> 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 coup…
Ask HN: Beating depression with or without anti-depressants?
111–120 of 388 posts
Re: Ask HN: Beating depression with or without anti-depressants?
#112PLEASE do not read any of these people's advice. Talk to a MEDICAL PROFESSIONAL, preferably a DOCTOR. DO NOT trust your mental health to strangers on the internet, be it reddit, or hacker news, or whatever. If you are based in the US and live nearby a university they usually have good counseling services and the infrastructure to refer people even if you're not attending the school. Search "{school} counseling servic…
No one with depression is going to read this and go “Oh, you’re right.” It’s self gratification disguised as help.
Everyone knows they really ought to see a doctor. There are plenty of reasons to be scared to. An untimely hospital visit bankrupted me thanks to no health insurance. My sleep doctor had to cut me a deal of only $50 per visit instead of the usual $150, and she really cared about me. I was part of a lucky few.
I think what rubs me wrong about your advice is that it’s positioned at the expense of all other advice. No one’s allowed to have an opinion except yours. Smart people like OP see right through such things, and it tends to push them away. Which is particularly troublesome when the advice is good, like yours is here.
Re: Ask HN: Beating depression with or without anti-depressants?
#113So here's my internet stranger recommendation.
First, Cognitive Behavioral Therapy is the "gold-standard" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/) in the therapy route.
> "(1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behavior (e.g., information processing)."
But often when people go to see a "therapist", either they don't do CBT, or the patient or therapist does not realize that all the worksheets and exercises really actually need to be done. CBT is a lot like physical therapy, if you don't do the exercises, you likely won't get better. If you have not tried CBT before, or are not sure, the book "Feeling Good" is the thing to pick up.
Second, to answer your specific question on SSRIs: SSRIs do have side effects. They're not that bad. I was on them for some 6 years. However, I would rather have not have had the side effects, and not taken the drug, in part because SSRIs also didn't make me in particular feel any better. That said, on average, SSRIs do work while you're taking them for most people. SSRIs + CBT at the same time tends to be the most effective combo.
Finally, here's my non-scientific advice from an internet stranger who has been where you are, and is no longer there. Take it as you will.
In your head there's a little voice. It's the one reading this right now! You can make it talk if you want. Here, make it say "purple octopus fiddly pop". See? That's not you. You're the thing _hearing_ that voice.
That voice talks all the time.
When you roll over at night, maybe it says "oh god, maybe I'm going to get fired". Maybe says "oh, I bet I deserve to get fired". Maybe it says "oh gosh, I can't even get this depression under control, and if I don't, everything is gonna collapse". You aren't that voice!
Sometimes it plays a little movie, like the last time an embarrassing moment happened, or what you could have said as a witty come back. When the movie plays, you're not really there, but your body doesn't know that, and so it builds up all physical sensations of emotion.
That voice is a reflex in your head. When someone taps your knee, and your leg kicks into the air, it wasn't you that kicked. It's just a reflex.
Here, I'll prove it to you. Set a timer for 3 minutes and try and not think about anything. Just pick a point on the wall, or maybe watch your breath. I'll bet you can't do it. The moment you try, there's the voice again. Maybe it's saying things like "oh why I am doing this" or "this is boring". It doesn't need to be articulating words; sometimes it's just a feeling. When you wake up every morning, "with a pit in my stomach that I carry around all day", that's the voice.
Most of the time, when that voice talks, it's wrong. It might say "oh, I'll bet so-and-so hates you". But did you check? Did you ask so-and-so directly? Out loud? Did they tell you to your face?
Or did you implicitly believe the voice?
The way out of the trap that you're in is to notice when the voice is happening. It's happening _all the time_. It's probably made a comment while you were reading this. Did you realize? If, when the voice happens, you immediately assume it's correct, and act as if it's true, you train the voice to say more things.
It's gotten into such a habit that you don't even realize it's happening. It's like biting your nails; your hand moves before you even realize.
CBT is one way of breaking the habit. The most common CBT exercise ("the 3 column technique" or sometimes "catch it, check it, change it") has you write down when that automatic thought or feeling happens. And by doing this, you train your brain to catch the thought before it leads you down a spiral.
Importantly, by writing down the thoughts, you hold the voice in your head accountable. When it says "some terrible thing is going to happen tomorrow", you get to see that, actually, the voice in your head has no idea what is going to happen.
Another way is meditation. Meditation is not a calming exercise. It's a way to practice watching your voice for a period of time. Over time, you build the muscle and train your brain out of the habit of constantly blending with the voice every time it has some demand.
Re: Ask HN: Beating depression with or without anti-depressants?
#1141. There are genetic markers that can inform the choice of medication for depression. We are starting to see better effectiveness than just the shotgun try each one until you find an option without too many side effects. 2. I took Prozac for a 3-4 years and felt like it helped a bit, and I had very limited side effects - even good side effects. A close friend is trying Zoloft/Stratera and is having annoying side effe…
Re: Ask HN: Beating depression with or without anti-depressants?
#115Re: Ask HN: Beating depression with or without anti-depressants?
