> “The treatment, known as Stanford accelerated intelligent neuromodulation therapy (SAINT) or simply Stanford neuromodulation therapy, is an intensive, individualized form of transcranial magnetic stimulation. In the study, remission typically occurred within days and lasted months. The only side effects were temporary fatigue and headaches.”
> “Twenty-nine people with treatment-resistant depression participated in the study: About half received SAINT, and the rest underwent a placebo procedure that mimicked the real treatment. After five days of treatment, 78.6% of the participants in the treatment group were no longer depressed, according to several standard methods of evaluation. “It’s quite a dramatic effect, and it’s quite sustained,” said Alan Schatzberg, MD, the Kenneth T. Norris, Jr. Professor in Psychiatry and Behavioral Sciences, who was a co-author of the study.”
Makes me wonder what percentage of the placebo group improved?
> The transcranial magnetic stimulation treatment currently approved by the Food and Drug Administration requires six weeks of once-daily sessions. Only about half of patients who undergo the treatment improve, and only about a third experience remission from depression.
> Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission.
Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission
The two mentioned in the article met the FDA definition of remission. It doesn’t say, how many improved in general. This is important specifically since the sample size of the trial is small.
It's the important & useful of the two endpoints they measured. Anything will have a positive effect on depression if it comes with a lot of high-tech vodoo and people in lab coats. Only it won't last and it will the "yeah, I guess I'm feeling better"-level of improvement.
It's quite possible humanity has survived because most people never get depressed. You need to be quite clear about definitions to have a meaningful conversation on this.
Yes. And given the prevalence of continued prevalence of depression, there might be some evolutionary benefit for the genes that also cause depression.
No clue whether it's the depression itself, or whether that's just a side-effect of something else that's useful.
But what about other chemicals, Glycine contributes to an increase in 5alpha Reductase which helps reduce Cortisol one of the stress hormones. It can be used in place of sugar in hot beverages and food, how much does stress contribute to depression?
https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conv...
And then there is Glutathione which increases light sensitivity, could this help reduce Seasonally Affect Disorder (SAD) also known as the winter blues, knowing that it also helps management of ROS, peroxides, lipid peroxides and heavy metals?
Glutamine, N-Acetyl Cysteine and Glycine help to increase Glutathione in the body.
I wonder if fMRI has a similar effect on the brain to homogenising milk, namely it softens the fat walls in milk. Is fMRI having an effect in the brain or in the vascular system with plaques that contribute to atherosclerosis, because induction hobs or magnetic induction reduces inflammation https://peerj.com/articles/929.pdf does this demonstrate that depression is caused by a variety of factors not just one's linked to serotonin even though serotonin plays a part with the immune system?
Likely more than 2 of 15 improved. The numbers to compare are 2 of 15 remission vs. 11 of 14 remission-- not <<unknown>> of 15 improved vs. 12 of 14 improved.
This is a great comment. I've always been a little uncomfortable with the thought of this magnetic treatment in a way I couldn't put into words and this nails it.
I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it.
Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.
The trial used fMRI data to find a cortical area that has functional connectivity with the DLPFC. That area is then targeted with a neuronavigation system (similar to AR), that helps the clinician place the TMS coil at the right spot and the right angle. This in addition to the magnitude of the pulses being based on the patient's threshold (e.g. minimum amount of stimulation that causes motor movement when used over the motor cortex) is what is meant by "personalized".
It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.
Magnetic therapy makes me feel sick to my stomach for reasons that have for long been unknown to me. I'm more comfortable with the idea of undergoing electroconvulsive therapy than something that involves magnets. I'm not sure why it bothers me so much, but it does to an unusual degree.
Human emotional responses to wireless technology, even before the invention of said technology, are very interesting. Check out the wiki page for James Tilly Matthews.
Yikes, hope I'm not a hatter like this dude. Thanks for sharing, lead me to discover the Travels Through Time podcast and listened to this episode: https://www.youtube.com/watch?v=d7GdAHr7ZHU
A whole lot of treatments end up refined with time.
The FDA approved treatment is "aim at the middle of the dorsolateral prefrontal cortex". Getting more activity and connectedness improves its regulation of overall emotional activity.
This research implies that aiming instead slightly differently and a different dosing regimen may be more effective.
This is no different from any other medical treatment, where we find refinements in how and where to apply basically the same treatment to get better results.
