HN Theater @HNTheaterMonth

This site has an unbelievable amount of armchair-science that gets rattled off. You are right, because depression and anxiety are primarily biological phenomena.

People looking for an actual expert discuss these things should watch Robert Sapolsky's talk: https://www.youtube.com/watch?v=NOAgplgTxfc

For example, in the talk, he points out one of the most telltale signs of depression is waking up early, which is completely backwards from the common perception that depression is someone staying in bed all day.

"I think depression is really caused by X, and anti-depressants are really just a placebo"

It's tough to quantify the efficacy of AD's, especially given the differences in individual neurochemistry, but claiming they don't work at all, or that depression isn't even real, is plain ignorant.

Everyone should be forced to watch Dr. Sapolsky's lecture before commenting on depression: https://www.youtube.com/watch?v=NOAgplgTxfc

Depression is not a well understood phenomenon.

It is vital in such a discussion to be mindful of the term "depression". It is used colloquially as a synonym for being "sad", "grieving" or just having a sad day.

I am depressed because my mom died. Usually means "I am going through natural grief process because someone very dear to be died recently" Robert Sapolsky explains this much better than I [1]

I have lived with major depression for 3 decades or so. Treatment is frustrating.

You go through whatever diagnostic process is being used. Then they throw pills at you.

This one might work, take it for 3 weeks - 3 months and tell us how you feel. You have to take it for a good amount of time to ensure that it's "fully working".

Some make you more depressed and more suicidal. Some have other serious side effects.

If the doctor treating, you figure that you tried out one for long enough they will throw a different pill at you and then you rinse and repeat until you feel better.

Then they will start to try combinations. That is even more fun.

I have spent years being a Guiney pig for the most part getting worse and having to deal with various side effects.

I am not unique in this. It is common for major depression to have to try and fail, try and fail, try and fail meds.

We have no physical way to diagnose depression as far as I know. You can't go to the ER and they measure something and can tell you if you are or not.

We dont know what causes it, (we have many ideas of things that sometimes do) and we have no way to measure how much better you are getting. Its based on talking, filling out endless forms, and being asked if you feel better.

There is no cure. (well death) (Being suicidal)

It is something you cannot run away from. It is in you, and you can run, but it makes no difference. (Exercise can be beneficial, but I am not talking about that right now.)

Well-meaning people will suggest all forms of activities that "Will make you feel better". It does not.

Then they will nag you about how much better you feel now. Which you dont.

I just want to urge people to be careful about using the term depression and dont build up too much hope in people (like me) because this new drug will fix you all up.

I would take LSD, MDMA, K (all have shown promise). If prescribed or as part of a study if I could. It will take massive research over time with plenty of Guiney pigs to figure out if it works, how it works, for how many it works.

With headlines and discussions on this, we will cause people with major depression to run out, buy street drugs, self-administer it and in all likelihood end up with even more problems.

Given the unknowns of street drugs, how pure is it, what else is in it, how much should you take? It is highly unpredictable.

[1] Stanford's Sapolsky On Depression in U.S. (Full Lecture) https://www.youtube.com/watch?v=NOAgplgTxfc

Years ago I found the video by Dr. Robert Sapolsky[1] to be a good introduction to the topic of depression. I also suffered a major depression of my own about six years ago. It was a horrible time in my life.

[1] https://www.youtube.com/watch?v=NOAgplgTxfc

There's a great video from a professor at Stanford, Robert Sapolsky, about depression, where he dives into the biological and psychological aspect of depression. [1]

> If I had to define major depression in one sentence, I would say, it’s a lot biochemical disorder with a genetic component, and early experience influences, where somebody can’t appreciate sunsets. And that’s what this disease is about.

[1] (2009, youtube) https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ podgaj

We have come a long way since 2009:

https://www.sciencedirect.com/science/article/abs/pii/S10898...

What Sapolsky was talking about was correct, but the fundamental driver seems to be oxidative stress imbalance. And the genetics part might be highly associated with the mitochondria:

https://www.nature.com/articles/s41380-021-01268-x

> suicides

While I agree with the message I don't think this will sell well. Many people do not even have the faintest idea of what depression is like and understand it as an illness. So they see it as a personal choice and therefore not a thing for the government to solve. Similar to drugs. This is of course despite the connections to environmental causes and government regulations. You greatly decrease rates of depression and drug usage, which are highly correlated, by the same thing. Making life better and less stressful. That even helps non-depressed and non-drug users.

Despite that, I think we should just talk about other types of gun violence. The vast majority of which involve hand guns. Which if you understand this, makes the national conversation seem extremely odd.

I'd encourage everyone to watch Sapolsky's lecture on Depression[0].

[0] https://www.youtube.com/watch?v=NOAgplgTxfc

[0^] My running hypothesis is that the since we have a new fiasco every other day that it causes over stimulation (like a stress response) and causes socio-motor retardation (analogous to psychomotor retardation)

Stress impact also varies per individual biological differences.

According to Sapolsky's lecture on depression [1], a stressful childhood experience is 30x more likely to cause depression in individuals with a particular serotonin-related gene variant.

[1] https://www.youtube.com/watch?v=NOAgplgTxfc @ 47:00

I tried everything except for medication. I was afraid i would no longer be 'myself' or that's what other people told me — or maybe that it would make the problem more real.

Anyway, I eventually took meds, and I have never felt more myself, or the person I want to be. I work, learn, socialize, live in a (relatively) clean apartment, which I leave to go outside.

It took me way too long accept that depression is not all my fault, that it's a disease, and that I needed to see a real doctor.

For those who suffer, or know those who suffer (that's probably everyone) I really recommend this lecture:

https://www.youtube.com/watch?v=NOAgplgTxfc

It's super interesting, it ties all the causes of depression together — childhood trauma, everyday experience, down to the neuron, and chemical reactions. It really helps externalize it.

⬐ sergiomattei

ADHD makes me feel like this. There's days where I wake up and I just can't cope with anything: everything feels like a chore to power through.

However, I don't like to medicate. I always feel like they tone down my personality and I'm just not energetic anymore. It's a real shame because the meds (atomoxetine, an SNRI) eliminate my anxiety.

I honestly try to power through the days. I find that having solid habits and a routine is a big help for days like this. It's a lot easier to get things done on a bad day when you don't have to think about things much: just wake up, do your bed, and start your morning routine.

Your post inspires me though, I might start taking the meds again. I dropped them for side effects and the aforementioned personality changes. I'm in a good place right now, but when the lows hit, it gets really annoying to constantly power through life on hard mode.

⬐ Cthulhu_

My girlfriend mentions that her ADHD meds (Concerta, or an off-license / cheaper alternative with the same active ingredients and slow release) act as a mood stabilizer more than anything. She's struggled with depression for ages, antidepressants or anything changing her hormones made her spiral downwards instead of make her feel better.