#116I’ve been on Sertraline for around two years. It was the first drug I was given - normally you try a couple till you find one that works - and it did it’s job. I started to come off them last Friday which involves a fairly lengthy multiple-month tapering process. Obviously slightly anxious that my anxieties will come back once I’m off them but they’ve gotten me out of whatever hole I was in and out the other side for the last year or so. Altogether I feel 10x better than at my lowest. I’ve also made lifestyle changes that helped - I cut drinking down to only holidays, I exercise frequently (just did a half hour swim and hour cycle), and I make sure to listen to my body more to try and avoid stress. However I doubt I could have made these changes without the jumpstart sertraline offered me.
Regarding side effects - I had nausea when I started and on any dose increase. I’m more prone to napping. And I put on maybe 30lbs, which I’m starting to shift now (I’m 6ft3 and male so this isnt as big a percentage change as it might sound). I’ve yet to have any side effects tapering down.
Whatever you choose, I wish you the best. Just don’t let stigma or your anxieties get in the way of getting better through meds.
And if you feel suicidal remember to call 911/999 straight away, or any other helpline, because that feeling will pass but the alternative won’t.
Re: Ask HN: Beating depression with or without anti-depressants?
#117Earlier quoted context omitted.
I DISAGREE. For this reason: I was given antipressants by my (former) doctor for a moderate anxiety "phase". It was escitalopram. And it did well for me - within a day! When it came to end the medication, I was told to just stop taking it. Which I did. But I should not have - I had anxietiy "echoes" over the following YEAR, really weird stuff. So I started to read about the medication: Studies have shown the longer y…
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Re: Ask HN: Beating depression with or without anti-depressants?
#118Not all drugs are created equal. I've been on Welbutrin for about four years now; absolutely life-changing; not an SSRI, so really minimal side effects. 10/10, will take again. Welbutrin is really special. It's not an SSRI, it's not a TCA. It's an NDRI https://en.wikipedia.org/wiki/Norepinephrine%E2%80%93dopamin... and there aren't a whole lot of others like it.
Re: Ask HN: Beating depression with or without anti-depressants?
#119So about a year ago I decided to try St. John's Wort, which you can purchase without a prescription (in the USA). It can help manage mild-moderate depression per the literature, and per my experience. It took six weeks before I felt a difference, and since then the part of me that wants to lay in bed and shut out the world, or distract myself through hours of living through other people's lives (reddit, HN, twitch, etc) has 'grown up'. I've only had couple days over the last year where the old me threw its weight onto my back, but the next day I was back to normal.
St. John's Wort doesn't come without caveats. You need take your dosage 3 times a day (with each meal). If you don't, you'll likely wont be able to drink alcohol for awhile (stomachaches), and the wort may be less effective. It also interacts negatively with a lot of other drugs (check online).
I take 300mg extract (0.3% Hypericins) 3 times a day.
Re: Ask HN: Beating depression with or without anti-depressants?
#120I agree with other comments that you should have this conversation with at least one doctor. But understanding other people’s experiences can be important, and can also make the prospect of going further less terrifying.
So I’ll share mine, though they’re limited. I’ve only been prescribed one antidepressant, trazodone, which is an SARI not an SSRI. It wasn’t prescribed directly to treat depression, though I was seeking relief from depression at the time. It was prescribed to help me sleep, which it did for a time.
This was during a really severe mental health crisis, and I was also plagued by severe anxiety. I probably would have continued to explore antidepressants, had I not found the root cause in my own case was undiagnosed/untreated ADHD.
My experience with trazodone was short, so please don’t take it as more than one small anecdatum. But it was:
1. Extraordinarily helpful when I needed it most. It did exactly what I needed it for.
2. Wasn’t particularly helpful as other contributing factors eased. I had other steps to take to work on improving my mental health further. But I was more capable of approaching them.
3. Did not have, for me, serious side effects. It just became less effective.
4. Wasn’t hard, for me, to stop taking safely. I don’t know if this would have been appreciably different if I’d taken it longer but I assume it would have.
This is, in my opinion, a success story! It’s probably not a representative one though. And this is where my anecdata gets more speculative, so please take this with a grain of salt: I know a lot of people who have psychiatric experiences which span a wide range. I know people who have experienced the “utter terror” of meds that didn’t work for them. I’ve heard and read similar experiences from people less close to me.
Of those people close to me who went off meds, they almost universally had worse experiences and outcomes. Almost everyone I know who’s had unpleasant experience with antidepressants stuck with it, and found something that works at least for a while until an adjustment was needed.
Reiterating, I am not a doctor. Just relaying my experience and what I can relay from people in my community. The biggest hurdle is the one you already leapt: facing this. The next biggest hurdle is that antidepressants take a long time to become effective if they will, and a long time to transition off if they’re not helpful. That’s a real hurdle! But with attentive care it should be about the same level of risk as declining treatment. Because attentive care is the more important factor there.
I don’t know what the answer for you should be. I do know that it’s more available to you because you’re asking the question in a well considered way.
I hope this helps.