It's all a little freaky if you think about it: even in evidence-based medicine, a whole lot of it is people making qualitative determinations and squishy adjustments to treatment, and undoubtedly getting it wrong a whole lot.
Then again, the stuff shows benefits in trial, and presumably we get most practitioners trained up and doing the thing that's the standard of care well enough...
There might be the perfect amount of paracetamol to take to treat your light headache.
But in practice people just take two 500mg tablets and call it a day. Works well enough most of the time, even though it might be 'wrong' in some platonic sense of the word. (Eg you might have been helped enough with a slightly lower dose. Or perhaps 1250mg would have been better and suppressed slightly more of the pain. Who knows?)
There are plenty of doctors that rather die than treat their cancer. There was even a "recent" HN story about it. The motivation is that for a nasty one, the treatment is often worse than the disease, and they rather spend their wealth and to easy their pain and enjoy their last months of living rather than going through a very hard process that might not work, might leave them in an not that good state.
Any study can only imply the outcome of what was observed. The techniques they used required an MRI machine so you aren't going to see magnetic fields wherever you go.
They stimulate activity in a precisely chosen part of the brain. There is no inverse. They could stimulate a different part. In fact, they use the motor cortex to calibrate the stimulation level to be the lowest that produces any involuntary movement. I imagine it must be interesting for the subjects.
> Makes me wonder what percentage of the placebo group improved?
For future reference, assuming this is a clinical trial, data from clinical trials is available online. This is the kind of statistic that you'd be able to find.
I wonder what results you'd get if you tried a treatment which was literal torture...?
Eg. "We'll poke this red hot poker into you 10 times to cure your depression"... Many painful screams later... "So, is the depression any better now, or should we do more treatment?".. "Yes, yes, I'm pretty much cured!".
How can we be sure that this 'torture effect' isn't whats being measured here? Especially when the treatment appears to have unpleasent side effects, and the success of the treatment is measured with patient feedback...
Part of being depressed is you don't even have the will to resist being treated in a way that you don't like.
In fact, I'd say that feeling powerless against conditions that you don't like is the core of what depression is.
It's why someone who is depressed doesn't feel like doing anything, because they feel like no matter what they do nothing will ever change so nothing they do is ever worth the effort.
Just mildly uncomfortable .. for a period of time longer than one would be willing to tolerate.
Something like being at the dentist when you have many cavities in your teeth.
You can tolerate one or two sessions. But the idea of doing it every day for two weeks straight is unbearable enough that you decide on the third day to report feeling well.
There are surely enough trials on depression per year that a result with 15 participants in the treatment group is to small to start bringing this to public attention?
With a sample size this small I don't think it should be in the news at all
Small n studies are often the most exciting. If you get a p<0.01 effect in 10 people vs. 10000 people... the lower bound of the effect size is similar, and so for the same prior each study should change our belief by a similar amount... but the upper bound of effect size is much larger in the large study.
The only thing that messes this logic of mine up a bit is publication bias. There's a much larger chance that small studies sit on the shelf unpublished if there's no clear effect.
I had an occasion to deep dive into hundreds of clinical trials about a year ago, talk to PIs and trial participants, etc. One thing I didn't even have awareness of, let alone appreciation for, was how essential it is to have a good trial design (or maybe how an insufficiently considered trial design can be vulnerable to catastrophic failure modes).
It seems that running these 'small batch' studies/trials can be tremendously helpful to inform and refine the approach before executing on a larger scale. Of course if it takes 3 years to reach an endpoint it probably doesn't make sense to serialize them, but to my layman perspective there appears to be clear value (and in this case encouraging results).
I'd be curious to know if any other executive/mental function changed, something that may not have been measured before or after the treatment; not feeling depressed, self-reported, is not necessarily the same as having the same functionality as someone who's not depressed.
> not feeling depressed, self-reported, is not necessarily the same as having the same functionality as someone who's not depressed.
Sure, though one aspect of the depression scales is (self-reported) ability to go about daily activities, get normal sleep, etc-- not just "feeling down". That is, it's self-reported information on functionality, too.
To be clear: I definitely think this kind of study is valuable, I don't think it should be in the news, unless the headline is something like "small study shows promise"
Agreed, small sample size; but in defense of the researchers, I don't think the general public appreciates how difficult it is to find research participants - nevermind a lot of them. And, ones that remain adherent to study protocol throughout it's entirety, so their data points can be included.