One thing to keep in mind is that it takes a few days for it to be fully effective (leftovers from the day before overlapping with the next dosage). Another thing is that if it doesn't seem to do anything, you may need a different dosage.

Another colleague diagnosed as an adult described the effect to be quite mind-blowing, as in, his head finally quieted down.

Anyway, nobody I know mentioned they feel like they are someone else. It helps them function and cope with daily life. The "ritalin changed my child into a mindless zombie" memes are over the top, or may imply they've been vastly over-medicated (although ritalin is short-acting, whereas concerta are slow release).

And finally, it's fine to take a medication break every once in a while, it does seem like you build up a tolerance to it.

⬐ throw0101a

> It's a lot easier to get things done on a bad day when you don't have to think about things much: just wake up, do your bed, and start your morning routine.

The routine stuff is the 'easiest' part in some ways. It's "not having fun" that can really create a drag over the long term:

> Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure.[1] While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers to refer to reduced motivation, reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), and deficits in reinforcement learning.[2][3][4]

* https://en.wikipedia.org/wiki/Anhedonia

⬐ sergiomattei

In my experience, for an ADHD folk the routine stuff is the hardest.

If it doesn't give you a hit of dopamine, it becomes extremely difficult. Anything from homework to daily chores means your brain entering a deep brain fog, almost like a subdued headache.

Getting to a point where I have the discipline and self-control to maintain a daily routine has been a lifelong challenge.

⬐ stevewodil

You can also try different meds if the ones you take have bad side effects

⬐ shadowfaxRodeo

I should have mentioned in my comment, the first meds I took did absolutely nothing, it was the second try that actually did the trick. Worth giving it another shot.

⬐ barbs

Out of curiosity, which meds did you try?

⬐ shadowfaxRodeo

Citalopram then Sertraline.

Different people have different reactions. This is not medial advice. Consult your physician to see if sertraline is right for you.

⬐ wayoutthere

With ADHD there are really only two options; atomoxetine (Strattera) and stimulants like aderall or ritalin (or any of the dozens of time-release versions of those two drugs).

I did stimulants for years and they really distorted my sense of self in a way that was hard to put a finger on until I got out of the long-term traumatic situation I was in. I felt like life was a treadmill and I was looking at my feet the whole time — I could go really fast but I lost sight of everything around me. I switched to atomoxetine and while it still takes effort to start something, it’s much easier for me to take a task to completion (or at least further towards completion).

⬐ pseudalopex

Wikipedia says guanfacine and clonidine too. And bupropion and modafinil off label.

⬐ corty

Amantadine and certain antidepressants are said to help some people affected by AD(H)D as well. But talk to your doctor before you go "oh, amantadine is cheap otc flu med...". And it depends on a lot of factors, like your exact symptoms (with/without hyperactivity), treatment goals, side effects and secondary problems. Really really talk to a doctor about this, getting "the meds" right is complicated and takes some trial and error.

⬐ cableshaft

This is what stops me. I definitely have at least societally caused ADD (i.e. internet is just a click away full of ways to waste the time away), but probably a bit more than that, and I have a close family member with diagnosed ADHD, so I probably could get it diagnosed and get meds for it...but I'm a little afraid I'll lose one of the good things about it, which is my brain keeps bouncing around from idea to idea and comes up with all sorts of interesting things.

Now being able to stay focused to get those finished enough to get them out the door and released on the world is another thing entirely, and I seem to be having more difficulty with that now that I'm older and have more natural distractions such as two dogs that always want my attention at the worst times :)

But yeah, always had issues with deadlines, getting to places on time, impulse control, focusing on things I don't care enough about (i.e. work), etc. I've muddled through anyway and done alright for myself, at least so far, but I might get more accomplished with some medication.

But then what if I stop coming up with cool game designs and stories and music as a result?

The other thing that stops me is that close family member had some bad reactions to ADHD meds (both physical and mental), so that also gives me pause, since we share a lot of the same genes.

⬐ cecilpl2

> But then what if I stop coming up with cool game designs and stories and music as a result?

It seems to me that you could try it, and if you don't like the results, then stop taking it. The effects aren't permanent.

⬐ ReactiveJelly

Yep. I tried Adderall and the effects weren't quite what I wanted, so I just told my doc and tapered off it.

(I had trouble sleeping, and it wasn't giving me executive function in the evening when I needed it to, instead I was crashing after work)

⬐ cableshaft

They were permanent in my family member's case. They're not taking the meds anymore (taking anti-psychotic meds now), but they're still getting worse. Granted they did take it for several years before it became apparent (and/or they let others know) that this had started happening.

Not saying the meds are definitely the cause, maybe it was a latent thing they always had, but we share enough genes I'm not sure I want to take the chance. The effects it had on them was/continues to be pretty scary.

https://www.healthline.com/health/adhd/adderall-psychosis

This is probably my main concern, actually, not so much the other, sorry for not making that clear.

⬐ pseudalopex

There are other medications that work differently.

⬐ ericmay

> But then what if I stop coming up with cool game designs and stories and music as a result?

Do you come up with the designs and stories and actually implement them or are they all half-finished projects? I think if you’re actually completing them, there’s no need to change and I somewhat doubt you have ADHD.

If they are all sitting half-finished on the shelf, yea that’s different. IMO

⬐ cableshaft

Almost all half finished, especially lately (pandemic really killed a lot of my creative drive and seemed to make my mind even harder to focus). I’ve got like 50 board game prototypes and zero published (1 signed with a publisher though, and a couple that have been finalists in design contests though, so maybe someday), eight novel manuscripts I could never finish editing (most written during Nanowrimo), six half-finished video games (8 finished and released ones in my past, but zero in the past…almost 10 years now), etc.

⬐ ericmay

I feel you there. Especially with the creativity stuff.

⬐ the_only_law

> It's super interesting, it ties all the causes of depression together — childhood trauma, everyday experience, down to the neuron, and chemical reactions. It really helps externalize it.

I’ll need to check this out. I really want to know more about what depression “is” before attempting to treat it. I’m skeptical about most suggested treatment options including medication, despite me being least skeptical about that. However, I was many years ago diagnosed and thrown on medication. Hard to not be cynical when you’re watching TV a decade later and see ads for a class action lawsuit regarding long term side effects of a medication you’re on because the company fraudulently claimed it was safe.

⬐ noname120

If you don't mind sharing, what meds did you go on?

⬐ mahathu

depression is not a disease, it's a name for a group of symptoms with wildly different causes and remedies.

