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Feeling Good: The New Mood Therapy

David D. Burns · 36 HN comments
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The good news is that anxiety, guilt, pessimism, procrastination, low self-esteem, and other "black holes" of depression can be cured without drugs. In Feeling Good, eminent psychiatrist, David D. Burns, M.D., outlines the remarkable, scientifically proven techniques that will immediately lift your spirits and help you develop a positive outlook on life. Now, in this updated edition, Dr. Burns adds an All-New Consumer′s Guide To Anti-depressant Drugs as well as a new introduction to help answer your questions about the many options available for treating depression. - Recognise what causes your mood swings - Nip negative feelings in the bud - Deal with guilt - Handle hostility and criticism - Overcome addiction to love and approval - Build self-esteem - Feel good everyday
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I strongly recommend the book Feeling Good by David Burns. I even recommend it to people who are not depressed.

It describes how depression is often caused by cognitive distortions that somehow cause us to believe that our lives aren't worth living. As a simple example, a depressed person might call a friend, but the friend doesn't return the call immediately, and so the depression patient concludes that the friend doesn't actually care. This is a pure hallucination caused by depression; there are 1000s of reasons why the friend might not have responded immediately. Furthermore, even in the unlikely event that the negative conclusion was true, and the friend doesn't care about the patient, that doesn't mean very much. Maybe the friend is actually pretentious, or is trying to climb the social ladder, or is a political zealot who can't tolerate people with different opinions - all reasons why the patient is better off looking for new friends anyway.

Maybe one of these books could help him:

The first one helped me understand how the mind influences the emotions, haven't read the second.

I’m currently reading Feeling Good ( It was recommended by someone here on HN. I’m half way through and I’d dare to say it’s already changing my life for the better.
I read Intimate Connections from David Burns (author of Feeling Good) and while it was after my low self-esteem period, I thought to myself "if only I had this book, it'd have taken 2 years less."
The coolest thing about CBT is that it doesn’t require a university degree to administer: just one cheap paperback and a couple days of reading.
I've read this and it changed my life. And I've bought a few copies for people, and on one occasion had (what was at the time an acquaintance.....heck lets not be opaque it was the bar back at my favorite bar) hug me and cry saying the book helped him not be suicidal. That it changed his life and brought him back from the brink while struggling with a crippling physical disability that was emerging in his early 20s.

I've read a LOT of these books. And there's a few in CBT that are helpful (including this one). There's DBT. There's practical self esteem work (confidence is repeated domain specific success). There's some philosophical work that helps. Lifting heavy weights helps. A blood test from privatemdlabs where you can see everything inside you (if you can afford it) helps. Nutrition helps. Sleep helps. Etc.

But feeling good, which has to be 20 to 30 years old, by far is the most effective thing I've ever seen.

Pro tip: type up the excersizes (or google them) and try journaling them into an evernote. The progress is 10x faster. 2 months of feeling good probably did as much as a few years of weekly CBT counseling.

Strongly recommend.

For those interested in learning more about CBT, "Feeling Good, The New Mood Therapy" by David Burns is probably the most recommended book out there.

There is also a handy CBT app called Quirk that I'd also recommend checking out

Burns is finally working on a sequel, "Feeling Great". Note that Burns has an ongoing Feeling Good podcast:
Claim that their form of therapy will change everything:

>The good news is that anxiety, guilt, pessimism, procrastination, low self-esteem, and other "black holes" of depression can be cured without drugs. In Feeling Good, eminent psychiatrist, David D. Burns, M.D., outlines the remarkable, scientifically proven techniques that will immediately lift your spirits and help you develop a positive outlook on life.

Ok, this is a premier example of Poe's Law
Please don't downvote this suggestion, for decades Burns' book has been the best self-help guide to applying cognitive therapy, for many including myself entirely adequate for the task. For myself, so good that in 20/20 hindsight talking therapy stopped being useful after reading and applying.

I have given people many copies of it over the years, with no bad results and a few good to very good ones.

> 736 pages

Woah, that's a lot more than I expected. I could read that, but I suspect many other people in my life never would. Are there more concise alternatives?

The book is a lot of worksheets and sections for individual problems. Think of it a textbook.

That said, it's still pretty good in audio-book format.

Also agree! This was the book that originally turned me on to CBT. It sounds super cheesy, but everyone should read that book.
Worrying is pretty normal. We all do it. There are a lot of ways to approach trying to worry less, however as you said you can't "just stop".

I'd recommend seeing a therapist and developing a treatment plan together. It's a practical way to identify what you are worrying about, why and how to overcome it. Then, I'd encourage you to learn more about personalities and your personality type. There are a bunch of 'personality type' systems out there, but the Enneagram is one of the least specific in its 'typing' and most useful in its insights.

- The Complete Enneagram: 27 Paths to Greater Self-Knowledge ( - Feeling Good (

Feeling Good is by David Burns, a Stanford professor who developed Cognitive Behavior Therapy. CBT is a way to identify and manage your thoughts. It sounds like you are a 'fortune telling' type of person and you try to read your crystal ball and then act on those assumptions rather than what you know. Burns goes into how to identify those types of thoughts, how to refute them and how to mitigate their effects.

>Feeling Good is by David Burns, a Stanford professor who developed Cognitive Behavior Therapy.

Uh no, I don't think so. The wiki page on CBT [0] doesn't mention Burns. (I did read Feeling Good years ago, don't remember anything about it - maybe because I'd read Ellis and a lot of others first.)

I did get a lot from, and have recommend to others with success, Albert Ellis' book The New Guide to Rational Living, about what he called rational emotive therapy - many subsequent methods are very similar, because it works. In short, observe your negative thoughts and change them. No woo or huge cost involved. From [1] :

"REBT is the first form of cognitive behavioral therapy (CBT) and was first expounded by Ellis in the mid-1950s; development continued until his death in 2007. ... Psychology Today noted, "No individual — not even Freud himself — has had a greater impact on modern psychotherapy" ... In his first major book on rational therapy, Ellis wrote that the central principle of his approach, that people are rarely emotionally affected by external events but rather by their thinking about such events, "was originally discovered and stated by the ancient Stoic philosophers" "



> I've been diagnosed with all kinds of stuff, including schizophrenia, OCD, depression, etc. (The docs aren't even sure themselves what I have)

This sounds all wrong to me, and obviously will be very stressful for you. You need to find a good hospital / doctor and get yourself diagnosed right. And only then can you consider the right treatment for what ails you (I know this must be obvious to you, but I want to emphasise it).

Depending on what you suffer from, life long medications might not even be required (though will be helpful during therapy). For example, depression and OCD can be successfully treated with therapy.

While I am averse to recommending self-help without knowing what you suffer from, I highly recommend that you read "Feeling Good: The New Mood Therapy" by Dr. David Burns ( ). The author is a real doctor and a trained Psychiatrist and explains how cognitive therapy can be effectively used to treat depressions and anxiety. And he also explains how anti-depressants works technically (you can skip that chapter if you find it too technical). It is well written and everything is explained in an easy to understand manner.

TL;DR Emotions are somewhat studied in terms of how to deal with them, check Cognitive Behavioral Therapy. Check out Feeling Good by Burns[1], there are specific chapters addressing perfectionism. And his podcast on this topic "“I don’t feel like doing it!” Quick Cure for Procrastinators""[2] (suggest to find it on iTunes[3]/Spotify to listen with 1.5x speed, episode 053)

I'm going through a stage in my life when I don't enjoy doing things anymore. Obviously, if a task is considered somewhat hard and I know I will barely enjoy it, there is very little internal emotional support (motivation?) for doing it, thus procrastination.

I did an exercise from the book which was to list tasks I did during the day and mark a satisfaction rate as well as an efficiency rate. All the tasks are like 10% satisfaction, 99% efficiency. Seems like a mismatch. Then I asked myself a question "What would a person who does useful and efficient things tell himself to feel that miserable? What would he think about?".

I got the following, which goes really deep into my internal motivations and fears: "All these tasks are worth nothing. I shouldn't be happy with them because I can forget that I don't grow and don't accomplish much in general. I may end up being a silly guy who only chills and has fun but in fact, has nothing meaningful going in his life. I shouldn't forget that things are not that good at the moment and it's too early to relax, to enjoy small accomplishments. A person becomes weak if he always enjoys what's going on around."

So if you experience a huge mismatch between satisfaction and efficiency (paradoxically I naturally have lots of fun doing things I am like 0% efficient in because I don't know yet how perfect result looks like), I suggest you to ask the same question "what thoughts could make a person that miserable?".

After listing advantages of believing the above and deep appreciation of my beliefs, it became clear that some of them are crazy self-sadistic. Even though they have the best intentions in the universe (making my life better) what they in fact achieved was getting me to the verge of having suicidal thoughts. And now I am doing exercises mentioned in the book and the podcast to give up these beliefs.

[1] - [2] - [3] -

> A person becomes weak if he always enjoys what's going on around.

For any person not retired or similar, this is a true statement, not a mere sample of "internal motivations and fears".

> For some reason I am repulsive towards 'self-help' books.

I wouldn't classify 12 Rules of life as a typical 'self-help' book because Peterson is not a self-proclaimed self-help guru without any substance.

If you check his career section on Wikipedia you'll find out that "Peterson's areas of study and research are in the fields of psychopharmacology, abnormal, neuro, clinical, personality, social, industrial and organizational, religious, ideological, political, and creativity psychology. Peterson has authored or co-authored more than a hundred academic papers. Peterson has over 20 years of clinical practice, seeing 20 people a week, but in 2017, he decided to put the practice on hold because of new projects."

And he doesn't try to sell you the idea that life is beautiful and amazing, he actually agrees that life is tragic and brutal.

> I always have a feeling that you just cannot sum up all the things to be "happy" or "content" or whatever in one book

I agree to that. You cannot sum up all the things which make you happy or more content, but you can follow principles which increase the probability of success in what you want to do, such as "be a bit better tomorrow in some minor way"[1]

> I am interested to know, how often when you face a situation, you stop and think, oh I read this and that in a book, I should act this way instead of my natural intuition to do the other way.

Not every time, but more often than before reading that book. For example, I've read Feeling Good: The new mood therapy(another great book with a self-helpish title) and after reading that book I really started to put in practice some exercises in that book which by now they became almost automatic. For so much time I was a victim of cognitive distortions and now I finally found a way to beat them. And not only me. [3]




I've just started reading a book on CBT[0] that I have been really enjoying so far. I think the gist is that much like logical fallacies, there exist cognitive fallacies that our brains start using that alter the way we perceive reality in a negative way.

Here's [1] a kind of silly example of it in action over on the Overwatch subreddit.



I just bought the book. Only $6 and has some pretty convincing reviews. Thanks! That Overwatch worksheet is hilarious - but kind of eye-opening in a way. Seeing that made me think that I just keep running over the same thoughts over and over in my head (definition of insanity, lol) instead of writing them down and reflecting. Thanks a lot!
Good luck! CBT doesn’t work for everybody, but since you read Hacker News I’d say there is a better chance it will align with you. Stoic philosophy and Mindfulness all touch on similar territory. I found a study of all three allowed me to pick and choose the best tidbits and internalize the processes.
This book is the standard book most doctors recommend (or so I'm told):

Not sure, but I've seen Feeling Good by David Burns[1] recommended in ADHD circles. Can anyone back this up?


