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

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

#351

Post by tbalsam »

strofcon wrote: post #156
opwieurposiu wrote: post #14

If you want to avoid SSRIs, you can try ketamine treatment. Should be able to find it in most major cities now. In my city the cash price is about $400/a session and you probably need 2-3 sessions. Pros: if it works you will start to feel better in just a few days, and you only have to get a few 2-4 hour treatments a year. Cons: hard to get insurance to pay for it, SSRI are cheaper. https://www.health.harvard.edu/blo…

Fortunately there are compounded racemic ketamine options in a lot of places, whether troches (lozenges) or nasal spray (that's the one I use). I pay out of pocket fully, and it's $60/month. Clearly YMMV, but worth looking into if the infusions are prohibitively expensive.

A hybrid approach is occasional infusions plus at home. I was infusion exclusive for a while and am at home exclusive now (extremely disciplined about it). But my Ket admin doctor and I both I think have the opinion that the occasional IV treatments.... It's hard to beat.

It just does something different. But then at home can help maintain in a more muted way. I think it's because a mainline infusion has no top end limit for drip speed, whereas buccal/nasal membranes can only transport so much at a time. There's a few dose charts that basically flatline at the beginning as transport/transporter stuff saturates vs the line which goes sky-high. Also the bioavailability is phenomenal, and it's easier with IV to avoid the dose creep/tolerance/psychological addiction aspects.

That said, IV Ketamine is hella expensive. :'( An $80 Ketamine nasal spray (not even with insurance, just that), can last me for 6 months with weekly lower dose solid session topup treatments. So, ~$12 a month. Less than HBO Max w/o ads. Hell yeah. That's a good price for an effective treatment haha. Both seem to have unique benefits too that I haven't easily gotten wjfb the other.

Just a few thoughts but am sure you're on a similar wavelength too so mostly just sharing! Curious to hear what your thoughts experiences were/are/have been.

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

#352

Post by tbalsam »

20088866 wrote: post #277

Side-effects: I generally react very badly to drugs. I wouldn’t put the SSRIs I’ve been on in the “really bad side-effects” by any stretch. Worth the trade-off in my case. Aside: Get yourself tested for the MTHFR gene mutation.

MTHFR is a slippery slope down a road to quackery and pseudoscientific BS, just a heads up. Not saying that methylation isn't a problem but it's one of the fastest routes to burn $ with little change. Naturopaths and such can technically help but most of it is the placebo effect with an involved provider and getting some life aspects straightened out. I love the idea of integrative medicine but there's so much crap these days that's hard to tell apart from real science.

Plus, it's like Scientology, the syndromes and tests continue to get more expensive with little actual recourse. The treatment protocols are long and feel like you're doing something to treat something untreatable but for many they do nothing. For some they do a lot. But if you do the basics you see in other sciences of the body (eliminate corn/wheat/dairy etc, exercise, eat cleanly with a balanced diet, lower inflammation), you can get most of the benefits. Right now I think a lot of DNA tests are sort of a modern day hocus pocus trick to convince people we have some all seeing eye vision of what's causing what. It gives security but the science is still very very weak and there's a lot more work to do.

I'm sure once genetic-related language models mature we can be a bit more sure but it's just a lot of hokey pokey for the money. But some people do feel better with it. I was not one of them, and some of my friends were not either. :'( sometimes I think it may be regression to the mean too, so it's all hard to say

Rant, over!

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

#354

Post by tbalsam »

MrWiffles wrote: post #42

Also, quick disambiguation for you, and/or anyone who stumbles on this in the future who may be looking for help: - 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, T…

TMS and ECS probably after running through the atypicals, they are a massive effort. I lean towards recommending pursuing mainline antidepressants and therapy then either atypicals and/or Ketamine if first lines fail. Once certain schedule one substances get descheduled with codesigned therapy, basically all bets are off. ;P

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

#355

Post by tomatowurst »

selfmodruntime wrote: post #309
tomatowurst wrote: post #57

Earlier quoted context omitted.