⬐ shadowfaxRodeo

Disease is a pretty vague term — perhaps there are situations where it has a more specific meaning but in general usage it just means "health condition"

Depression is used as an example of a disease in the first few paragraphs of the wikipedia entry for disease

https://en.wikipedia.org/wiki/Disease

Here's the Merriam Webster definition, I think depression fits into it.

https://www.merriam-webster.com/dictionary/disease

⬐ mancerayder

The issue with people I know who take them are more than not feeling oneself, it's potential side effects like sexual issues, weight gain, and for the creative types, feeling less creative (so perhaps more of the losing oneself fear).

⬐ sirspacey

Thank you so much. You changed my life.

⬐ machinehermiter

Same here. Prozac and walking 30min a day building up to 50min a day changed my life. I eventually quit smoking a pack a day cigarette habit also. It took years for me to try SSRI though.

Not taking prozac was a combination of being stubborn but you also never really read anything good about SSRI. It doesn't fit the narrative that big pharma is evil.

I tried therapy but the therapist were honestly terrible. The only good one was the one that prescribed me Prozac but the actual discussions were basically nonsense.

SSRI get a bad name IMO because people want to take them and magically have all their problems solved that lead them to be depressed. IMO it has to be in combination with a real willingness to absolutely change your life and habits. Have to get in good physical condition. The idea you can sit around all day, getting more and more out of shape but somehow not be depressed is not really logical.

On the topic of destigmatization, I recommend this Robert Sapolsky lecture (on the neurobiology of depression) to everyone to understand just how physical and systemic depression is: https://youtu.be/NOAgplgTxfc.

For understanding how lifestyle changes can help treat depression, I recommend this: https://youtu.be/drv3BP0Fdi8. He contradicts the author on the point of exercise—it is one of the most potent medicines (though hard to administer to yourself when you’re depressed).

Reflecting on my own (extensive) experiences with depression and its co-conspirators, I think there are two deep fears that inhibit seeking or sticking with treatment:

1. What happens if I don’t get better? Then I’m hopeless.

2. What happens if I do get better (and it’s not enough, or I ruin my progress with a relapse)?

I don’t have a definitive answer to either, but reasonable responses include: trying and failing feels better than languishing/surrendering (not trying is the only thing that’s likely hopeless), it is (or should be) OK to make nonlinear progress in managing chronic illness (depression or otherwise), and the universe/existence is at once magnificent and meaningless so just try to relax and enjoy the ride with your fellow creatures.

⬐ zeeshanqureshi

Great lecture. I can't remember how many times I've recommended it to people.

Another good (and recurring[0]) resource for a model of depression can be Robert Sapolsky's Stanford lecture on it[1]

[0] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

[1] https://www.youtube.com/watch?v=NOAgplgTxfc

Stanford's Sapolsky does a pretty good job explaining what is and isn't. I recommend the full lecture, it's interesting stuff: https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ getpost

Sapolsky himself struggles with depression, which he claims is genetic, IIRC. Not that I know anything, but I was struck that someone with his knowledge and intellect seemed to have given up attempting to treat it. He maintained psychological defenses that made me wonder whether he'd received adequate care.

I'm not sure where I heard this, but likely it's one of the following podcasts, which are worthwhile.

Sam Harris #91 - The Biology of Good and Evil https://samharris.org/podcasts/91-biology-good-evil/ YT version: https://www.youtube.com/watch?v=rLWzMH8psFU

Peter Attia #51 – Robert Sapolsky, Ph.D.: The pervasive effect of stress – is it killing you? https://peterattiamd.com/robertsapolsky/

⬐ Ardren

Thankyou, I'm watching it now.

⬐ nient

Here is a condensed, blog-post version, based on that Robert Sapolsky's lecture. https://www.scienceme.com/the-biology-of-depression.php

My understanding of the research is that, compared to a placebo, antidepressants help as much as 20% more of the population (20% -> 40%), and the broader scope of drugs can help around 30% to 40%[1] of people. People routinely feel suicidal, take SSRIs, and later stop feeling suicidal.

[1] https://youtu.be/NOAgplgTxfc?t=2294

I would recommend people watch this lecture by Stanford professor Robert Sapolsky, who studies these things in depth and is an actual expert.

https://www.youtube.com/watch?v=NOAgplgTxfc

There is a lot of arm-chair thoughts on this matter in this thread, and I feel this lecture sets a lot of things straight.

A helpful quote from the talk: "...the single point I want to hammer in here over, and over, and over, is something that people with depression constantly battle with. Back to semantics, we all get depressed. Bad stuff happens to us. We all get depressed. We feel lousy. We feel withdrawn. We feel a sense of grief. And we're not taking much pleasure. And we withdraw. And then we get better. We cope. We heal. We deal with things in life. What's the deal with you that you can't do that? And there's this lurking sense given that all of us have periods of being depressed and come out the other end. When you look at people who instead go down and stay down there to this crippling extent, there's always this little voice between the lines there of, come on, pull yourself together. We all deal with this sort of thing. I will make the argument throughout here that depression is as real of a biological disorder as is juvenile diabetes."

I find it very disheartening to see antidepressants described as "happy pills" that "numb your senses". Comments like this only serve to reinforce the stigma around these medications. This stigma is the part of the reason why I held out from seeking help for years.

My experience taking Mirtazapine has been the exact opposite. At the deepest point of my depression, that is when I was "numb". Like many people I would listen to sad music when I was depressed, but eventually sad music didn't make me feel sad anymore, I literally just felt nothing.

Since being on Mirtazapine, my depression is gone for the first time in 13 years and it's completely changed my life. I still have the full human emotional range - I have good/bad moods (mostly good), days where I feel bored/meh, I cry at the sad parts in films. The antidepressants cured my depression, they haven't given me a false sense of inflated happiness. The question of "am I actually happy?" doesn't even really cross my mind. I'm just content.

The only side effects I experienced were 3 days of extreme tiredness when I first started taking them, which then subsided. And my appetite increased, so I have gained a few pounds, but since I was already quite skinny and had started lifting weights, this has been a net plus.

I found this lecture by Stanford professor Robert Sapolsky highly insightful - https://www.youtube.com/watch?v=NOAgplgTxfc - We all get depressed, it's a normal part of life, but depression is a disease which causes you to stay depressed for no reason, and it's as real of a disease as diabetes (we know this because the brains of people with depression look different, even when they're sleeping)

What's weird is that, when I was depressed, I already knew everything that he says in that video. I doubt this will make sense, but it was as if I knew it, without really "knowing" it. I knew I had depression. I knew how depression affected the brain. I knew how antidepressants worked. But if you'd asked me if I wanted them, I would have said no.