Mine's inherited and atypical, but the sorts of things being suggested here have helped, e.g. a SSRI. I strongly recommend getting a copy of this book: or any other good guide to cognitive therapy, which has an added behavioral aspect nowadays. Therapists ought to be versed in CBT, and if things are bad enough they're worth a try.
It depends. An engineer uncle and myself both developed disabling anxiety at around the same time in our lives; lately I've been wondering if one of our root problems in an inability to lie to ourselves (in his case a general habit of lying that could have gotten people dramatically killed on TV), but I don't think that fits into what you're talking about.

As for what how my doctor and I have "hacked" anxiety, and the last one is most certainly a hack done in desperation:

A long time ago ('80s) I learned Cognitive Therapy, which is now Cognitive Behavioral Therapy (CBT) with some additional stuff added to cognitive psychology (in simplest terms, you feel bad because you tell yourself bad things, view the world through dark glasses, etc., cognitive distortions of reality). I cannot speak highly enough of this; for example, many many years later I realized that thoroughly applying it to myself pretty much ended the usefulness of talking therapy. Start with this book and see what it and you can do: (so good I keep an extra copy or two handy to give to people).

A laser specific SSRI, trade name Lexapro, generic escitalopram. Probably helps, not entirely sure; mixed with this is what my doctors and I suspect is depression of a bipolar nature (not like normal depression, but I only go manic if prescribed the wrong drug, like Paxil; this has been troublesome for a very long time, but not disabling by iself).

Critically, given what could otherwise be life threatening insomnia etc., a low dose of an "atypical" antipsychotic that has a useful sedating side effect (an antihistamine, so also good for your allergies :-), trade name Seroquel, generic quetiapine fumarate.

In that vein, sometimes one can over-interpret normal behaviors as more negative than they actually are. The book "Feeling Good" [1] covers this, and ways to deal with it in a very accessible and straightforward way.


There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day).

One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me).

Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough.

As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.

Having wrestled with severe depression for many years, I've learned a few things.

1) There is hope! Don't give up.

2) Many people will not understand. That's okay.

3) Cognitive Behavioral Therapy (CBT) works. It's hard work, but it's easier than having depression and anxiety. It's really about renewing your mind. Best book on the subject is an old one:

4) You have to find help from others. You will likely run into quacks, and well-meaning but unhelpful advisers. Don't give up.

I've read Feeling Good, and found many of its basic premises to be flawed. Conscious thoughts aren't, as Burns claims, always a leading cause of bad feelings. Biological, hereditary, and environmental factors can have a large effect on mood. Burns believes negative thinking patterns are 'distorted', and we can ameliorate depression by 'correcting' them. Several studies have shown that the depressed people are actually more, not less, likely to appraise situations accurately.

Out of curiosity, who did you find that was able to help you?

CBT is used to help cancer patients deal with pain. It's not about "correcting" thoughts. Have you said something similar on HN before, under a different account?
I'm sure CBT has been used with cancer patients, but pain management is not the heart of what CBT is about:

CBT is however about fixing negative thought patterns. Start of chapter 3 of Feeling Good (I just pulled open the pdf) Burns says 'Illogical pessimistic attitudes play the central role in the development and continuation of all your symptoms'

I don't think I myself have posted about this before, and just did a search. Hacker news does seem to be often dismissive of the psych field though, as there is not a lot of good science that would appease a critical thinker.

You said that emotions can be caused by a wide range of stuff and suggested that CBT might be less effective in those situations.

But it doesn't matter what causes the emotions - CBT helps people deal with negative emotion no matter how they're caused. Pain management in cancer patients is a good example where emotions are caused by something external but where CBT is still effective.

You might want to have a look through some better books or websites to get an idea of what modern CBT involves.

You've got a lot on your plate right now-- multiple competing priorities, compounded by the family situation.

Strongly recommend reading> David Burns on Cognitive Therapy -- the writing exercises can help tremendously with the depression and your own personal development. The subject should also appeal to your Neuropsychology jones. >

Hello JSeymourATL i appreciate the suggestion however i'm a deep follower of Burns :) in my room i have some of his charts taped onto my wall to remember how to think clearly. Thank you so much! :)
Good on ya! Regarding your college conundrum, take a look at the military tuition assistance route-- it's been a smart play for a lot of guys. They need geeks more than warriors these days... >
I'm also recovering from a depression which lasted for quite a while. It absolutely sucks because you think you're worthless, nobody loves you, you can't get anything right and the best would be if you just wouldn't exist anymore.

And on top of that you isolate yourself. I know how hard it was to ask for help therefore I want to show you some things which helped me:

- Realize that your depression is lying to you. It doesn't tell the truth. It makes you believe that something is logical even if it isn't.

- Read 'Feeling Good' - terrible title, great book. It will probably work better than average on the average HN reader because it takes a 'rational' approach to depression (cognitive-behavioral therapy). It helps you to recognize destructive thought patterns and how to deal with them.

- Garbage in, garbage out. What works for computers also works for your body. Yeah, you're a geek but you can eat some vegs instead of the 500th pizza. Also working out (or other sports) are pretty great.

- Long term: Therapy which tries to work on the root cause and not just at symptoms.

Finally, here's a rather extensive list with lectures, books, exercises, etc. which help dealing with depression [1]. Back when I was fed up with feeling crap I created a spreadsheet with the 8 activities and tracked those every day.

Note: Every person seem to react to differently. I read about people who improved a lot by meditating - on the other hand, it didn't work for me.

So, try some things out and don't give up. You can beat that liar in your head.



PS: If you have any questions feel free to ask - if you want to send me a private one write at <username> @

I have to submit to reality even though it makes me question a lot of things, but yes, you have to stop believing your own emotion and self when things become either too dark or too shiny.

About isolation, it's kinda tough, people may leave you alone after a while which reinforce the feeling of uselessness.

I just want to second "Feeling Good". I only read the first 30-50 pages, and that was enough to instantly and permanently decrease my depressive thoughts by about 85%. Your results, of course, may vary.
> - Long term: Therapy which tries to work on the root cause and not just at symptoms.

This can lead people down the wrong path and can be harmful rather than helpful.

I've been depressed for over ten years, I'm currently thirty years old.

I left my job in January due to depression, though I didn't tell anyone. I haven't worked a day since then and am just living off savings as they dwindle. I haven't spoken to any of my former co-workers who were my only contacts in the Bay Area since I moved from the East Coast to work at a startup. I've spent all day every day numbing myself with weed, porn, mindless internet browsing, etc. I don't even code, every time I open up Xcode or Android Studio I just end up doing nothing. And I honestly just don't want to do anything.

The last time I went out socially was in January of this year and even that was just with my then co-workers. And over the past ten and fifteen years it hasn't been any different. I can count on one hand the number of times I've been out socially over the past ten years that wasn't work related (and while employed the number of times I went out with co-workers also number in the single digits).

The isolation is what kills me. I haven't had sex in several years and haven't had any intimate relationships in my entire life (the sex were just one nighters and nothing more, and I've never had a "best friend", not even in high school or middle school). Unlike a lot of people with depression, I don't have friends, family (all on East Coast), or girlfriends (I've never had one). I don't even talk with people online, not through FB, not anonymously on web forums or instant messaging. In the past week the only people I've talked to is the cashier at the local supermarket, and that was just to say I wanted a bag and say "thanks see ya later". In fact this is the first time I've written about depression online, I've only told a few people (my mom and a doctor) that I even have it.

I've had a hard time dealing with it. I'm trying to get into meditation and what not. But I mostly fear the effect of this extreme isolation. There's a lot of evidence that it kills your brain (literally).

I'm reading a book called "The mindful way through Depression". I bought it over two years ago and only started reading it two months ago. I'm still only halfway through. The worst part of depression is that it saps my energy to do anything, even when I do read the book I'll read several pages and not remember a thing of what I read.

Sorry about the wall of text if anyone reads this, but it's 5:46 AM and I'm not doing anything else. I haven't gone to sleep yet...I'm just mindlessly browsing the web (I discovered a new TV show earlier today and am marathoning it right now). Either way I still hold some optimism for the future.

People expect a big change to come along and fix things, but that is rarely the case. Regression or progression is a battle of inches with goals that are miles apart. For me, using a "one" system has proven greatly beneficial in making progress. I made a list of the areas in my life that I want to improve, and every day I try to do at least one thing towards achieving those goals. In my case the primary goals are: physical fitness, personal projects, eating healthy, reading, and home cleanliness. All I need to do is make at least one effort per day at improving any aspect of each of those five goals. It can be as simple as doing a single push up, updating one word on one page on a website, taking a multivitamin, reading a blog post or a chapter in a book, or putting away some laundry, as long as it's at least something. Most of the time I find that once I do at least one thing, I will end up doing more, since I've already started and have momentum. One push up turns into 10. Washing one dirty glass turns into emptying the sink of dishes. Sometimes it's the bare minimum, and that's fine too. Tracking each day can turn it into a bit of a game. Jerry Seinfeld's system makes a lot of sense to me:

Progress is often slow and painful and it's easy to lose perspective on where you were, where you are, and where you want to be. Reflecting on your goals and your accomplishments can help you maintain perspective and stay positive. Also reflect on your mistakes so that you do not repeat them. Don't beat yourself up over mistakes, everyone makes them every day, you are just more aware of your own. If you are kind to your future self it makes it easier to have a positive image of your past self which can improve your outlook on the future. To me that is what meditation is all about.

Since you smoke, maybe try and use that as a reward. Right now it sounds like a coping mechanism, which can help, but it's no replacement for feeling and dealing with your emotions. That's dangerous long term. In the morning, before you wake and bake, read a chapter in a book. Do 10 push ups and then get high. That way you start the day on a positive note and knock out one or two of your daily goals right away.

If you are isolating yourself and not going outside you might also have a vitamin D deficiency from lack of sunlight exposure. A daily multivitamin can help with that and other dietary deficiencies. You aren't alone in what you're feeling and it can get better as long as you try. Good luck!

You reminded me of this Reddit comment: "No More Zero Days"

A typical multivitamin is only going to have 500 IU D3. That's very unlikely to help anyone unfortunately. I know a lot of people that see a huge benefit in mood with D3, but you need to take a lot more. Most people I know who take D3 for depression take 8000 IU/day, some 10000 IU. I wouldn't take any less than 4000 IU. (Research hasn't indicated toxicity until at least 20,000 IU.)

I feel for you, but I'm going to be blunt. You've got to get rid of the weed. As long as you're smoking, your head isn't going to clear and you're not going to want to do anything. Flush your stash down the toilet and don't look back.

Then, as someone else has said, getting a job is a really good idea. Otherwise you're going to wind up on the street, which will be far more depressing than your situation now.

Once those two things are taken care of, get help. I don't personally recommend staying on antidepressants for life -- no, I'm not a psychiatrist; this is just my opinion -- but they can be a useful temporary crutch.

