SSRI's definitely have an unsettlingly long list of side-effects, but keep in mind two things:

1. Not everyone experiences them; anecdotally, my sister started Prozac recently, and she's told me it's been great for her 2. If you do experience side effects you don't like, you can just... stop taking them. There's lot's of different SSRIs with different effects, and from what I've read it's common to cycle though a few before finding what works best.

Also, SSRIs are not the only option. As mentioned, I'm taking Bupropion, which has virtually no serious side effects. Look it up. And if you want to try it, you can just ask a doctor for it; tell them your concerns about SSRIs and just ask for Bupropion. No doctor is going to force you on SSRIs if you don't want them.

Side note: the XL version is the 24, slow release version. Works much better for me than the standard 4 hour tablets I started with.

On the topic of CBT, as others in this comment section have recommended, I read Feeling Good by David Burns, and it did help. It wasn't enough on its own, but a basic understanding of CBT goes a long way. The basic idea is training yourself to recognize bad thought patterns and taking action before they affect your mood. Honestly, it's stuff everyone could stand to learn.

Finally, I also figured out that I had ADHD. This was related to my depression because, frankly, it was depressing to struggle to accomplish the basic tasks other people seemed to have no trouble with. Especially noticeable as a programmer, where intensely focusing on a single thing for a long time is... basically the job description. Adderall has been a life changer for me.

> Have you been able to triumph without chemical assistance and what did that look like? Is my utter terror of these drugs warranted or should I just bite the bullet and try them?

I totally get the mindset of not wanting to take drugs. It feels like a crutch; something you shouldn't need to do. But eventually I realized that taking drugs daily wasn't any different than wearing glasses daily. I need the glasses to correct a biological defect with my eyes. I need the drugs to correct a biological defect with my brain. Humans are fragile, and a lot us aren't built to spec. The great thing about living in the modern world is that we can actually fix these problems.

Where are you located? What are the symptoms? Many times, depression is a symptom of a deeper problem, especially if lifelong.

  What do you mean specifically by "I was able to sleep when I wanted to"? You have profound insomnia? Any serious enough sleep disorder will give you depression, and if sleep is an issue - address that first. Sleep medicine is quite involved, and often if it's something subtle you'd have to travel to get expert advice. Stanford is a pretty good sleep medicine centre, both in respiratory and circadian disorders.

As for the safe treatments: there are now clinics that offer ketamine infusions (nearly instant remission even in very severe cases), and psilocybin, under medical supervision.

Both are fairly safe, and have no discontunation/withdrawals symptoms. You will be screened if it's appropriate for you, and it will always be administered under medical supervision the entire time. Ketamine is extremely successful, most in nearly instant remission that least at least a week or two, but the effects do not last forever, and most patients require ongoing treatment. At least you may know what it feels like to be not-depressed.

SSRIs are fairly safe in hands of a competent and most importantly caring prescriber. SNRIs however, at least anecdotally, many prescribers no longer use. Look for someone who truly cares and wants to help. Discontiuation is real, but any competent prescriber will know how to taper it, often a compounding pharmacy is used.

You should have any and all thyroid issue ruled out definitively, all nutritional deficiency ruled out, all allergies/intolerances, no matter how seemingly insignificant eliminated. Full in-lab polysomnography and sleep endoscopy should be done to rule out any sleep issues. Actigraphy might be helpful too, if you have a circadian disorder.

The best proven au-naturel anti-depressants is lots of exercise and lots and lots of social interaction. Did they help?

If not, and you have so called endogenous depression, some sort of medication will be more than likely needed, but in such cases SSRIs will be tried and are often found insufficient. You may need MAOIs, most of the time Parnate will be used. It is safe, but it comes with absolute contraindications to a few foods, and requires a dedicated diet (no cheese, and no fermented foods, not that difficult to maintain), and you'd need someone with an experience using this medication, it's a bit of an orphan drug at this point. I'd try ketamine or psilocybin first.

I never heard of anyone with lifelong depression recover with therapy alone, usually a combination of medication+therapy, and very, very often an underlying condition was found too.

I am on anti-depressants. They are life changing for me. As close to a miracle drug as I can imagine. They let me function

I took SSRIs, the side effects are manageable, and not too bad. Did not work for my depression but improved my anxiety a lot.

My take is taking or not taking SSRIs is depends on your situation. If you are in a position that YOU HAVE TO, then do it. Example of you have to: you have a toddler, not much money saved, partner is a stay home, you are risking losing your job and not getting another one.

If you have the privilege of sorting your issues out without SSRIs, go for it. Trying doing something exciting, something you love the most in life, for me its going to Japan, nothing else interest me right now.

The issue with SSRIs, is that they might not work. I won't avoid them to much as much as Benzos tho.

Doctors are full of shit on this equation. Find a psychiatrist or a therapist. Exercise, read, enjoy the Sun and be busy. Do not take anti depressants.