One thing that I have come to realise, is that I had to unlearn all the negative preconceptions I had about "happy pills", and be ready to accept that the medication had the _potential_ to work, in order for it to work.

During the 13 years that I was depressed, there were still lengthy periods of time when I felt relatively happy. Unfortunately, this led me to the (incorrect) conclusion that I could cure my depression myself if I just found the right combination of lifestyle choices. I started exercising, eating better and trying to get enough sleep. I tried to maintain good relationships with my family and friends, and explore my hobbies. The depression always came back.

Ironically, all this time spent trying to get better without medical help, probably extended the years of suffering, yet it was absolutely necessary to create the conditions that were needed for me to actually get better. The final pieces of the puzzle were: to truly accept that I had a disease, caused by unresolved trauma in my childhood, to seek counselling to resolve those issues, to lose the preconceptions about antidepressants, and to start the medication.

This process alone took around 2 years. I am one of the lucky ones, I genuinely count myself as lucky that I "only" wasted 13 years. Depression is an insidious disease.

The final thing I will say is that I often felt at the time that the therapy sessions weren't achieving much - it is only looking back that the impact becomes clear. (Also, you don't have to be depressed to benefit from counselling.)

Talking to friends and family can have just as big an impact, but therapists are trained listeners, you don't have to explain "why" something was traumatic, they just get it.

I would recommend looking at this video if you're interested in the subject: https://www.youtube.com/watch?v=NOAgplgTxfc

He also has a full playlist on human behavior which is very interesting

Sapolsky on depression: https://youtu.be/NOAgplgTxfc

“Depression is agression turned inwards”.

He explains what our current understanding of depression is. I think you’ll have a whole new understanding of depression after watching this.

Okay, my mistake for getting dragged into the archetypal HN argument. It's clear you cannot be convinced. Your original point - that depression has no biomarkers and is extremely subjective - has been proven wrong by a couple others and you've shown no gratitude or interest in this information. Only replying where you think there's an argument to be won.

Maybe you, some random person on Hacker News, are not in fact smarter than the medical consensus?

https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ anm89

And again, I didn't say there are no biomarkers. I belive there are biomarkers.

The idea that I'm not coddling your victimhood/ helpless mentality is offensive to you, not any specific argument I'm making.

⬐ ExtremePopcorn

ah, also - are you cool with suicide? if so I think your hardline approach is fine, it's really just being forced to live + treated like shit (ref. your post) if you don't enjoy it enjoy it enough that I think is the real issue

⬐ ExtremePopcorn

Uh no, sorry, it's the argument. You've been on this site for four years now - be honest, have you ever seen someone with a lazy armchair opinion enter a debate, receive strong pushback including scientific citations, and then refuse to change their opinion? It's literally every fifth thread here. Though imo, more fun when it's idiots telling tptacek he's wrong about security than when it's someone a dick to someone with depression (my victim mentality!!)

But sure, let me actually respond to you:

* At no point have you acknowledged or shown any awareness that depression is not "one thing". Like how people discuss "curing cancer" as if that's any sort of meaningful statement. How complex do you think depression is? What point of complexity does something need to reach before you defer to experts? Depression is still more or less a black box (watch the Sapolsky video I linked or look up some starslatecodex articles on ketamine.) Again, no sign of awareness of this on your part, which suggests you haven't done the most basic research.

* Yep, you never said there are no biomarkers. You said:

> Depression is a set of guidelines in a book that ask vague subjective questions about how someone perceives the world. And then if the person decides you have it you have it. If they don't you dont. This has very little to do with the first scenario."

This was your reason for stating that depression wasn't an illness. That it was based on a list of subjective questions. Sadly you didn't respond to the person saying that this was equally true for schizophrenia. Is schizophrenia an illness?

* I said it was an undercurrent, meaning subtext. Do you understand why subtext can't be quoted, and why that's work that you need to do for yourself? (If you somehow can quote subtext, though, immediately switch careers to political journalism, you'll be a wonder.)

* The only really offensive part was when you said "I do also believe that people don't have zero agency in this problem." Like, cool, a few sentences in and you've also added in a complete strawman to make yourself look reasonable. So this was just debate club to you.

The last point, combined with the fact that you're only responding when it might let you feel superior, leads me to believe you're not here in any sort of attempt to learn. How's your own mental health? You're clearly get some need fulfilled by arguing on the internet, which generally isn't the best sign. Watch that video, it's good, and absolutely full of things you do not know.

Robert Sapolsky described it this way [1]:

> You get someone who is severely depressed, like to the point of hospitalization, and when they are absolutely crippled with psychomotor retardation, that's not when you worry about suicide.

> This is someone who's having enough trouble getting out of bed and getting dressed each day. They're not going to figure out how to shred the hospital mattress and make a noose out of it.

> Where you've got your problems is when somebody begins to get better from a severe depression. When they're starting to come out, that's where the psychomotor retardation relieves enough that suddenly they've got the energy to do something catastrophic. That's when people are on suicide watches (when you have clinicians who are oriented well).

[1]: https://youtu.be/NOAgplgTxfc?t=514

The stress vulnerability model[0] in psychology may give some insight with regards to mental illness.

Robert Sapolsky elaborates on them comprehensively in his Stanford lecture about depression[1]

[0] http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_v...

[1] https://m.youtube.com/watch?v=NOAgplgTxfc

The reviewer seems uninformed about the research reported by Robert Sapolsky (almost ten years ago) that depression is not a unitary phenomenon, but rather likely a combination of imbalance in epinephrine, seratonin, and dopamine. https://youtu.be/NOAgplgTxfc

Was Sapolsky playing fast and loose, or are the multiple components of depression widely appreciated in the field now?

⬐ jdietrich

The idea that depression has multiple causal factors has been the consensus for a long time; drug companies briefly pushed the serotonin hypothesis to sell SSRIs and some poorly-informed clinicians believed their marketing materials, but the overwhelming scientific opinion is that depression is the product of a mixture of genetic, neurological, cognitive and social factors. In the research community (but not necessarily in clinical practice), it is readily acknowledged that depression can be caused (or at least triggered) by a variety of biological factors such as comorbid diseases, malnutrition, brain injuries and drug side-effects.

Sapolsky's perspective is somewhat fringe, mostly because he's a neuroendocrinologist rather than a psychiatrist. His perspective reflects his research interests rather than a broader clinical perspective. I can't say that I'm hugely familiar with his work, but I'm not sure how much of it is actually clinically relevant.

Depression correlates with hormonal changes, but saying it's a result of it is reductionistic and inaccurate. Depression also highly correlates with changes in inflammatory markers called cytokines[1], but reducing it to a single biological factor never yields an accurate pathogenesis of the disease. Robert Sapolskys Stanford Lecture gives a good overview of the interaction an relationship of the main risk factors causing depression[2].