Agreed 100%. Daily smoking, (especially starting in the morning) puts your life in a permanent twilight. And regarding girlfriends... a chronic stoner is usually pretty unsexy.

Put the weed away. Maybe put the computer away also. Start exercising. Spend as much time outdoors as you can. You need to feel physical want and frustration and pain a little bit. Don't hide from it... feel it. This (in my opinion) is one of the best antidotes to apathy and depression.

Yes! it's a very easy trap to focus on the 'big things' when you're unhappy or depressed, while often the solution lies in simple things like diet, exercise, and general lifestyle.

Sometimes I think our brains actively keep us from realizing this, because they want to stay in charge. So we find solutions in more abstract, mental things, where sometimes the first (and sometimes the only really necessary step) is to start taking care of the whole of us.

Just upvoting this for visibility, hope someone has some helpful comments for you.

I really, really don't know what to tell you. I mean I can tell you what needs to happen, where you should start, but I've been there before and for me the biggest obstacle was that I didn't care, had no energy or motivation. So while I knew all the right answers, actually acting on it was the biggest obstacle.

I'm not sure if that's your problem, too. If not, really just try ANYTHING and EVERYTHING. Not knowing anyone with a bit of savings can be extremely liberating. It means you can literally get out of bed and do anything that day.

If I were you I'd start by writing down the things you'd like in life, then writing down what you need to do to achieve them. Set a goal and work towards it. You mentioned removing isolation. So work, education and sports are the main places we meet people. And once you meet a few there, you go and meet others through them elsewhere (like at a party). So get a job, any job, a volunteer job may even be the best. People love you, it's often a very gentle and caring crowd, there's no pressure, no attachment or stress, and it's incredibly satisfying. Then do a sport, a teamsport. Anything that fits. Used to play football, do that. Never did sports in your life? Join a beginner running team.

And get out, solo, too. Buy a bicycle and just ride, take music if you'd like, explore and think while you're out in the sun and the wind. And beyond that, take care of yourself, try to keep a more regular schedule, try to really wake up and sit down for breakfast, don't buy some crap and roll out of bed and into a chair and eat it while doing mindless browsing. I know I know, hippy territory here, but being mindful of the moment, consciously deciding to prepare a proper breakfast, and eating it at a table, with a moment of zero-distraction clarity, it creates the kind of dignity that can allow you to try something new. If you don't do that, you just fall into the same pattern and spend another day doing nothing in your chair. I've been there, that pattern is the worst.

Anyway feel free to post more of your thoughts or PM me anytime :)

Since when did being mindful got associated with being hippy?
My point is that a lot of people have an anti-reaction to words like mindfulness, meditation, vegetarianism, yoga, when science shows it seems to really help. A bit like how a stereotypical redneck shuts down when a stereotypical hippy suggests a different lifestyle.

So I was just joking to recognize he MIGHT just be rolling his eyes at that point, but to consider it none the less. This attitude may not be so prevalent at HN, but when someone has depression for 10 years, chances are he's heard the same story (e.g. "oh, read this book about mindfulness, you'll be better before you know it!") a million times before. I get that. I didn't want him to stop reading at that point. I used the word mindful purposefully because of this, not 'mindfulness'. Anyway you can ignore my point.

Please just takes some risks. Honestly, bold moves is what lifted me from a similar state. I'd been diagnosed and was living at home with my folks. But picking up and forcing myself into new situations is what lifted me out.

Don't worry about the fact that you're 30 and never had a GF. Honestly, it doesn't matter. I'm 33 and my GF is my first and she doesn't give a fuck. All she cares about is that I'm honest and that I reveal my true self. That's hard when you're a 30 yo dude and you're meant to have had a spate of relationships. But trust me, if you own that you haven't had much experience and become cool with it - women don't care. I've been there. My girfriend is super hot too ... but you learn that that doesn't even matter.

Just face up to who you are. Quit comparing yourself to your ideal and accept your imperfections and fuckups. Don't be a depressed waste of space like I was, pretending how bad I had it. Force yourself outside. I'd even get on something like Tinder and start getting pussy again just for your self esteem and self worth. Keep building and working on that. It's not easy, but stay focused on the small stuff and making fractional progress. Trust me, it adds up.

Don't be a cliche depressed fuck like I was. It's just so shit overall. Take risks and challenge yourself based upon the fact that you'll be fertilizer in no time. There's really no other alternative.

>>get on something like Tinder and start getting pussy again just for your self esteem and self worth.

I appreciate you helping here but i would disagree with this statement. This could be a recipe for disaster and lot of mind fuck. Never ever base your self esteem and self worth on how much sex you are getting and from what type of women.

I'm not saying it is the only thing to base self esteem on. But sex, almost universally enhances quality of life and self-worth, unless you identify as asexual or enjoy being alone (which it didn't sound like it to me). My point was that the hangup of not having had a GF should not be something that people should feel shame for.

I agree though. I think Tinder can be terrible for people's self worth. Meaningless sex can be really destructive. But it sounds like meh_master isn't meeting people - and I think Tinder is a good way for people just to connect (even if it doesn't lead to hooking up). Just trying to help a guy out who seems to be looking for some answers and is in a pretty lonely place :(

Find a doctor and get diagnosed. I'm not going to tell you that it will help you get better...I can't promise that. But getting the diagnosis will allow you to sign up for Social Security disability and keep you from eating through your savings. Everyone is different and every depression is different and the only thing I'm virtually certain of about your situation is that the stress of eating into your savings isn't helping you. Having someone who forces you to talk about yourself beyond a superficial level on a regular basis probably won't hurt either.

That said, here's what I wish someone had told me ~10 years ago when I first sought help:

1) Psychiatrists are too quick to prescribe medication. It alleviated the initial symptoms and allowed me to go back to work, but it separated me from my emotions in a way that's been hard to recover from since I've stopped taking them. That sentence looks weird to read, but it's the only way I know to describe it.

2) Try CBT and mindfulness therapy first. Also, socialization exercises help. It may not seem like it, but simply adding a "how was your weekend?" to your interactions with the cashier at the supermarket or forcing yourself to smile at 1 person a day can make a difference, however small.

3) Depression isn't only disease. It's a state of mind that can be useful. Take this opportunity to think deeply about things. Your current state of mind probably allows you to "dwell" on an issue in a way that I sometimes wish I could regain.

4) Sunlight helps. If you're feeling near catatonic, you might try being near catatonic in the park, in a back yard or anywhere where you can sit outside.

Good luck with getting better and I hope you can believe that it's worth it to try.

That sounds very similar to (though more intense than) what I go through. All I know to do is break cycles. Run out of weed, don't buy more for a while. Sitting around too much, force myself to go outside and walk around a park. Force myself to go to a social outing that I really would rather not go to.

I have found that even though I dread doing these things, and in general hate forcing myself to do stuff I don't wanna do, when I am actually doing them I am truly enjoying myself. More than I thought I would. Like, I might dread going to a get-together because the convos will be boring and I'll be waiting to leave, but then when I'm there I manage to find someone actually interesting.

I think there is a large "eat your vegetables" aspect to breaking out of this. At least for me that's the case. There's stuff that I know I should do but I just don't feel like it at all. But if I examine why I don't want to, I really find that there's no actual good reason. That's an indicator that I'm not thinking straight and need to spend a while doing things that I wouldn't otherwise do.

The only other thing is being extremely honest with myself. Honest about what I really want, honest about what is not making me happy. I was in a marriage that left me feeling unfulfilled, but I refused to admit this for over a year. That drove what turned out to be the longest and probably most severe depressive episode in my life. I am lucky though, and know that my depression is fairly mild, comparatively speaking.

Get a job. Any job, but preferably something involving manual labor or with tangible results. Or volunteer. Build Habitat houses or something. You're not coding or doing anything else useful now so it's not going to take away from that. It will get you out of the house, put you back in contact with other people, and give you a feeling of having accomplished something every day.
Hey meh_master,

First, congratulations for exposing yourself here. I know it's not easy. As someone else said, I wanted to email you but you don't have a contact in your profile. Feel free to write to me if you want to speak to someone - I'm in Europe though, so I probably won't reply to you as timely as you might expect.

I would second the advice of the other commenters who told you to do a bit of physical activity. And, if you are still in good term with your mom (as your comment suggest), maybe you could move in with her temporarily? You'll save some money on the rent and will have someone to talk to.

Good luck!

My thoughts are with you meh_master. You really deserve better.

Please watch this at some point.

Things can get better but please, please, please try to find the strength to reach out to someone, anyone and open a conversation.

Take a look at too.

Take care and look after yourself.

I've been through depression myself, and managed to fully recover and now living a very happy life. I've also seen many friends and family go through depression, some recovering.

I would suggest three things:

[1] Have more social contact, even if it is going out for a walk and saying 'hello' to people.

[2] Do some enjoyable physical and mental activities every day.

[3] Find a motivating goal and work towards that goal every day.

Feel free to email me at [email protected] and I'll be happy to chat with you more.

Try to pick up some kind of sport. Taekwondo worked for me, you just have to conquer the embarrassment of being a beginner among new people, but those communities are usually friendly and get a lot of newbies all the time anyway. No social obligations, just go and do your own thing, over time you'll probably build some relationships as a side effect.

Running was a big help for me too. Again, just gotta get over the initial hump of laziness and being embarrassed at doing something that you're not very good at, until you start to get into it.

If you find it hard to get started, consider making an appointment with a psychiatrist and ask about Wellbutrin. It gives you energy rather than feeling low throughout the day and makes it magically easier to not get caught up in logically pointless and destructive thoughts. The best part is, you can continue to self-help it just becomes easier, and you only meet once every 6 months rather than every week with a psychologist.

Just my 2 cents, best decision I ever made after ~10 years depression, went when I was 29. Look up Dysthymia.

I took Celexa and Cymbalta a few years ago but neither seemed to do anything for me. I may give medication another shot in the future, but I don't know.
Yes I tried Prozac and Zoloft 12 years ago before giving Wellbutrin a try early last year. It worked worlds better/differently because it is a non-addictive stimulant as well. Some doctors prescribe it to their children as a safe ADD medication.
Non-addictive stimulant? Maybe it isn't chemically addictive, but all stimulants have the possibility for psychological dependency. Trading one dependency for another is not what I would consider to be progress.
It only has a noticeable stimulant effect in the beginning, after a few weeks you can't tell a difference and it just becomes part of routine with the same anti-depressant benefits. Whatever small risks you're assuming are far outweighed by the rewards.
Interesting. I tried Adderall a few years ago as a stimulant, but it had no noticeable effect.

I ended up going through a month supply of it in under a week, I kept upping my daily dosage hoping for a miracle cure, because I wanted a magical pill. Happiness in a pill or something that would numb me to daily life.

I used Adderall a lot in college and a bit after but it only works temporarily and doesn't target depression. Actually the subsequent low from Adderall and other stimulants is why I hate them and they never turned into a serious addiction.