Dangerous advice. Anti-depressants are band-aid solutions. Depression isn't an imbalance of "chemicals", it has been marketed that way for decades to sell pills. As soon as you are off them, you will likely relapse back into depression. While it can help someone that is in immediate risk, it does not solve the core issue of what depression is which requires a holistic, non-conventional view that Western medicine shun…

> Depression isn't an imbalance of "chemicals", it has been marketed that way for decades to sell pills Medical professionals have been finding that in cases of clinic chronic depression , the patients brain doesn't produce nearly enough endorphins compared to others. Also, antidepressants are from a time where we didn't yet produce problems to sell the solution and they have helped millions of patients. But I guess…

They are describing a symptom not addressing the root causes and it doesn't require a medical degree to see this.

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

#356

Post by aniken »

I sympathize with your situation, and can relate to some of the things you described over the last couple years due to a high stress work environment. One thing I realized was that a majority of the population are magnesium deficient and this can have a dramatic effect on some people. Initially I tried taking the RDA amount as a supplement and it did nothing. Eventually I said screw it and tried a much larger dose, 1 gram per day of magnesium chelate lysinate glycinate. I felt like a different person within 48 hours. Interestingly I found this pubmed article shortly therafter which described exactly my experience:

https://pubmed.ncbi.nlm.nih.gov/16542786/

The doses in the study are way above the standard RDA.

Other than that exercise makes a huge difference for me. I try to do the stair climber for 5 mins each morning and get my heart rate up, and then just walk outside or on the treadmill for 30 to 60 mins right after. If I go more than 2 days without doing that I generally start to feel like crap again. That has made a big difference. Feel free to pm me, happy to discuss, and kudos to you for speaking up about your experiences and asking for help.

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

#357

Post by ahD5zae7 »

This is just my story, not a medical advice. I have been talking to a therapist weekly for a couple of years. Some time ago he suggested I try talking to a psychiatrist and maybe try some SSRIs. I did just that and throughout 2021 I was on 10mg of Lexapro daily. It helped my mood tremendously. It was even better than I imagined.

As for the side effects, it wasn't too bad. Lower sex drive for sure, but not non-existent. Slight paranoia for a day or two in the first week, but not after. Towards the end of the year I was getting some fatigue during the day, but that might have been long covid as well.

After a year of taking them my doctor decided to try tapering them off over a month period. I did that and since January 2022 I've been feeling very well, libido is back. Probably no side effects of withdrawal, or slight enough to be indistinguishable from daily life. Now it's been ~3 months and I'm still feeling good, no relapse at all.

All in all - 9/10, would recommend to a friend. Although I'm just one person and surely other people have some horror stories to share...

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

#358

Post by sweetdreamerit »

As a chartered psychotherapist, I would suggest you go to a psychotherapist. Furthermore, I suggest you have some "aerobic therapy" (that is, exercise) and, if you can, interact with some people. A couple of resources may help you gather some information and make a more informed decision: [0] https://www.who.int/news-room/fact-sheets/detail/depression [1] https://www.nimh.nih.gov/health/topics/depression

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

#360

Post by The_rationalist »

inter_netuser wrote: post #102
The_rationalist wrote: post #67

Earlier quoted context omitted.

> Anti-depressants, if dosed and chosen properly, have basically no side effects WTF is that bullshit ? SSRIs destroy libido and possibly permanently (see r/pssd) MAOIs have many side effects NRIs are not effective NDRIs can cause tinnitus. Stims are cardiotoxic and usually not prescribed for depression. TCAs are not an action mechanism and therefore fall in the above categories. Atypical mechanisms are not better ei…

This is the reason why some people suggest not to listening to any comments. A lot of stuff here are factually incorrect: 1) MAOIs are safe, and Parnate specifically is extremely effective. However, requires a special diet to adhere. 2) Stimulants ARE prescribed very frequently to augment antidepressants in difficult cases, especially in people with serious illness. 3) Moclobemide has every effect of an MAOI in effec…

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