[1] https://scholar.google.com/scholar?q=depression+cytokines+me...

[2] https://www.youtube.com/watch?v=NOAgplgTxfc [Robert Sapolsky On Depression]

⬐ rygxqpbsngav

Great. May be I am wrong. But just found that Ashwagandha regulates Cytokines too.

https://www.spandidos-publications.com/ijmm/42/1/425

I think its use for stress & anxiety reduction is studied too,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/

⬐ kekebo

It's not so much being wrong than just naming one piece of a more complex puzzle. A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep, and lifestyle factors like smoking, alcohol, certain drugs like amphetamines, to just name a few.

In general, expecting that the intake of some chemical will fix the multitude of factors contributing to this complex disease seems short sighted and may create false hopes in people suffering from it, so far no easy chemical fix has been found or it would instantly replace SSRIs in their lacking efficacy. For me personally the only things that helped over long were radical mental discipline (daily mindfulness, cognitive behavior therapy), daily exercise, nutritional changes and a willingness to be comfortable being uncomfortable to make those changes.

⬐ rygxqpbsngav

Agree. I am a strong believer of treating things without medicines at all. Although I do take herbal supplements proven through centuries to be safe. One thing I can be sure is, there is no negative effect using ashwagandha.

> A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep

If that is true, you get best sleep when using Ashwagandha and its effect on stress, like I said previously is well studied.

https://examine.com/supplements/ashwagandha/

it is there for centuries and affects in a multitude of ways for a body to bring it into balance in every front. In ayurveda, if a practitioner or doctor was unable to diagnose a disease properly, they simply give them Ashwagandha, as it will work or fail to but never works adversely. I still strongly recommend trying it with any other interventions you mentioned like exercise, etc. I never discouraged any other interventions. It helped me personally, so I am inclined to suggest it to others who are hopeless at the moment. Like I said, zero harm. I never suggested it as a one shot solution. People with depression need more caring than any other.

⬐ rygxqpbsngav

I have to disagree with the false hopes part. Just went to find some reviews(in 100s) on aswagandha products who gave 5 star reviews who claim it helped them with their depression better than prescribed ones. I think we are getting lost in the loop again - "I won't take it until it is well studied" while rest of the people already befitting from it without any side effects reported. Problem is no one wants to do it for other medicines like "Metformin" which is proven to result in a person getting promoted to insulin injections later. Strangely no one till date knows how it works! Diabetes is similar too, it happens because of a multitude of factors, yet it all reduced to one single medicine "Metformin". Did you ever question that? Why?

⬐ kekebo

It's nice that it works for you and others, it doesn't for me and most people around me. Selling it as a magic cure leaves me and those people excluded. While science has its pitfalls I think we should try to be more scientific than giving out general recommendations based on (potentially faked) online reviews for a marketed product. I can recommend checking out the Sapolsky lecture i linked above which should quickly make clear that a single chemical treatment approach is highly unlikely to ever become a general cure for all cases of depression.

I think this is a good answer, but depression is a complicated beast.

It would be difficult to give a comprehensive comment in depression, so I think you did fine, but I want to point out that it is difficult and complex, and as much as we understand about it, there is so much that is not understood.

This [1] is a video of a Robert Sapolsky lecture on depression that gives a high level but comprehensive overview of the current (as of 2009) state of understanding depression, kinds of depression, the role of some neurotransmitters.

This is a compassionate, technical, and broad overview.

1. https://youtu.be/NOAgplgTxfc

Wow, Sapolsky's explanation of a various neurotransmitter mechanisms, starting with transmission across a neuron synapse, is simply beautiful.

Video link starting at 14:48 min: https://youtu.be/NOAgplgTxfc?t=888

There is something special about serotonin - throughout evolution, it has been an important part of regulating social emotional processing in animals and humans. It strongly regulates the function of the salience network in the brain, alterations of which are associated with anxiety disorders.

Like other neurotransmitters, serotonin is specifically synthesized in a specific brain region, the raphe nuclei. (Dopamine is from the substantia nigra)

Brain circuits have lots of overlap but they definitely have specialization. Case in point, genes associated with serotonin processing have SNPs for depression-like illnesses.

Sapolsky gives one of the better lectures on the specific features associated with abnormal serotonin, dopamine, or neuropinephrine signaling, and their associated symptomology. Ultimately it's the job of the psychiatrist to figure out what's out of balance based on behavior.

https://www.youtube.com/watch?v=NOAgplgTxfc

Not a sufferer of OCD, but anxiety and depression (and associated neuroticism). One of the scary things to accept is that you have no control over what you think, free will is a (darn good) illusion.

Since we have no idea why these obsessive and dark thoughts are occuring in psychiatric patients, the best thing you can do, as a patient, is to get good at identifying all the bullshit that's going through your head: "No, that random crowd of people doesn't deeply despise you", "No, you don't have to kill yourself because you can't finish your studies in regular time", "No, you won't be laughed at because you're looking for an SO"

Precisely none of the fears I had have ever come to pass. I am, relative to people I interact with, (by a huge margin) my largest critic, which can be disabling, when every time you make some small trivial mistake you think "Oh god, nobody will ever forgive me for this, what a stupid PoS you are". It's all a fiction told by a disordered part of the mind.

On the bright side, things have been improving a ton for me since when it was really bad a year ago, but it takes medication (not an option for everyone), time and lots of patience.

One of the best things I came across on the web are the works of Robert Sapolsky, biology and neurology professor at Stanford. Specifically his 25 part lecture series: https://www.youtube.com/playlist?list=PL150326949691B199, his talk on depression: https://www.youtube.com/watch?v=NOAgplgTxfc and his book "Behave" (there's more from him, just look around).

It's not that I learned some "magic fact" that suddenly frees me from all nonsensical thoughts, but it has opened up the complex, nuanced world of human biology and behavior and numerous interactions between genes and environment, between mind and body or between different functional parts of the brain (obviously a course like this can only give a broad overview).

There's so much hidden stuff happening that, without us being conscious of it, influences who we are, and yet one doesn't have to be a plaything of one's environment, because several of these factors can be influenced like which experiences you seek and which you avoid, once you are aware that these things can shape you. That said, a lot of stuff like your genetic predisposition, prenatal environment, childhood, external stressors (e.g. death of close relatives and friends) can not be changed, but it also matters _how_ you think about them.

One will not become resistant to psychiatric illness no matter how fancy and elaborate you think about it or yourself, but it takes off the edge of thinking of oneself as this especially hopeless case. And equally importantly Sapolsky's course/book shaped my thinking of others, made me much less prejudicial (I sometimes catch myself with prejudice, but normally I notice), much more aware that everyone else is also subject to the same rules and phenomena that govern human thought and behavior and there's nothing "wrong" with them (in the sense that they're just "an evil person" or somesuch thing).