Wellbutrin had a stimulant effect at first because I wasn't used to it, but it slowly becomes less noticeable, leaving only the positive effects. I remember thinking about a week or so in: This is how other people get to feel?!? wtf

Do the mindless internet browsing in coffee shops, it's a bit better. Cycling is my preferred exercise, either having a look around town, or off to the next town, catch the train back, or cross country. Unless you join a club it's fairly solitary, but it gets you out, covers more ground than running, provides a bit of adventure, keeps you occupied, distracted, avoiding monotony. Weed doesn't work for me, swap it for coffee.
I really recommend you do whatever it takes to find close friends who you can talk to about this stuff if you don't have that already. Whether that means joining some kind of help group, church, whatever. Other people are a great normalising influence - they correct our negative thinking, but also help normalise shame and other stuff because it normally doesn't feel so bad once it's shared (and because we realise other people are just as screwed up as us, or at least, have problems of their own). Plus friends help us focus on others rather than ourselves.
I was hoping to email you, but don't see a way to contact you. Could you please add an email address to your HN account? Stay strong meh_master.
Go out for a run every day. I have gone through depression (one of them extremely bad) and I know the feeling of isolation. Fortunately, the brain is very plastic, so this damage might be reversible.

Is there any specific reason you are depressed? I got a severe depression due to hormons and vitamin deficiencies; you might want to get that checked.

Drop me a line.
Well, you're not the only one. I have been depressed for nearly 10 years and (voluntarily) socially isolated.

My work (in multiple jobs), which wasn't difficult, made me exhausted and put so much additional strain on me that every day I felt closer to suicide. While I haven't been suicidal since I left I still think it is more likely than not that my life ends that way.

I no longer have friends, I don't talk to anyone except for polite chit chat, and have lost my libido but unlike you none of these things bother me though I know this isn't healthy.

I don't have any advice to give. Books, therapy and exercise didn't work for me and I'm afraid to take drugs because of the permanent or long term side effects.

PS: I'm also not looking for any advice or empathy from the armchair psychiatrists here.

I feel obliged to respond to this post since I've feel that you've basically described my life. I quit my (soul-crushing) job three months ago and plan on living off my savings until I manage to gather the energy to find another one (or to kill myself). I'm 29 and never had a girlfriend either. I feel utterly invisible to the opposite gender, as if there was some kind of unexplainable communication gap that I never managed to cross, while everyone else (including the countless couples of teenagers I see walking in the parks) just seems to have moved past that. For me this is the thing that kills me the most. I feel like I've wasted the best years in my life, and that because of that and missing out on some basic experiences that most people share, I feel extremely alienated from the rest of my peers. So I just fake it all. I lie about my life. I live like an impostor, and when someone is about to uncover that, I just run away or make up more excuses and lies.

I've got a few good friends, but they are far away. I've still got my family though, but I haven't told them about my depression. I actually have told no one except one friend, who was supportive but didn't really understand what I'm going through. I've been depressed for as long as I can remember, since I was a teenager I guess. Something like 10 years. I've also been thinking of suicide for years now, on a weekly, sometimes daily and hourly basis. The biggest problem is that I don't see the purpose of life. Most people will talk about family (children), career, religion... Things that don't work for me. I don't believe in any gods, I don't want any children (who would inevitably inherit my shitty genes) and my career is nowhere near where I would have wanted it to be, to the point that I was better off right out of college because I was mentally more apt then than now that I'm burnt out. (And lost almost all passion for programming)

I probably some form of ADD as well, because I've lost almost all ability to focus when trying to work on programming projects.

Right now I'm far away from home, taking holidays in the sun, and trying new hobbies. But nothing ever seems to stick (including meditation, which I've failed to pick up many times now). I've met people, but ultimately there is always a moment where I'm alone in a room and start wondering what is the point of going through all that. Life is ultimately absurd and we're all gonna die anyway.

Even writing this message feels utterly stupid. It's probably the worse answer that one could write to your message. Usually when I write these kind of messages, I tend to write them and immediately delete them because I feel so silly and pathetic. For once I'm gonna hit the reply button anyway.

I've been where you are. For me the path out was exercise. Wake up and work out - every day, 7 days a week, first thing after you wake up. "Working out" can mean walking to the end of the block and back. And then you get to think, "Even if I do nothing else of value today, at least I worked out." Do that every day for a month, first thing. If you can ingrain that pattern in your brain, I promise you one block will become two and two will become four. And you will look at the crap you're about to put in your mouth and think, "this is not food." For me that was the path out. There's ways to overcome the women thing - really. And 30 is not too late, not even close to too late.
I could have written something similar when I was in my late 20s.

My teenage years were filled with depression. My circle of friends consisted of a handful of people I knew from IRC. My 20s consisted of a string of failed business ventures. I was living at home. I had almost nothing in my bank account. I had very few friends and I would inevitably sabotage every friendship I had. I was overweight. I didn't have a girlfriend and had never even experienced a kiss. I lost a parent and then lost a step parent. I felt like the supposedly best years of my life were slipping through my fingers.

After being rejected by a girl I met online because of my weight/appearance, I decided that getting in shape would help. Eventually I was able to lose weight and I met a girl after attending a rare social event. I thought she was perfect and we hit it off but after our first date she rejected me in a very harsh way. I was devastated and decided to end my life.

I'll spare the details but I spent considerable time researching. I purchased the instrument of my demise. I wrote letters to the few people who I thought would care apologizing for my shortcomings.

Before I took what I believed would be the solution to my pain I took all of the money I had from a gig and went on a solo trip overseas. The first night I cried myself to sleep. I literally walked everywhere until the heels of my feet bled. I talked to some people I met and had a wonderful experience that reminded me good can enter your life in the most unexpected of ways and at unanticipated times. But most of my travels were in my mind.

My pain didn't end when I came back but I didn't end my life. Today I am in much better financial shape but I don't feel I have lived up to my potential and I'm still very much a procrastinator. I still don't have many friends. I have a girlfriend although anyone in a relationship can tell you they look easier than they are. There are days when I feel lost or like an impostor. I still have more regrets than I can count. I am currently mourning the loss a pet who I considered one of my best friends.

You're not silly or pathetic. I don't know what the purpose of life is either. Life is absurd and undeniably impermanent. I don't have any advice to give but if I could suggest one thing, it's that absurd, impermanent things aren't inherently worthless and incapable of providing happiness. "Nothing matters anyway" is as much an invitation to experiment with life and live it without worry or expectation as it is to give up on it.

Human beings are wired to find intrinsic value in certain things. Art, music, puzzle solving, beauty, achievement, scientific knowledge, friendship, fine tasting food, travel experiences, charity work. Even life itself has some intrinsic value that we recognise. Ultimately none of these things has permanence and the pursuit of them all is absurd in some sense.

All of these are things that transcend our animal needs and desires. We value them not because of their ultimate usefulness or their needfulness, but because they have intrinsic value. Not ultimate value, but intrinsic value nonetheless.

Trying to fill your life with as many nice experiences as possible before you die only exaggerates the impermanence of our physical lives. And striving to "leave a legacy" for future generations can distract us from the intrinsic value of things that only we can experience and appreciate, and necessarily only in our lifetimes.

I'm absolutely desperate for the New Horizons spacecraft to finally arrive at Pluto next year. I'm going to look at every photo that thing sends back and be thrilled at having lived at precisely the right time to see it. And I'm going to keep looking and soaking it in until I am sick of that sucker. I'll read every article on it. Not because I think that it's going to have any meaning in the broader framework of my life (I'm not a planetary scientist), but because that will be an experience only people in my generation can have. To me, that rock will be beautiful, no matter how ugly and devoid of life it looks.

The same is true of a day's work. Any such day is probably meaningless. But at the end of it you can look at what you've done and derive satisfaction from it. Not permanent satisfaction, so that you don't have to do it all over again tomorrow. But real satisfaction that only you can experience.

Once I read a geology textbook, and learned about how the mountains are pushed up by continental shelves pushing together and worn down by erosion. Layers of sediment get uplifted. Earthquakes cause faults, and so on. After reading enough, I actually started to lose the sense of the beauty of mountains. All I saw was mechanical processes at work.

But this didn't last. Eventually, my innate sense of beauty captivated me again, so that when I look at mountains I am filled with wonder and a deep sense of awe. This despite the fact that I still know precisely how they got there, scientifically speaking.

I'm unsure whether the intrinsic value there is in the mountain itself or in my appreciation of it. But for that moment when I can actually visit a mountain, when I can actually have that experience, I appreciate that beauty.

But somehow, sitting around all day looking at photos of beautiful mountains, or even living right under one, isn't going to make me enjoy the rest of my life. The mountain is an experience I get to have irregularly. In this way, the intrinsic value of that experience catches me by surprise.

I even think that if I got on an aeroplane tomorrow to fly to a mountain to see it, I wouldn't be that affected by it. I'm sure we can do many things to increase our enjoyment of life, but I think that we have to be careful of believing that if we keep feeding experiences to ourselves we'll keep enjoying them. Treasured experiences can be very opportunistic. They depend on a happy coincidence of circumstances which I am uniquely able to appreciate at that time and place.

At least for me your message is very valuable, because the recognition in everything you say makes me feel less alone, or weird for that matter.

I quit my job just short of a year ago and took some time off. To some extent, it was helpful, because leading up to my quitting I noticed that I found it harder and harder to deal with even simple dilemma's or interpersonal issues. I felt myself steadily getting weaker, less resilient, and more isolated.

Leaning into that isolation, at first, helped. Having saved up some money I also didn't have to worry about, well, anything basically.

But at least in my case I feel I let it last a bit too long. The lack or purpose, even a 'stupid' purpose like showing up for a job I hated, ultimately made me feel terrified and the resulting existential 'depression' was possibly worse than barely-managed lifestyle I had before.

For the past few months I've started engaging again. I try not to ask myself too often what the 'point' is, but rather I try to dip my toes into different things, in the hope that I can find something that pulls me in so much that I stop dwelling on myself and 'big questions'.

I'm also considering a psychologist, even though for now I think I'm in an upward trajectory.

In the end, I've come to the (tentative) conclusion that my problem is not that I cannot find meaning, purpose, fulfillment or, well, happiness. Because in the end I believe nothing 'really' matters in some objective sense. And if I believe nothing matters, why would it surprise me that I cannot find something meaningful?

But that's not the issue at all. No matter how meaningless we think life might be, I've rarely met someone who truly feels that way too. We generally don't live with full awareness of our rational beliefs. And I myself too have gotten caught up in things that, until I reflect too much, feel intensely meaningful.

Rather, my problem, or at least one of my problems, is that my inability to handle the day to day realities and my attempts to 'fit in' (even while openly rejecting 'normalcy') have kept me from losing myself in whatever 'game' is challenging and fulfilling enough to not feel like a pointless game. As a result, not only am I stuck in a perpetual state of 'this is not meaningful, I need to reassess/fix/change/improve', and simultaneously a tremendous lack of experience with the mind-boggling variety of life games there are to play.

In fact, maybe an even bigger problem is that I have the arrogance to think that there is no game that can fool me.