It's also extremely expensive, and unless you're a god at writing grant proposals, most uni research labs are cash poor.
There's a reason most studies don't have lots of participants, and in most cases it's not laziness on the part of the researchers.
Yes. It's asinine to run a large N study before having run a small one. So small N doesn't mean bad, it means preliminary.
Internet comment sections however are not great at nuance, and the difference between a bad study and a study leaving unresolved uncertainty is often beyond them.
Probably although based on my understanding maybe not as risky as it might seem based on what's been done. I agree it's an issue and I don't mean to minimize it, but at the same time there's good evidence location is much more fuzzy than it seems. At some level it's nontrivial because it has implications for actual causal mechanisms.
weird how people can often become depressed due to actual real-world experiences like grief or loneliness, but slap a magnet on em and they can go into remission.
Makes you wonder whether they'll go into remission for a while and then slip back into depression if the environmental factors are still there. I guess if it can knock you out of a depression where the trigger is no longer present but the trauma persists, that's incredibly valuable, even if the mechanism seems very strange.
At one point I was in ER close to death from large clot. Doctors had been treating my clotting disorder with Prozac. Since clearly I was just making up symptoms due to my “depression”
Anyway Doctor was explaining the damage to lungs and odds of survival, but I was totally chill about it thanks to Prozac.
Plus side doctors finally believed me that I wasn’t making up stroke symptoms.
Sometimes depression has a real cause that needs dealing with.
It’s not just environmental factors that cause chronic depression. Sometimes the environmental factors are the “trigger” that start depression in a person predisposed to it.
Actually being depressed can worsen environmental factors. Depression can make it hard (or impossible) to maintain work, relationships, hygiene, sleep, diet, and exercise. Losing the things can make the depression worse.
Yeah I know - it's a vicious cycle. I meant in cases where the depression trigger was an event like a death in the family, but where the person managed to keep it together despite their depression. In those fortunate cases, the only problem that needs solving is the person being "stuck" on a trauma - not a self perpetuating cycle.
What you're describing sounds more like grief than depression. While the profound sadness that comes from loss can certainly manifest itself in ways that seem like depression, they are not the same thing.
Depression can be acute or chronic but everything about what you think or feel is still just chemistry and chemistry is just physics. It's a bit surprising it can be treated with such a blunt instrument as external magnets but then again we use electroshock with some success.
Yeah I am not against this treatment, but I do think sometimes the mind--body relationship isn't treated very well in modern medicine.
Every mind issue is also a brain issue, and so there is no actually boundary between the "real you" and an ailment --- it's an arbitrary division influenced by social norms.
I am no expert but I understand medical ethics is more trolley problem type stuff than issues like this. Similarly is the fact the many psycological ailments are highly culturally specific but the DSM just sort of assumes American context and doesn't go into this.
This is TMS but they specifically targets the subgenual cingulate uniquely for each patient with help of fmri . Usuially they target a location at r13 which is easier but the location of the subgenual cingulate is unique to each person sometimes u are lucky and it's r13 sometimes it's not
Note that this is an enhancement to an existing therapy. Depending on where you are in the world and the healthcare providers you have access to, the existing therapy called Transcranial Magnetic Stimulation (TMS) may be an option.
For those taking this seriously: fMRI requires careful presentation of stimuli and a complex analysis. It’s not just a scan. I doubt you can get that at Scans’R’Us.
Edit: Apparently, the clinics that claim to be offering it might just be doing something that is loosely based on what is publicly known about the SAINT protocol. Dr. Nolan Williams hasn't released full details, so it's not possible for clinics to replicate it exactly. This clinic https://www.cambridgebiotherapies.com/accelerated-tms/ talks about how they've tried to reverse engineer the protocol at the bottom.
There's two SSRI-like drugs called vilazodone and vortioxetine that are indicated for it, as is esketamine.
There are also a few antipsychotic-like drugs that are used at low doses for antidepressant effects along with other antidepressants, but I'm not sure if the newer ones are indicated for depression, or if the newer ones are just reformulations of existing medications. It looks like there's a newer olanzapine combination on the market.
“I don’t procrastinate anymore,” he added. “I’m sleeping better. I completely quit alcohol. I’m walking my dog and playing the guitar again, for nothing more than the sheer joy of it.” Most importantly, he said, “I’m remaining positive and being respectful of others. These are big changes in my life.”