Depression is a real disease. It should and can be treated. Stanford professor Sapolsky on depression - https://www.youtube.com/watch?v=NOAgplgTxfc

This is the quintessential video for understanding clinical depression. A Stanford lecture given by Dr Sapolsky:

https://youtu.be/NOAgplgTxfc

I highly recommend watching it to better understand the disease.

⬐ su30mki117

That's a great video, but I think it's from 2011. I recently came across another video from 2016 which is a bit more technical and sheds some light on the results of recent research. People interested should definitely give it a watch - https://www.youtube.com/watch?v=BZbunmaU-60

⬐ camel_Snake

Someone else (maybe it was you) shared this recently on hn and I watched it and don't regret a single minute. Insanely informative and the style of presentation where one covers the history of our understanding of a topic is possibly my favorite.

I remember finding this talk quite insightful: https://www.youtube.com/watch?v=NOAgplgTxfc

https://www.youtube.com/watch?v=NOAgplgTxfc

There are two things that both get called "depression". Like so many other confusing things, this all is the result of fuzzy language.

There is depression: the feeling of being sad. This can be triggered by all sorts of environmental factors, and is ultimately a psychological disorder that can be solved by changing environment variables.

There is also depression: the neurochemcial/neurophysiological disorder that has depression (sadness) as one of its symptoms.

It can be treated with various (miracle) drugs.

--

People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease, belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates.

Required viewing: a lecture on this topic by somebody who knows more about it that anybody else who is currently alive: https://youtu.be/NOAgplgTxfc

⬐ tcj_phx

> People who want to fight against the idea that these modern miracles (drugs that treat depression) are effective treatments for this debilitating, but curable disease,

The modern miracle drugs that effectively treat and cure debilitating depression are not SSRI's. Whatever benefits SSRIs have are probably a result of their influence on neurosteroids:

>> Certain antidepressant drugs such as fluoxetine and fluvoxamine, which are generally thought to affect depression by acting as selective serotonin reuptake inhibitors (SSRIs), have also been found to normalize the levels of certain neurosteroids (which are frequently deficient in depressed patients) at doses that are inactive in affecting the reuptake of serotonin. This suggests that other actions involving neurosteroids may also be at play in the effectiveness of these drugs against depression [0]

[0] https://en.wikipedia.org/wiki/Neurosteroid#Role_in_antidepre...

Other miracle drugs are also helpful for addressing the cause. Big Pharma doesn't care about cause/effect, they just want patients on maintenance treatments.

Depressed people usually have some sort of metabolic problem, caused by thyroid problems, inadequate diet, etc. Emotional stress is usually a major factor too.

> belong in the same category as flat earth era, anti-vaxxers and now, apparently, "raw water" fans/advocates.

Where do you belong? Are you a tireless advocate for the status quo?

⬐ newfoundglory

> Depressed people usually have some sort of metabolic problem, caused by thyroid problems, inadequate diet, etc.

In my experience, thyroid etc are the fist things tested for before suggesting depression. Do you have any kind of evidence for that argument ?

⬐ cpncrunch

IMO it seems more likely that there is one "thing" called depression, that it is caused by a number of factors such as stress, emotional upset and illness, and that the chemical imbalance is the brain's way of generating feelings of depression.

⬐ None

None

⬐ jdietrich

SSRIs are not miracle drugs. They work, but they don't appear to work especially well. The NNT for SSRIs is about seven, meaning that you need to give SSRIs to about seven patients to resolve one case of depression. That's not terrible, but it's a million miles from a miracle. That number is likely to be somewhat inflated by publication bias.

There is no evidence to suggest that Robert Sapolsky "knows more about it than anybody else who is currently alive". He has published four papers on depression, which are all highly speculative and do not involve novel primary research. The most recent of these papers was published 14 years ago. He is clearly an eminent neuroscientist, but he is by no means an expert in depression.

A cursory review of the linked lecture suggests that Sapolsky is making bold, weakly substantiated claims about the neurobiological basis of depression that would not be supported by the majority of people working in neuropsychology and psychopharmacology.

Your decision to link to this lecture is somewhat peculiar, given that it actually refutes your core claim. In Sapolsky's own words: "all of this knowledge winds up being effective for treating maybe 30, 40 percent of people... the vast majority of people, the antidepressant drugs don't do a whole lot" (timestamp 38:30).

https://doi.org/10.1002/14651858.CD007954 https://profiles.stanford.edu/robert-sapolsky?tab=publicatio...

As a person with MDD, I'm glad studies like these are coming out. This is the best resource material I've seen about MDD and it's helped me a lot https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ dredmorbius

I'll second this video recommendation. Robert Sapolsky is an incredible researcher and lecturer.

while on the subject, highly recommend this video on depression from Stanford's Sapolsky to understanding the underlying biological aspect of it: https://www.youtube.com/watch?v=NOAgplgTxfc&t=1216s

Here is a great lecture by Stanford's Sapolsky On Depression, that explains clinical depression fairly well.

https://www.youtube.com/watch?v=NOAgplgTxfc

If you haven't seen the lecture from Robert Sapolsky (author of the book the article is summarizing) on Depression, do yourself a favor and see it now! He's wonderfully eloquent and approachable even to the laymen in giving the neurobiological underpinnings of what is a terrible illness.

https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ TheSpiceIsLife

Thanks for linking to this. This guy is extraordinarily thorough.

⬐ snsr

Thank you

⬐ alexvoda

Thanks indeed. It clarifies a lot. We are lucky to live in a period when sufficient knowledge on the subject has accumulated and has been put together for us to have some understanding of how it works. Going from here to finding fixes is a long way since there are a lot of variables, but at least we have an idea of how the leverage points in the system interact.

Here's the medical view on depression: https://www.youtube.com/watch?v=NOAgplgTxfc

Robert Sapolsky is a genius. Listen to this lecture, please.

I think you're combining Prozac's increased-suicide effect and the well-known danger zone of depression recovery:

https://youtu.be/NOAgplgTxfc?t=480

I suppose there could be something in Prozac being an engine of recovery without support (or suicide watch), essentially launching people into the danger zone, but I don't know.

Robert Sapolsky compares depression to cancer in another way.

https://www.youtube.com/watch?v=NOAgplgTxfc

> for me it was about NOT talking oneself into sadness.

Exactly. one tool you learn is how your thoughts/feelings/actions interact:

You cannot control your feelings, but they do influence your thoughts. You can control your actions, but they can influence at least some of your feelings. You can control some of your thoughts, which will influence your feelings.