I've found a lot of help in being around people who do not suffer from all that introspection. They seem to just randomly try things first, and only then concoct a story and meaning around it. And partly as a result of living in this way for a long time, they have actually figured out a lot of what makes them tick, and they found that 'game' that challenges them just enough to make them feel purposeful, but not so much that it overwhelms them.

And sometimes I think one good solution is to do more of that.

It's like I've gone through much of life trying to find that right partner without actually trying out relationships. The result is that I have spared myself the trouble (mostly) of broken hearts, mistakes, and terrible breakups, but I've also kept myself from actually figuring out what kind of relationship fulfills me. Because you can't really figure these things out without doing them.

I suppose mostly I'm just expressing my own process/issue in the hopes it helps someone feel less alone in their struggle. I don't think any of what I'm doing is necessarily a good prescription to anyone else.

Ultimately I find that at least one things that drags me out of depression is to focus on the trouble of others, or to swap stories. It doesn't solve things long-term, but I think it helps. The only thing I find worse than depression is feeling alone.

This is going to sound silly, but have you tried bodybuilding? Not just running or hitting the gym once a week, but actually weight lifting? It works for me every time, and I think here's why:

- it releases endorphins - making you feel real happy just after the workout

- it increases your testosterone - making you more likely to do those "manly" things like approach a woman, or do something you've been previously afraid of.

- it makes you loose weight - making you more attractive to the opposite sex, which boosts your self esteem

- you'll see progress: depression is all about breaking with bad habits and progressing in something. as soon as you'll see progress - it will be easier to keep going, as you'll visualise the reward.

- you'll make new friends: I've made more friends in the gym than anywhere else I think

- you'll get the girls: sooner or later, once that muscle shows up, you'll get laid, and women will want to date you. The only better route to that is making a million bucks quick, but you're not mentally ready for that, so lay off the PC, go lift some weights until you're exhausted, sleep, and lift some more. Repeat until depression is gone.

PS Don't break anything. Get a proper book (I suggest Arnold's Bodybuilding Encyclopedia) and follow the rules.

I get frustrated with advice like this - there have been periods where I've gone to the gym 5 times a week and had it have no affect on my emotional state whatsoever.

Moderate Depression is literally a different disease from severe depression. Don't assume what helps one will have the slightest affect on the other.

On the women thing - I lost huge amounts of weight after a massive diet and exercise regime and it... made no difference at all. I'm 5'5" therefore an untouchable as far as they're concerned (just google around on male height + dating if you don't believe me, I'm tired of arguing as to why this is the case people tend not to want to believe it.)

I think this side of things would make a difference with women, however, if you have no obvious flaws so for normal dudes it's applicable. But don't think it will necessarily have an impact on the depression. Severe depressives should see their doctor and try to get outside help.

Obviously it's all personal, I'm just saying it helps me. I'm 5'7" and date models. Lots of bodybuilders are short.

Also, a lot of people confuse "going to the gym" with proper bodybuilding. There's a big difference, at any time the gym is 90% full of looser guys on the treadmill. Like with anything, to get proper results out of it you have to take it seriously, research, read books, maybe get a trainer to get you started. You'll only get out of it what you put in. Light jogging on the treadmill won't help much, and it's not just about extra weight. There's something about pumping iron at your lifting-limit in particular that releases endorphins:

I feel like I did nearly avert a situation much like you are describing. I was just falling into a pitfall of depression when a decision, made in a strange, drunken state changed my life forever. By the weirdest circumstance I went to a latin dance class. The combination of structured social contact, technicality and physical exercise did wonders for my self esteem. There's a certain meritocratic vibe with dancers where with just simple repetition and hacker mindset you can become quite good, and people will respect that however your physical appearance. You can make lots of really great friends in a short time. I think that's one of the greatest life hacks a depressed hacker can do. You learn to interact with people easily as there is a very clear framework on how you approach people, there is always a big shared interest to talk about, and the amount of calories it can burn is incredible. I'm sure one can accomplish this with other shared activities, for example sports, but the amount of positive influence latin dances can do to a hacker is in my opinion unparalleled.
To both you and parent poster thanks for taking the time to write down your experiences. I used to completely dismiss people who had depression and anxiety, until I started having anxiety attacks myself. Now that I know how real they are, I instead feel like I want to study and understand the experiences of others and even ask questions (I will manage to restrain myself).

The fact is, technically minded people think about these conditions differently than others. We have the ability to be more detached, even from our own circumstances, and report our experiences without the mysticism and sentimentality. We also understand the placebo effect and evidence-based science, so we tend not to share endless anecdotes based on pseudoscientific potions and cures which are supposed to somehow magically solve the problem.

Therefore, I personally find your post hundreds of times more helpful than what I might find elsewhere. I also find blog posts (such as the linked article) from technically minded individuals on these issues, recounting their experiences, extremely insightful.

Although I've only seriously suffered from anxiety disorder, not depression, I can relate to a few things you write.

There were periods in my life (actually before the onset of my anxiety) where I couldn't see the point to life itself (I mean from a logical perspective; I didn't have suicidal thoughts). Actually, I had this from a very young age. I started off at age 4 with a passion for lego. But I quickly realised that I couldn't build a machine for doing real, useful work with this lego (it would break). And even if I did, what point would there be for me in building an excavator or a digger or motorcar that used the levers and pneumatics/hydraulics I was learning about with my lego? What purpose would I use the machine for? And even if I could answer that, what would I want to do that for, etc. So what was the real purpose in playing with lego?

I'm 38 and have never had a girlfriend! I live in hope. (The only thing I can recommend there is a dating website. I sure wish I'd discovered these when I was 29!!)

But when I was about 29/30 something strange happened that rewired my brain, seemingly all at once. All in the same year I suddenly became intensely interested in chess, scene (assembly) programming and a sport called martial arts tricking, after decades of not really taking all that much pleasure from anything. None of these things have any ultimate usefulness! And yet my entire mindset just suddenly flipped.

So what (scientifically speaking) happened to me? I've no idea, and I'd love to know!

Tricking stayed with me for 9 years. And even now I look back at it longingly. It has no ultimate purpose, but I miss it like crazy (there's no gym nearby where I can do it in my current location, and I'm getting a little old for it now). It's as useless as my childhood lego.

I don't want to suggest my experience has any immediate practical benefit for someone with depression. But I can definitely relate that what makes life enjoyable and livable, paradoxically, isn't necessarily something that gives it ultimate purpose.

I'm not suggesting I did something myself to change things. I just want to relate that even though I'm technically minded and fully understand what you mean by "life is ultimately absurd", this ultimately isn't an obstacle.

A king called Solomon apparently once wrote, "I have seen all the things that are done under the sun; all of them are meaningless, a chasing after the wind." When I was 29, I definitely thought I was suffering from the "insanity of Solomon" (a little early I thought). But apparently, it turns out, life is meaningless. That just isn't the problem.

Obviously standard advice applies. Most people here (especially me) are not psychologists and if the depression and associated thoughts keep up, seek qualified help, if you haven't already. Psychologists should be able to help you root out contributing factors, help you isolate and shut down unproductive thought patterns/habits that exacerbate the problem, and psychiatrists can dispense medication which might give you time to reset and recover. At least these days they too are starting to pay attention to evidence based science!

Well, ignoring the on-line aspect, this is the standard beginning book:

I read and used the early '80s edition, before the "behavioral" was added to it, and around a decade or so ago realized that learning and following it made further talking therapy essentially useless.

The theory behind the "cognitive" part of it, simply put, is that thinking bad, not to mention incorrect, thoughts about yourself makes you feel bad. Adjusting your mental filters and the like to reality can then make a very big difference.

(Not, in my case, a complete cure, I've got an inherited refractory depression that my doctors and I supposize is bipolar in nature, I just never go manic nor cycle all that much. Adding a SSRI to the mix significantly improves it.)

It might sound outrageous, but you're in a good spot in life right now.

I've been there a couple of times, I've even had a suicide attempt at 17 and ended up spending 2 months in the hospital with kidney failure. But each time depression crept it on me again, I was better and better equipped to deal with it. The last time I was depressed towards suicidal (about 2 years ago), two things helped me: This book: And a low-dose hit of LSD, which practically sucked me out of depression in one night (for the reasons outlined below). This was my way, you might need to take a different path, but speaking from experience, it is possible to get yourself out of this and then good things start to happen.

It will get better, just hold on.

The reason you're feeling like nothing works, is because you've forgotten what you've came here for. What this life is about. It's not about how well you write code, it's not about how many friends you have or how much money you make or what car/phone you have. What is it about then ?

That's for you to find out. That's how the hit of LSD or psilocybin (mushrooms) might help, but you need to know what and how you're doing it.

The other reason is the way you interpret reality and what you say to yourself every day. Details about this are in the book.

And some other ideas:

Stop everything, take a vacation and go on a trip. It's summer, go to a festival in the mountains or south to the sea, visit Paris or Barcelona or go to India. Do something you've always wanted to, but never had the time or resources to accomplish.

> That's how the hit of LSD or psilocybin (mushrooms) might help, but you need to know what and how you're doing it.

I figured out your LSD therapy was a form of self-help, but as someone who is under constant, long-term care of a psychiatrist, I have been told more than once that in the case of depression drugs and habitual alcohol intake are a no-go. LSD is especially dangerous. Please don't advise suicidal and mentally ill people to solve their problems with drugs.

And finally, depressed people don't need advice, they need patience, understanding and someone who is able to listen to them.

Your psychiatrist might be uninformed or maybe what he means is not to indulge in drugs as a way to escape reality (which I agree with).

Psychedelics, when taken in a safe setting and with the right goals (eg. as a therapy aid, not recreationally) can be extremely efficient for treating depression and all sorts of emotional issues.

There's a lot of literature and articles on the subject, for instance:

As as a side note, consider that psychiatrists are not gods and they know what they learned. In fact, I bet it would be detrimental for the whole industry if you could treat your mental issues in one or two settings and not use expensive psychiatric drugs for years.

> Your psychiatrist might be uninformed or maybe what he means

I think I am able to judge the competence of the doctor I am using, and, as their patient, determine the value their opinion better than a person on HN that happens to read a lot on the Internet and quotes an article with gaps in logic and no scientific proof that mushrooms actually help cure mental illness in people.

> In fact, I bet it would be detrimental for the whole industry if you could treat your mental issues in one or two settings and not use expensive psychiatric drugs for years.

Yeah, I bet it's the same with diabetes and cancer.

Magic mushrooms' psychedelic ingredient could help treat people with severe depression

Drugs derived from magic mushrooms could help treat people with severe depression. Scientists believe the chemical psilocybin, the psychedelic ingredient in magic mushrooms, can turn down parts of the brain that are overactive in severely depressive patients. The drug appears to stop patients dwelling on themselves and their own perceived inadequacies.

However, a bid by British scientists to carry out trials of psilocybin on patients in order to assess its full medical potential has been blocked by red tape relating to Britain's strict drugs laws. Professor David Nutt, professor of neuropsychopharmacology at Imperial College London, will tell a conference today that because magic mushrooms are rated as a class-A drug, their active chemical ingredient cannot be manufactured unless a special licence is granted.