Serious question: are these typical signs of depression? Now I'm wondering if I have depression.
Yes, they can be. Self-diagnosing isn't a great idea; lots of non-depressed people have some symptoms of depression. It would probably be a good idea to find someone to talk with though.
Where "someone" is a therapist or counsellor. They can refer you on to someone who works with pharmaceuticals if necessary, but there's a lot to try before going that route.
Heads up, ‘There is a lot to try before going that route’ is a medical opinion that is hard to notice. Exactly what the treatment plan would be and in what order is entirely up to the doctor and sometimes (often) the best thing that works is the actual drugs.
I’m just conscious of this because I’ve seen this argument used to justify delaying actual treatment in favour of ‘alternative medicine’.
True, yes, but nothing you hear in a CBT session should be super surprising. It may help you see things in a new way or understand the motivations of the other people involved in your life situations, but they're not going to tell you sleep with crystals or wear a magnetic bracelet or something.
Basically the counselling/therapy part of the process would be identifying if there's a "real world" root cause to address ahead of going the pharma route and facing potential side effects, and/or the reality of having to go off it later and immediately regressing because the root cause hasn't been fixed.
In any case, I'm obviously not a doctor; neither this post nor the GP should be construed as medical advice.
Anecdotally, the lack of those things are definitely present in myself when I'm experiencing a depressive episode (I am diagnosed with clinical depression): I sleep badly, either not at all or for 12-18 hours a day, I drink far too much, I do not leave my house, and my hobbies either fall by the wayside entirely or I partake in them with no enjoyment or happiness from it.
If you're experiencing those, it might be worth talking to a psychologist or your doctor (to get a referral): you don't have to tough it out. But people who don't have clinical depression also have those issues too, which is why the diagnostic criteria is a little more involved.
For me, a short 3-4 month course of a particular SSRI lets me beat back the worst of it, and Cognitive Behavioural Therapy keeps it at bay. I haven't had an episode in years now
Noticed that both you and the OP mentioned drinking. Just the drinking can cause much of this. Drinking screws up your sleep cycle, which can also cause much of this. Drinking sessions are also time consuming, so you have less time for other things you enjoy anyway. Sure, some things you can do while drinking, but those may not be the things you would prefer to be doing while sober.
Alcohol is a central nervous system depressant, which is commonly just shortened to “depressant”. This doesn’t mean it causes depression, it means it has a particular effect on us humans biologically.
That said, it does also exacerbate clinical depression, so this gets confusing quickly!
That's a massive oversimplification which came out of non-scientific 12 step literature and is simply not true in many situations.
I have on many occasions beaten back total anhedonia and a desire to die with a few drinks. It's not an optimal solution obviously, but when your options are limited it is sometimes quite preferable to not drinking.
>I have on many occasions beaten back total anhedonia and a desire to die with a few drinks. It's not an optimal solution obviously, but when your options are limited it is sometimes quite preferable to not drinking
As someone who has suffered major depression, I agree totally that recreational drug use can be helpful in managing some symptoms of mental disorder. I do however feel like moderation is a very important aspect of this which can be harder for folks when they are already feeling down
Sure! Though I drink basically not at all when I’m not in a depressive episode. It’s more of a subconscious “self medication” thing, and the symptoms don’t subside even if I’m not drinking sadly.
A Central Nervous System Depressant and Clinical Depression are two (basically) unrelated concepts. Alcohol is the former. Despite having the same word in them, they are only tangentially related to one another
>For me, a short 3-4 month course of a particular SSRI lets me beat back the worst of it
Can you elaborate which one are you using? I was prescribed Wellbutrin/bupropion (along with some therapy sessions) about a month ago and I seem to notice no changes. I'm going to continue to be hopeful but it seems like this wasn't the one for me so just wondering what you were using.
Escitalopram is what I found worked for me. None of the SNRIs did (Effexor and so on), and bupropion isn’t even prescribed where I am for depression for what it’s worth, but I’ve heard some people have decent luck with it, typically as an adjunct with an actual SSRI though.
It took me months to find the right one for me though. Worth talking to your doctor about it if it’s not helping much!