(I may not have stated this exactly correctly, but the gist is the same ). So basically you learn that if you begin "investing" in healthier actions and thoughts (i.e. not sulking or self-pity or rumination), it will slowly pay off in less negative feelings.

No it doesnt' solve every single problem in your life, but a big part of depression is "learned helplessness" [1], and learning about thoughts/feelings/actions can be the first tool to counter this.

[1]. https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ chillacy

I found this last week on HN, but there was a great book that's short and hands-on called Learned Optimism: https://en.wikipedia.org/wiki/Learned_optimism which was written by one of the researchers on Learned Helplessness

Incredibly moving and informative talk about depression and its neurobiological symptoms: https://www.youtube.com/watch?v=NOAgplgTxfc

Is the depression inherent to the disorder, or is it caused by the unrelenting stress brought on by living in an environment that is actively hostile to this individual?

Either way, it's just something to consider based on personal observation/experience. It could be completely wrong, could be a bit of both. There's no harm in asking questions.

* * *

edit: to you comment below. I am suggesting that the depression itself (for example, in the case of a bipolar individual -- not in the case of major depression, which is a different thing altogether), could be a symptom not of a "disease" but rather a natural reaction to living in an environment that is toxic to him or her.

In such an environment, it is perfectly natural for this individual to lose all drive, feel "worthless", and even break down mentally.

The links between chronic stress and depression are well known. Robert Sapolsky has a great lecture on the biology of depression: https://youtu.be/NOAgplgTxfc

(tl;dw: major depression physiologically looks very little like "sadness" and a hell of a lot like chronic stress (an over-active stress response) and does indeed fit the profile of a biological disease, often caused by early trauma.

My question here is: have we built societies that are inherently traumatizing to individuals with particular behavioral phenotypes? Looking elsewhere, at societies and subcultures where these "disorders" are not as common or as debilitating to me suggests that there is at least some truth to this.)

⬐ dfc

That is your description of a cultural environment where someone with depression thrives? It kind of seems like you dodged the question. I am interested to hear how someone can thrive when they cant manage to get out of bed.

There's a HUGE difference between depression/anxiety the symptom, and major depressive disorder.

For those with an hour to kill, Robert Sapolsky has a wonderful, accessible lecture on the topic[1].

1.) https://www.youtube.com/watch?v=NOAgplgTxfc

⬐ Tempest1981

Good descriptive word: Anhedonia -- the inability to experience pleasure from activities usually found enjoyable. https://en.m.wikipedia.org/wiki/Anhedonia

Also: psychomotor retardation: Physical difficulty performing activities which normally would require little thought or effort such as walking up a flight of stairs, getting out of bed, preparing meals and clearing dishes from the table, household chores or returning phone calls. https://en.m.wikipedia.org/wiki/Psychomotor_retardation

While I don't have actionable advice for you, on the subject of depression I strongly urge everyone to read this blog post by Wil Wheaton: "Depression Lies", http://wilwheaton.net/2012/09/depression-lies/ It moves me to tears.

Afterwards, read his wife's account of it, "The Other Side of Depression", at http://www.annewheaton.com/the-other-side-of-depression/

For an overview of the current scientific knowledge, an introduction to brain chemistry and the psychology of depression, and -- most importantly -- a forceful argument that depression is a bona fide illness, a biological/medical condition, not just some "oh, pull yourself together" thing, see this video of Stanford professor Sapolsky: http://www.youtube.com/watch?v=NOAgplgTxfc

Depression is an illness. If the guy had died of cancer, would you be reading so much into his decision to "let himself go"?

(I confess I find this turn of phrase so repugnant that I can barely bring myself to type it, even inside scare quotes. Its implication is that a person with a proper philosophy, or one whose belief was sufficiently sincere, wouldn't have slacked off to the point that they suffered from a debilitating, painful, often fatal condition that is apparently the number-four cause of disability in the USA: https://www.youtube.com/watch?v=NOAgplgTxfc )

⬐ tptacek

Most especially if you read the heartbreaking details of his last year. Nobody informed about the details of what happened to DFW could possibly argue that he had control over it.

There is mountain of evidence:

http://m.youtube.com/watch?v=NOAgplgTxfc

⬐ QuantumChaos

would you be able to point to how specifically this video addresses my points?

I would be much easier to have a discussion if you did this, since otherwise people who don't have time to watch a 1 hour video will have to take it on faith that this video really addresses the questions I asked. And assuming it did, it would probably be useful to have the points summarized here so we could discuss them.

I agree that depression can be caused by many things. This might be more of a case of chronic depression vs. temporary depression, although I don't presume to know which one the author was/is dealing with. People bounce back from temporary depression, but chronic depression is a problem for life.

Here's a great lecture that discusses the differences (I'm pretty sure it was this one... if not, it's still a great lecture): http://www.youtube.com/watch?v=NOAgplgTxfc

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

http://www.youtube.com/watch?v=NOAgplgTxfc

⬐ scott_s

I've watched 11 minutes of it, and I plan to watch the rest. Fascinating lecture.

⬐ stevenrace

This lecture is part of Dr. Sapolsky's Stanford class on 'Behavioral Biology', which in itself is captivating.

Money might buy "freedom from depression," but I suspect it does so by buying antidepressants and therapy.

I think Robert Sapolsky is on to the best explanation of depression: it's a disease rooted in biology and genetics, similar to (and exacerbated by) chronic stress. (Here's a lecture that I'm sure has been posted here before: https://www.youtube.com/watch?v=NOAgplgTxfc). Reducing stress can alleviate the symptoms, but really effective treatments treat depression as a disease.

This was posted in a HN comment not too long ago. It's a very good lecture that goes into both the biological and psychological aspects of depression and then manages to tie them together.

http://www.youtube.com/watch?v=NOAgplgTxfc

> We say that there is something wrong with their brains, rather than saying that there is something wrong with society.

The real answer is probably a little bit from column A and a little bit from column B.

Professor Sapolsky at Stanford gave an interesting lecture about depression a few years ago... highly recommended:

http://www.youtube.com/watch?v=NOAgplgTxfc

⬐ wiredfool

That's a really good video -- I saw it linked in the aftermath of Aaron. It's worth the 52 minutes to watch it.

⬐ paganel

There's also this, "How To Be Alone": https://www.youtube.com/watch?v=k7X7sZzSXYs . It did help me a couple of times.

I've been incredibly vocal about my stance on depression here on HN in the past, specifically that saying things like "man up" is absurd.

Depression, like every other disease on the planet, is not something you "man up" through. It's a disease that happens to manifest itself in the same places that personality does. To a casual, uninformed observer, depression is a choice of behavior.