"We haven't started the study because finding companies that could manufacture the drug and who are prepared to go through the regulatory hoops to get the licence is proving very difficult," said Nutt. "The whole field is so bedevilled by primitive old-fashioned attitudes. Even if you have a good idea, you may never get it into the clinic, it seems."

And here is some info about the history of Shrooms:

Jun 13, 2014 · georgewfraser on Founder Depression
Another good resource is the classic "Feeling Good" [1], which describes basic cognitive behavioral therapy in a self-help format. It's old but good and has been validated in clinical trials.


After years of bouncing around therapists, I found CBT. It fit my personality (obsessive, perfectionist, anxious) so well and has altered, for the better, how I approach every thought.
I second, "Feeling Good" is great.

BTW, there is another book by the same author(David Burns) -- "When Panic Attacks" [1]. It is focused on anxiety, not depression, but these two conditions often go hand in hand.


Apr 19, 2014 · hga on Employee Equity
Based on a variety of things including family history, my doctors and I believe I have "depression of a bipolar nature" ; not true bipolar but something akin that only expresses itself as depression. Based on his posting just now, it's very different from what he has, except for the "depression attacks", which perhaps got better with time, and definitely got better with anti-depressants, which generally cannot be prescribed to those who are frankly bipolar (and in my case one actually made me hypomanic, that's mania without hallucinations).

The #1 thing you can do to at least not help drive yourself deeper into depression is to learn cognitive therapy, which nowadays has a "behavioral" aspect added to it that I'm not familiar with (this is the CBT Michael refers to in his message composed at the same time as mine). Buy this book; I keep extra copies to give to people:

If you're truly bipolar, there's no substitute for a doctor's care as well, you'll probably need a mood stabilizer, of which there are many varieties from the "gold standard" of lithium to modern atypical anti-psychotics.

Apr 05, 2014 · hga on The Other Side of Depression
Indeed. The popular book by Burns ( in an earlier '80s edition before the behavioral angle was added made a significant and permanent improvement in my life, all done by myself, although with medicine and talk therapy added to the mix (my depression is not standard "unipolar affective disorder" and medicine is key to improving it, but not a complete solution).
Apr 04, 2014 · hga on The Other Side of Depression
Well, I recommend in general getting this book: (the good basic, for "patients" vs. doctors book on cognitive therapy (now cognitive-behavioral therapy, but I read it before that addition), and take the Burns Depression Checklist at the beginning of chapter 2. Based on your score, you'll get a rough idea from "no depression", "normal but unhappy", then "mild depression" all the way to "extreme depression". Based on that you can then know appropriate steps to take.

I'd add that I'll bet anyone can benefit from going through their thought patterns applying the insights of congnitive psychology, the therapy side of which says, very roughly, one way to make yourself depressed is to think incorrect bad thoughts about yourself (which includes how you view other people viewing you, etc.).

(Which is not to say there aren't also pure biological causes (see tokenadult's excellent comment:, family history eventually revealed that's a factor in my particular type of depression, but it's certain that self-applied cognitive therapy from an earlier edition of this book made a big difference for me, it's just not enough.)

Human connections are complex and it seems we are losing the skills necessary to interact with one another in other situations than a specific set. Maybe it's also related to aging but I get the feeling that calling someone to grab some beers it's a lot less common now than interacting via facebook.

The book "Feeling Good"[0] by Dr. David Burns might help you with your depression.


In this regard, i feel we must be the change we want to see.
Here it is at Amazon.

I can only directly recommend the '80s version, before the "Behavioral" bit was added, but I found it to be very very powerful. In 20/20 hindsight, so good that talk therapy afterwords hasn't been useful (there's no doubt a bit of Psychologist Roulette as grivo puts it involved, maybe there's a better therapist out there that I haven't found, but...).

When you use words like "bi-polar and depression" it gives the sense that this is a medical disease. And while speaking strictly, it is indeed a medical disease -- I want people to see the raw human factor in this.

Depression, for example, in my experience, and from what I've seen -- often has a cause; a rational, explainable cause (that the sufferer often isn't aware of). When you treat someone's depression as a "medical disease" like the cold or the flu, you are completely ignoring the human factor.

Many cases of depression can actually be solved without drugs -- by addressing the problem at the root of it. "Feeling Good: The New Mood Therapy" by David D. Burns, goes into this. (

I don't know why people ignore the real human factor when it comes to depression. Instead they resort to a bunch of drugs that do not address the root (psychological) cause of the depression, but rather just give some temporary fleeting relief.

Bipolar disorder cannot be solved with therapy. Additionally, clinical depression is different from situational depression. Yes, you are right, that many people would benefit from therapy in addition to drugs, but bipolar disorder, especially, is not a disease that responds to it. It is a chemical/biological disorder and needs to be treated as such.
The many many people in our lives suffering from a chemical/medical issue can not solve their problems with therapy alone. Depression is multi-factored and definitely partly chemical - maybe for some it's solved by spending more time in the sun but for many of our friends it is a serious clinical issue not to be mistaken as having a purely talk-it-out solution. Stephen is an excellent example here: he has the sheer intellect and forwardness of self-examination to know it can't be beat without looking at all factors and wouldn't presume to say that it's solved with drugs, or therapy, alone.
>maybe for some it's solved by spending more time in the sun but for many of our friends it is a serious clinical issue

Or so a 21st century corrupt medical establishment, that abuses and neglects science in favour of greed (from inventing mental issues out of thin air to over-prescribing medication, to even advocating unnecessary operations) likes to tell people.

Depression sure is a true medical condition for some (relatively few) people -- but in the quantities and degrees it affects the general population though, it's anything but.

And in these cases the situation can be exasperated by well meaning friends, relatives and practitioners searching for a root cause that, if addressed, will make it all go away.
In case you hadn't seen it, the author of Hyperbole and a Half recently posted about her depression, and she hit on similar things in a poignant way:

Extensive HN thread:

Jesus christ, yes. This is why many people suffering from mental illness don't talk about their problems: they end up feeling worse because their friends either try to "fix" them, or they end up comforting the friend, or both. It's always with the best of intentions, but I recently had an experience where I truly understood how terminal cancer patients feel; a friend wanted so badly to help, and kept feeling worse and worse about what was going on with me, and I just tried my best to comfort them at my own expense.

When the only reason you haven't killed yourself is that you don't have the strength to do so, the last thing you want to do is have the people you love going down with you.

(Note, before people get worried: I'm on the way up again now, and getting the help I need to ensure I don't get bad again.)

I always cringe when I hear or read a non-depressed person's advice to a depressed person. It often involves getting more exercise and going out in the sun. Getting more exercise and sunlight might help this person, but it probably won't be enough. The person will probably need cognitive-behavioral therapy and maybe even medication. Even then, a depression-free life is not guaranteed. Mental illness is complicated.
If I was one of your friends, would you have liked me to have just treated you as I normally do? If I had someone close who was dying, when I'm seeing them I think I'd just interact with them as I normally do (though accepting and recognising they are, in fact, dying), and not let the fact that they were dying to get in the way of our relationship. I rationalize this by thinking people don't want to feel being pitied upon. They want to feel important; and seeing them just because I want to see them would help in that regard.

Am I doing the right thing?

For me this depends very much on who it is that's trying to help.

If they've not experienced something similar to the mental health problems I'm suffering from it's usually best if they treat me as normal. The effort required to try and explain aspects of what I'm going through, usually with little success, is often far more detrimental than any benefit they could hope to provide. Being distracted from the problems, even if only for a short while, can be blissful and hugely appreciated.

On the other hand, I'm usually happy to be treated differently by people that have had similar experiences to me. I can often communicate to them in a sentence things which would take hours of conversation with somebody who'd not been there before.

It's a difficult situation for both the supporter and the supported, particularly in the early days.

> The effort required to try and explain aspects of what I'm going through, usually with little success, is often far more detrimental than any benefit they could hope to provide. Being distracted from the problems, even if only for a short while, can be blissful and hugely appreciated.

> On the other hand, I'm usually happy to be treated differently by people that have had similar experiences to me. I can often communicate to them in a sentence things which would take hours of conversation with somebody who'd not been there before.

I very much agree with both parts of what you've said here. I'm curious if & how you tend to balance between the two?

Generally when I'm having a bad time just having some casual distraction works fine, especially from someone who doesn't know what's wrong.

When I'm stuck in a rut, just having a few friends who can stop me bullshitting and keep me talking works wonders.

Most people I regularly spend time with are aware that I'm bipolar even if they aren't in the "been there" category. This is quite deliberate. When I'm well, I do my best to explain the difficulties I have during an episode to try and avoid people feeling alienated. This is not something I can do effectively whilst ill.

The result of this seems to be that when I become unwell people in this group provide me with the best kind of support that they're equipped to give while others help me talk it out.

Unfortunately this hasn't been so easy to achieve with family members as it has with friends since they're so desperate to see me well, although things are improving. Fortunately (or unfortunately) my wife is also bipolar so I don't have that problem with her.

As to balancing talking it out vs. distraction? I rapid cycle so distraction can be very effective for dealing with short-term mood swings. If I notice that I'm distracting myself a lot then that's a sign that bigger trouble is just around the corner and is when I start to seek help. My wife and I discuss the state of our mental health very frequently so there's always a certain amount of discussion going on as well.

Yes. Absolutely, absolutely, yes. What I want more than anything else: to feel normal. Even if it's just for 10 minutes while we're bitching about how bad some new album is, or playing a game. I won't say that's universal, but in my case I can't imagine anything better.
Please stop spreading misinformation. There are many kinds of depression, and there are two significant camps - little-d depression, which is depressed mood from negative life events (missing the bus up to funerals) and big-d Depression, which has biological elements and is what people mean by 'clinical depression'.
Temporary relief may be what is needed under many circumstances. I'm personally quite clear on the roots of my depression, but that doesn't make it easier to cope with. For some people it's a mystery or problem that once solved, ceases to be debilitating. For others it's an endocrine problem, best treated with drugs. For yet others, it is best treated with cognitive exercise. Each case is different and dismissing a whole class of clinical strategies is no better than treating those strategies as a panacea.
Are anti-depressants over prescribed? Sure. Are there cases where the root cause of depression is biochemical? Yes.

I've been on meds for bipolar for five years, and I see a therapist every week. The meds get me stable - like healing a broken broken leg - and the therapy is my personal trainer building me up to run the marathon. Neither would be as effective without the other, but in my case, if I could only have one, it'd be the meds.

As a counterpoint, I offer Robert Sapolsky, who most emphatically calls depression a disease:

I've watched 11 minutes of it, and I plan to watch the rest. Fascinating lecture.
This lecture is part of Dr. Sapolsky's Stanford class on 'Behavioral Biology', which in itself is captivating.
mental illness is an illness where something has gone wrong with the body in the same way that cancer is an illness where something has gone wrong with the body. Stigmatizing it in any way is not useful. Telling people to "just be happy!" isn't useful.
"Depression, for example, in my experience, and from what I've seen..."

Your anecdotal observations shouldn't drive your understanding. Go read up on it. Suffering from mental illness myself I find your post quite offensive.

I roughly agree with your sentiment, but your last sentence is IMO a bit too rough with the "resort to a bunch of drugs" part.

Any psychiatrist worth his salt, will primarly prescribe drugs as a means to help people cope, while working on the actual underlying causes. Indeed, in many cases, using drugs in the treatment may be the only option to make the patient's day-to-day life bearable. Drugs may also be essential for allowing the treatment team to examine, possibly very problematic, underlying issues.

Also, a SSRI, for instance, can of course not "treat" someone of a clinical depression; you will virtually always need professional cause-oriented therapy to get better. Most patients know this, or will realize it as they experience how their meds work.

Finally, there are some mental disorders, and many individual cases, that require constant medication, despite of the quality of the other treatment given. For example, full-fleged bi-polar disorder, where a manic or a depressive episode may have very severe consequences.

I have read that book and it is indeed very good because it gives the reader tools to succeed and the clinical research proving that what we think and the way we think greatly influences our mood.

Dr. Burns stated that the methods often work best when used in conjunction with medication. Some people may be so far down the rabbit hole that medication is necessary to restore improper brain chemistry.

Are people really not aware nowadays that Depression is used wildly and can be a real neuro-disease?

Did you know they can surgically put a pacemaker in your brain to "treat" you?

I thought it was common knowledge.

Even in cases that can/should be solved by addressing a root problem, often you still want to apply drugs so that the patient doesn't, for example, kill himself in a down period between his/her second and third psychotherapy session.
Pills are easy... Aside from a 30 minute visit to the doc.

Addressing the root cause typically requires working with others over a period of time... and that work is oftentimes what people with depression want to avoid.

No. That's a lie. I'm bipolar and have spells of depression that feel like doom. I've been dealing with it as long as I can remember. It can get really bad. Working out helps (if I have the strength to move), medication helps, but nothing and I mean NOTHING can make it go away until it has run its course.
There are cases of depression, so called endogenous depression, which can't be cured in any other way than with medication.
It IS a disease in the sense that it's an abnormal reaction to something.
Are people really not aware nowadays that Depression is used wildly and can be a real neuro-disease?

Did you know they can surgically put a pacemaker in your brain to "treat" you?

I thought it was common knowledge.

what is ignored (thanks to psychiatry being left wing, and trying to mitigate the downside rather than build on the upside) is that bipolar brings a lot of BENEFITS. when bipolar people are very hyper, they can achieve great things.

thats the reason why people with bipolar usually don't want to be medicated - the highs bring genius.. the problem are the lows which follow it.

average people don't make the big breakthroughs.

It's not like that, at all. Depressed or overly happy, I'm not productive, I just lose time doing nothing usefull, nor correct... But while stable, I van achieve very nice stuff pretty fast, because I van use my obsessive side tout good end. Trust me, being high or low is as destructive as the other, for you, your project and the people around you.
I know three bipolar people, and all of them take meds because they don't like what happens when they're off meds.
In bipolar disorder, depressive episodes are much more common than manic episodes. They get high , but they suffer much more than they gain from their illness and AFAIK, bipolar depression is much worse than usual unipolar depression and much much worse than depression caused by life events.
I'm not aware of any conclusive research showing that depression is more common than mania although people are more likely to seek treatment when depressed than when they're manic.

I also struggle to believe that there is any evidence to support your claim that depression as experienced by somebody who is bipolar is worse than somebody who is unipolar which is again worse than depression caused by life events.

This doesn't sound like you're talking from personal experience.

Saying that the highs bring genius is a gross simplification.

Yes, manic episodes can provide productivity boosts and huge amounts of energy but it doesn't have to go much further before it becomes impossible to complete a thought let alone a sentence, where you cannot sit still, where your judgement is severely impaired or you're suffering psychoses.

None of these symptoms (and there are many more) are particularly conducive to productive work, let alone breakthroughs.

try this link:

( -- The Greek philosopher Aristotle once said "there is no great genius without a mixture of madness," and now there is some scientific evidence that there is a link between mania and high IQ and creativity, since a study of over 700,000 subjects showed those who scored the highest grades were almost four times more likely to develop bipolar disorder in their adult lives than those scoring average grades.

Fry has Bipolar Disorder, diagnosed in England.

This is a very different illness to depression. And depression has different forms.

Yes, talking therapies are powerful. But you seem to be making the mistake that a talking therapy isn't affecting brain chemistry, or that drugs are inherently bad.

Comments like yours are very frustrating. Do you talk about people ignoring the real human factor when we put a broken bone in a cast?

But the biological theory of mental illnesses is very far from established. We have no reliable way of identifying them and no understanding of their mechanism. Existing studies of the medications we use to treat them have been subjected to pretty devastating critique; e.g. the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients.

The belief that mental illness is biological ("chemical imbalance in the brain" and so on) is very widespread and very emphatic. But the gap between that and what we actually know is drastic. What explains that gap? Most likely, it's that (a) people very much want to believe it, and (b) the belief has been heavily marketed.

Mental illnesses like cancer are defined by there effects not there underlying cause. As such they tend to treat a wide range of physical causes under the same general umbrella. And drugs or therapies which work wonders for some people often have little benifit for others. However, there are well studdied physical mechanisms for things like specific types of addiction which do present a physical mechanism.

A great example of this is Heroin addiction and alcohol addiction are vary different biochemically. There is even a wide range of Alcholhol addictions, but you will see them treated side by side. The simple truth is we can't really understand why someone has issues but we do have treatments that help people lead productive lives and that's enough to be useful. Just as your dentist does not need to know how pain killers work to use them effectively.

Steven Novella addresses the biological theory of mental illness quite well in this 10 minute segment from the podcast The Skeptics Guide to the Universe:
i realise it's anecdote, but i grew up with a parent that was depressive. was on lithium, etc. life was pretty damn miserable until the first SSRIs became available - they were the first drugs that had any noticeable effect and they changed our lives.
Anecdote it may be, but I'm glad to hear that. I know both sides of that coin myself.
> the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients.

No. Biological theories of mental health and mental illness are very much established.

And yours is a complete mischaracterization of the work of Kirsch et al.

Their meta-analysis found that in ALL cases of depression, there is statistically significant improvement in quantitative measures of depression treated with SSRI. In moderate to severe cases of depression, the improvement was clinically significant (ie a clinician and patient clearly note the improvement). The meta-analysis done on clinical trials were overwhelmingly trials of 6 weeks of SSRI or less. Suicidal patients are almost all excluded from such trials. Treatment groups were treated with SSRIs via research protocols, and not usual clinical practice: there were no attempts made to match patients to an SSRI that would be most likely to help, to wait on a response, to use SSRIs that were helpful based on a family history; dose adjustments were typically prescribed by study protocol and not by patient response, patients were not switched to another SSRI when there was no response or if intolerable side effects developed, often no attempt to treat side effects with other agents were done, etc. In other words, none of the things any physician routinely does to optimize treatment were done in those trials, and yet there were STILL improvements in measures of depression across the board.

No reputable psychiatrist or physician will fail to recommend an SSRI in cases of moderate to severe depression. Therapy can also be helpful, but the evidence is overwhelming that SSRIs help in clinically significant ways in moderate to severe depression. There is no credible doubt about it.

Despite your assertions about what "people very much want to believe" - in my experience, people very much want to believe that the brain is somehow different - that something beyond biology is at work. Believing that somehow depressed or otherwise mentally ill people can just "snap out of it" or "pull themselves up by their bootstraps" is erroneous, unhelpful, but fits nicely into really completely shitty and cruel narratives about human beings.

But please. Perhaps you'd like to advance a theory on how an organ like the brain differs from every other organ and does its work in ways not explainable by biology, chemistry, physics, etc.

And yours is a complete mischaracterization of the work of Kirsch et al.

It isn't my characterization so much as a paraphrase of various sources I've read/heard on this, including Kirsch himself. My understanding is that Kirsch and Sapirstein's findings are two: (a) for all but severe depression, the improvement of SSRIs over placebo is measurable but too small to be clinically significant; (b) even that small measurable difference is questionable, because the studies were not really double-blind. (Patients could figure out which group they were in because of the SSRIs' side effects.) Is either of those descriptions of their findings wrong?

I haven't kept a list of sources, but one I remember is [1]. Is Kirsch mischaracterizing his own work?

I noticed that you didn't use the word 'placebo' in what you wrote. My understanding is that Kirsch et. al.'s findings were specifically about lack of clinical significance beyond placebo. Could that explain the discrepancy between your description and mine?

Perhaps you'd like to advance a theory

I would not. Do you think that lack of a better theory has anything to do with whether this one is substantiated or not?


Shouldn't the default position be "we don't know"?

No that's a common misunderstanding. Science is the search for the best model/theory as such it's hard to rank something as better or worse than we don't know. Thus the default theory is "There is no relationship between X and Y". Even if not clinically useful there does appear to be a connection and as such you can replace the default theory.

After even more research the current theory is something like. "They appear to beat placebo's which have no side effects." Which again is far more useful than "We don't know." As it suggests comparing them to placebos that have side effects. Again not because they are going to help you treat patents directly, but because it tells you more about the disease and possible what research could be useful.

Science is the search for the best theory as such it's hard to rank something as better or worse than we don't know. Thus the default theory is "There is no relationship between X and Y".

For the purposes of this discussion, that's a distinction without a difference. (BTW I edited my comment before your reply showed up, and had deleted the bit you quoted.)

More significantly, your suggestion of comparing SSRIs to placebos with side effects strikes me as an excellent idea; it is what Kirsch's study would naturally seem to suggest. I wonder if such studies will ever be undertaken.

Edit: I did find at least one such study:

Authors' conclusions:

The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small. This suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos. Further research into unblinding is warranted.

Your comment is far more nuanced. You're reading the science. While I gently disagree with you I understand what you're saying, and I could fairly easily be persuaded that you're right.

The comment I replied to had some worrying flags.

It made blanket statements about meds; it suggested that depression has a "root cause". I took that to be a reference to classical psychotherapy -- some event happened a long time in the patient's past and that event must be uncovered by the therapist for the patient to address it and recover. Re-reading the post I see that I might be wrong! Perhaps the post is just talking about regular evidence based cognitive model.

> The belief that mental illness is biological

Well, for something like bipolar disorder this feels like it's true. I don't know much about BPD, and I don't know many people in real life who have it. But it seems that people need the meds.

When talking about depression I recognise that there are various types. I'm not a doctor and have no special knowledge. When people ask I suggest they investigate talking therapies (and probably CBT) first. But I know that people might get benefit from meds, especially if they're on the more severe end. I know that meds can have unpleasant side effects.

It's great when someone replies as thoughtfully as this, and I love your phrase "gently disagree". Would that more disagreements were of this kind.

> Well, for something like bipolar disorder this feels like it's true.

I agree. The open question is on what level these things are best to be understood. In some sense everything about us is biology, just as in some sense everything is physics. But we don't think of, say, heart disease as best addressed by physics. Similarly, that there is a biological stratum to our actions and feelings does not automatically mean that chronic emotional suffering is best understood as biology. One might as well conclude from the tongue and larynx that language is biology too. And indeed it is, sort of—yet its meaning lies elsewhere. Or you might as well conclude from the importance of neurons to learning that education is brain biology. Why bother with teachers or schools? We should just 'learn' the neurons directly. Such examples are obviously silly, at least given our current knowledge.