It isn't. You don't get depression from weakness in the same way that you don't get cancer from weakness.

Depression also kills more people per year than cancer does.

Cancer about 20,000 -- depression about 30,000.

(Highly relevant lecture by a very brilliant neuroscientist: http://www.youtube.com/watch?v=NOAgplgTxfc)

--

That said, Ed Weissman made an inappropriate comment. Every single person here, including me, has made inappropriate comments in the past.

Let's not start the pitchforks and torches just yet, guys.

He who is without sin, and all that.

⬐ larrys

"That said, Ed Weissman made an inappropriate comment."

Could you detail which part of it was inappropriate and why you feel that's the case? (Serious question is it all - or on a point or two?)

⬐ regularfry

The "man up" in the original comment wasn't said in reference to depression.

⬐ mbesto

I've been incredibly vocal about my stance on depression here on HN in the past, specifically that saying things like "man up" is absurd.

And this is exactly why this article from TC needs to be banned from HN. The article suggests Aaron asked for help because he was depressed. This is simply NOT true. First, it was submitted by sethbannon[1] and second, nowhere on the website do I see anything directly from Aaron asking for help[2]. The fund is overseen by Bettina Neuefeind and funds go directly to pay legal costs.

I need to leave HN soon if this is the type of shit that continues to get over 400 points and sticks on the top of the frontpage for hours.

blhack - I'm not blaming you for any of this, hopefully your not taking this as an attack against your specific comment.

Context is everything.

[1]- http://news.ycombinator.com/item?id=4529484

[2]- https://free.aaronsw.com/

A really good talk on Major Depression, what it is (a terrible, paralyzing biological attack on the mind) and what it is not:

Robert Sapolsky (Stanford) : http://youtu.be/NOAgplgTxfc

Someone previously posted this lecture and I remember it being quite good -> http://www.youtube.com/watch?v=NOAgplgTxfc

Can't let Robert Sapolsky go unmentioned:

http://www.youtube.com/watch?v=NOAgplgTxfc

⬐ albemuth

Came here to post this, in this lecture he makes the point that major depression is the most devastating disease you can suffer. He also compares major depression to diabetes in that you can't will yourself out of either one.

⬐ gghh

I kindly ask you to look at your schedule for the next week, find a free hour and listen to this lecture. You're likely to better understand yourself, or gain some empathy for the people around you. It won't waste your time.

CBT does not "basically" teach a person how to "fun."

Educate yourself with Robert Sapolsky: http://www.youtube.com/watch?v=NOAgplgTxfc

Thanks for saying this, Thomas...

The worst part of depression is a sortof profound loneliness. This is the feeling that ends up leading a lot of people towards suicide. There's nobody that "gets" them, and nobody that they can talk to about what they're feeling. They feel isolated from their friends and family, and this feeling is exaggerated by people who don't understand that they are suffering from a neurochecmial/neurophysiological deficiency; not from something that they can just "push through".

Imagine telling somebody with cancer that they just have to wake up one day and decide they don't have cancer anymore.

What makes all of this worse is the feeling that what you're going through is somehow invalid. Not only are you suffering from the worst kind of emotional pain and loneliness imaginable, but you're being told that you're a fool for it, and that you're a failure or a weakling for not being able to snap out of it.

That's dangerous.

You know...a lot of my family members are pilots. Part of the training that they go through, something that seems to be constantly drilled into them, is to watch out for hypoxia. This is what happens when you're flying too high without supplemental oxygen, and your body starts malfunctioning. You sound like you're drunk. (This is what hypoxia sounds like, it's terrifying: http://www.youtube.com/watch?v=_IqWal_EmBg).

This is recognized as a dangerous part of the job, something to monitor yourself for.

I think that hackers need to keep in mind that depression is kindof our hypoxia. It can sneak up on us, and it can kill us if we don't address it.

And there is nothing wrong or weak about being depressed, just like there is nothing wrong or weak about being hypoxic.

Here: http://www.youtube.com/watch?v=NOAgplgTxfc

is a very very good lecture by Professor Robert Sapolsky on depression, major depression, and why it isn't really something that you can just tough out. Highly recommended.

Stanford Professor Robert Sapolsky, posits that depression is the most damaging disease that you can experience. Right now it is the number four cause of disability in the US and it is becoming more common. Sapolsky states that depression is as real of a biological disease as is diabetes.

This is a very, very good lecture on depression: http://www.youtube.com/watch?v=NOAgplgTxfc

Honestly, I think the disorder should be renamed. People associate being "depressed" with the same feeling that they get if they drop their iPod into a lake. They're sad.

General sadness is one of many of the ways that depression as a cognitive disorder can manifest itself. I can't tell you how many times I've talked to friends with real, serious, dangerous depression and heard that there are people who tell them that they just need to get over it and cheer up.

You can't cure cancer with ice cream, same goes for depression.

⬐ haploid

"[I] heard that there are people who tell them that they just need to get over it and cheer up."

I do this. A great many of my friends and family do this too. I'm not sure why you find it so difficult to believe that there are people who do this.

It's basically impossible for people without depression to imagine what it's like to be physically incapable of eventually "cheering up" or "getting over it". This is often compounded by the fact that depression( along with asperger's )is the modern hypochondriac's condition of choice.

Combine inability to empathize with widespread attention whoring by people claiming to have depression when they don't, and it's quite easy to see why many people would react cynically or casually.

It's rather unfortunate for those who are genuinely stricken with mental illness, though.

⬐ blhack

>I'm not sure why you find it so difficult to believe that there are people who do this.

I didn't say that it was, I said that it was very common (which should indicate that it isn't difficult for me to believe).

>It's basically impossible for people without depression to imagine what it's like to be physically incapable of eventually "cheering up" or "getting over it".

This. Right here, exactly what you just said is the problem with people understanding this disease. "Cheering up" has absolutely nothing to do with getting over depression. This would be like feeding somebody with mono lots of redbull so that they would have more energy and wouldn't be sick anymore.

>It's rather unfortunate for those who are genuinely stricken with mental illness, though.

Yes, it is, and just about everything you wrote only serves to perpetuate the general lack of understanding that most people have when it comes to cognitive disorders.

http://www.youtube.com/watch?v=NOAgplgTxfc

"Stanford Professor Robert Sapolsky, posits that depression is the most damaging disease that you can experience. Right now it is the number four cause of disability in the US and it is becoming more common. Sapolsky states that depression is as real of a biological disease as is diabetes."

⬐ antipaganda

The most damaging disease you can experience? Sure, in a sense. I've never held down a job for more than six months because of it, and several times I've had to pick up the pieces of my broken life after a particularly bad episode. To be honest, though, I'd rather have this than, say, down's syndrome.