To know that chronic emotional suffering is a biological disorder requires more than the involvement of biological phenomena in it; it requires an experimentally verified model. My understanding is that we don't have anything close to that. The one that entered the public imagination, the serotonin-deficiency theory, is widely dismissed by experts [1,2,3,4]. The only argument seems to be whether they knew it was false from the beginning or discovered that it was false decades ago.

Yet we insist that modern science has discovered that mental illness is biological just the way that cancer is and so on. What do you call a conclusion like that which goes far beyond what we actually know?

It's worth realizing that psychiatry has always made this claim. The grounds for it shift every 20 years or so, and the previous grounds are always dismissed as ludicrous if not harmful (think lobotomies etc.). Nevertheless we're perpetually certain that we're beyond all that now.

> But I know that people might get benefit from meds

I don't think anyone questions that; the question is whether the benefit is that of a placebo or not. My understanding is that SSRIs are no more effective a treatment for depression than tricyclics were a generation earlier; their advantage is rather that they have fewer side effects [5]. So whatever explanation there is for their efficacy must plausibly explain how both of those (presumably very different?) biochemical mechanisms could do it. Given that even inert placebos produce most of the same effect (Kirsch's finding), the placebo explanation is pretty clearly a major candidate. If there's another, I'd like to know about it.

(I realize you were talking primarily about bipolar disorder, but I haven't read about that, so I've continued to talk about depression instead. That may lessen the relevance of the above.)


[2], via

[3], paywall bypassable by clicking link at


[5] This looks like it was withdrawn because it was to be superseded by a larger study, but I couldn't find that one.

One of the problems with describing an illness as psychological is that people think we are dismissing their illness, that we are saying the illness is not real. They think we are either saying that it's all in their heads, or that it's not serious, or that it's just a matter of them needing to "pull their socks up".

I think that might be why people cling to a biological model for mental health problems.

Obviously, we're not saying any of that. I say that there are powerful talking therapies; that these are evidence based and effective for many people; that medication may help although it's probably over-prescribed and it can have unpleasant side-effects; and that some people won't respond to any of that and may need electro-convulsive therapy or other severe interventions.

I agree that people tend to overstate the biological model, and that is a problem. It's a problem because, as you say, we don't know if it's true, and it's a problem because it steers people away from talking therapies.

A bit of background to support this point, bipolar disorder also does not respond to antidepressants, see

It is effectively treatable for most sufferers, of which a combination lithium-lamotrigine therapy is currently considered the treatment of choice. See

Talking therapies do not stop these kinds of mood swings, but they may be able to help people cope with the effects of mood swings. As importantly, they can help people follow their prescription, failure to do so being the #1 reason for these pharamceutical treatments to fail.

1) Even if there are drugs(antidepressants, stimulants, etc) which can relieve depression by interacting with dopaminergic, serotoninergic or noradrenergic neuronal systems, it doesn't mean that depression was caused by lack of specific neurotransmitters.

It's like making implication that if reboot solves a problem with your laptop, than this problem was caused by infrequent reboots.

Simple lack of one(or even several) neurotransmitter is an old hypothesis. Modern "neuronal" theories are more complicated and elaborate.

2) I'm going to give advice other than exercising, sleeping and eating well. These things are great, typical HN depression thread contains lots of advice on that by more knowledgeable people than me.


OP and other depressed or anxious people, there are self-help books by David Burns: "Feeling Good: The New Mood Therapy" and "When Panic Attacks". Both are available on amazon kindle: and

What's good about them?

First, they contain various scales for deprssion and anxiety. If you like to quantify things like OP, get this book, and measure your score 1-2 times per week.

Second, Burns features cognitive model for depression. It is considered that depression(and anxiety) is caused by unrealistic distorted thoughts, which you often think automatically and may not even notice such thoughts. They have vast impact on your mood though. So, literally, you feel the way you think. Change your thoughts and your moods improves. (easier to say than done, I agree)

Third, these books describe a great amount of cognitive tools, which will help you to think rationaly and realisticaly(and consequently - feel better). Even if you aren't depressed, you may find awesome tools which will help you to beat procrastination(Anti-procrastination sheet and daily activity schedule are my favourites).

Fourth, they are well-written and helpful on its own. The main power of these books is technics though. Reading + Using Tools > Just Reading.

3) If you're having difficulty fighting depression on your own - get professional help. Find a good CBT therapist, CBT shouldn't be very long, so you won't waste a lot of money.

Even if you aren't going to commit suicide right now or in the near future, try to get professional help as soon as possible. Suicidal urges is very alarming sign.

Remember, your problems are temporary, your pain is temporary. It shall pass.

For more practical advice, I will quote myself from another recent HN thread:

"There are great books by David Burns: "Feeling Good: The New Mood Therapy" and "When Panic Attacks". Both are available at amazon kindle: and The "Feeling Good" book is focused primarily on depression issues and "When Panic Attacs" (as its name suggest) on various anxiety disorder. I suggest to read them both. They are really helpful, but not just because of their content(which is good), but because they present of number techniques from Cognitive-Behavioural Therapy, which you can apply on yourself. But please note that reading the book and using these methodics is order of magnitude more effective than just reading the book and internalizing its contents."

I advice you to get these books(if you don't have kindle devices - don't worry - they have cloud reader so you can read them in your browser), and read them. They are not a replacement for professional treatment in cases like yours, but they may help, and they are easily obtainable.

I can't comment on the whole situation, since I live outside of the USA, but I can give you some advice about Problem #1.

There are great books by David Burns: "Feeling Good: The New Mood Therapy" and "When Panic Attacks". Both are available at amazon kindle: and The "Feeling Good" book is focused primarily on depression issues and "When Panic Attacs" (as its name suggest) on various anxiety disorder. I suggest to read them both. They are really helpful, but not just because of their content(which is good), but because they present of number techniques from Cognitive-Behavioural Therapy, which you can apply on yourself. But please note that reading the book and using these methodics is order of magnitude more effective than just reading the book and internalizing its contents.

Also, can you please elaborate on your issue with finding a therapist? Can you just go to a therapy session? Or you can't because you have to overcome strong anxiety first? If you are able to come and see a therapist(being able to manage your anxiety if you have any), then find a good CBT therapist and do come see her of him. Therapists are trained to deal with people who have all sorts of issues, even such serious as yours.

Thanks for the references; I'll give them a read ASAP.

> Also, can you please elaborate on your issue with finding a therapist? Can you just go to a therapy session? Or you can't because you have to overcome strong anxiety first?

I've attempted to find a therapist I can communicate well with online (complete failure there -- every service I tried was less than worthless, simply because it didn't give me what I really wanted, which was a judgement-free, confidential way to talk through things) and in person. In person, it's very difficult for me to talk about personal matters (business/tech stuff isn't a problem) so finding someone I can trust is incredibly difficult.

Not all therapy is talk therapy - I thought I needed that, but had similar reservations about how open I could be face to face. When I finally bit the bullet I ended up in most-self-directed CBT, with none of that recounting-childhood-trauma or what have you. It was very pragmatic, more about giving me processes to deal with things, than me telling the psych things and them telling me how to deal with them.
I just wanted to reply to give another endorsement to David Burns' Feeling Good ( - I personally use the Feeling Good Handbook ( which is the exact same thing but a little condensed. It's a big book which can be hard to tackle with depression.

Guys, if you're suffering from depression or anxiety, this is the be all and end all of lasting treatments that works. I actually Ctrl-F'ed for it when I opened this thread.

Agreed, strongly recommended. My Mom's a librarian, and she's given it to dozens of people over the years; back in the 1990s she even bought a dozen paperbacks on sale and would mail them to friends who were having problems.
Wow, 700 pages for the 4 dollar Kindle edition. Hard to not give it a try
Sep 13, 2012 · makmanalp on Depression lies
No problem! I don't know much about this but it appears that usually there is a trial period where people have to go through trying several different medications till they find the right one.

Meanwhile, try reading this: I haven't really read it but I've been exposed to the CBT methodology that it's based on (see my other comments on this thread) and it works.

Get help soon, and good luck! :)

Ah, that turned out to be easier than I expected, after I remember that I always keep a copy to give to someone depressed (it fully satisfies the "or at least should know about" criteria):

Feeling Good, The New Mood Therapy by David D. Burns, M.D. (

This is the best popular treatment of cognitive therapy (nowadays cognitive behavioral therapy, I haven't read this newer edition). Anyone who's depressed really needs to try this out, with or without the aid of anti-depressants.

The thesis is that you, at least in part, make yourself depressed by telling yourself depressing things that are largely false, about yourself, about what others are saying and doing to/about to you, etc.; in general, incorrect filtering of what you perceive.

So you identify those things and do you best to correct your mis-perceptions. Since I read an earlier edition in the '80s, behavioral therapy has been added to the mix, and that's supposed to help (I can't vouch for it either way).

Anyway, after I read this (and a few other cognitive psychology works) talking therapy became absolutely useless ... I'd "fixed" myself as much as possible in this way.

(Knowledge of this is also really useful to understanding the end of the Evangelion anime TV series (seriously, the creator was coming out of a multi-year bad period, "living by not dying").)

Second the Burns book recommendation.

Burns wrote a book in the 80s about how to meet people. It was the best book I ever read on how to meet girls. No gimmicks, just advice that works.

Please read this :

Just $8. It works.

thanks =)

I own it (an older edition) and use it. It's well-thumbed. It helps a lot, but not the whole answer. You prompt me to use it more, thanks.

With a little bit more effort, I am sure you can find more happiness within yourself. Write to me if you need more nudges :-) (gmail kirubakaran)

Wishing you all the best!

thanks! =) you too!
Aug 05, 2008 · 13ren on Ask YC: A Hacker's Dilemmaa?
I think I know what you're talking about. It actually sounds like an aspect of depression. Have you asked yourself if anything else is happening in your life that might contribute to your feeling sad? Are you in basically OK shape physically - getting some exercise, some sleep, some nutrition?

The other thing is positive thinking. I don't mean "happy" thinking; I mean positive in the sense of foreground vs. background. Foreground is something that can help you get where you want to go; background is something you don't have that would have helped you. When building something, you attach things to what you've already got - not try to attach things to space! Trees grow this way; crystals do too. And lots of people talk about building or growing software.

There's a framing issue too: I find it really helpful to compare what I have now compared with what I had before (to highlight the fact that I've had some impact). This is to counteract the frame of comparing what I've done with something that was better, was perfect.

Funny thing is, when I approach things in this "positive" way, I feel a lot more encouraged and inspired. Exciting ideas come to me from nowhere, and I have lots of energy. So, even though it seems like a fun, easy way, it results in much higher productivity. For me, anyway.

PS: there's a school of thought that depression is caused by formal reasoning errors ("cognitive distortions"). As a form of mind-hacking. I find it extremely fascinating:

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