I tried Lexapro 6 years ago when I first attempted to work on this issue. I was prescribed some minimum dosage(I forget what). I will never forget the first day. I didn't feel happy or sad or even anxious. It was as if every emotion was stripped out of my head and instead it was replaced with perfect neutrality. Nothing mattered int he world anymore. I had no thoughts or opinions, just complete neutrality of thoughts and emotions. This also became my most productive week in years. The thought process was literally "Ok I have this task to do, let me do this task, I am done with this task, ok lets do the next task. Repeat until there are no more tasks." No breaks, no distractions were noticed while the task is being performed.
Unfortunately, the side effects were so bad I gave up after a week. Horrible nausea all the time. Such extreme fatigue that i'd sleep 16 hours and still feel exhausted. Not to mention other side effects that are not appropriate to discuss here.
I am considering trying this nightmare of a drug again because I still remember that productivity but man that first experience literally felt like poison was seeping into all areas of my body.
Yeah that absolutely apathy is what kept me alive when I was so close to the edge.
But the side effects (and primary effects!) are also why I only ever stay on it for 3 to 4 months. The sexual side effects alone are enough to impede my recovery, let alone some of the other ones.
So I use it like a bandage to get through the worst parts, rather than a “take every day for years” drug. The “take every day” bit for me is CBT exercises to rewrite my mind, and it’s worked :)
The physical sides for Lexapro at least for me disappeared. I also got the nausea initially. It’s rough, I know.
There are other more modern SSRIs that might be worth trying too, but if escitalopram seemed to work then it might be worth trying to stick it out to see if the sides get better. They usually do
I gave up after the Lexapro until this year where I am trying to tackle this issue again with the Welbutrin. I keep reading that maybe ayahuasca or psilocybin might be the miracle key that solves the underlying issues.
Buproprion is quite good at removing false reward loops. Made me really tone down video games. It's used also for smoking cessation. It's quite subtle. The other SSRI/SNRI meds have strong side-effects.
I will say that the effect is permanent. It's rewiring your brain when you use it.
If it's helping you to spend some time on harder but more important self-improvement, then great.
If not, you should consider switching drugs.
I currently take ADHD medicine, which is helping in many ways, but a mixed bag in others.
All the drugs are going to grease the wheels in some way, but you'll have to experiment to find the one for you.
which ADHD medicine is good these days? do they raise blood pressure or act as a stimulant? (I guess I'm asking if there's anything better than adderall and ritalin these days)
Note that these are still stimulants tho. Vyvanse is unique in that its a slightly modified dextroamphetamine (adderall) molecule that gradually gets metabolized by the liver into dextroamphetamine, sort of a "natural" extended release and has a much smoother (side) effect curve. Concerts and XR are just cleverly designed pills that release two doses of plain methylphenidate/amphetamine spaced out, so there's two distinct peaks with a small lull between.
>Buproprion is quite good at removing false reward loops. Made me really tone down video games. It's used also for smoking cessation. It's quite subtle. The other SSRI/SNRI meds have strong side-effects.
That would be a miracle if it did that. My doctor put me on this precisely because it is less strong than other drugs like Adderal. He does not want me going down an addicting road unless necessary. (my summary of what he told me)
So far I have been taking it for about a month although I have missed days here and there and while I try to take it at the same time, sometimes the window varies by +/- 1-3 hrs. I am on the 150mg XR version. What is typical time frame we are talking about before we notice changes? 1 month? 6 months? How long did it take you?
The fact that I am on HN/Reddit/youtube for a couple hrs each day instead of exercising/coding/tidying up/working on my life seem to indicate that no reward loops have been broken thus far. In fact I am slowly sinking in the other direction(but i'm not sure if buproprion is causing it). I have broken another all time record for weight gain despite increasing my exercise regime somewhat.
Was considering stopping treatment after a month if no changes are noticed and wait some time to clear it out of my system before trying something like ayahuasca or psilocybin.
I took Wellbutrin for several months. As mentioned, the effects were subtle for me. The pill isn't going to do the work for you, just grease the wheels a bit. You should probably give it 3 months before quitting.
I'm currently on Adderall. If you have ADHD, it has more benefits than drawbacks in my opinion, and the effects are not as subtle. It does give you focus for tedious tasks, though it's up to you to assure that those tedious tasks are actually important and not a rabbit hole.
Neither drug is going to make you stop browsing Reddit or HN. If you want to reduce browsing Reddit, turn off all the default subs and then subscribe to specialized subs catered to real, specific interests of yours. You will not miss the default subs. HN is only good for about 1 page usually, then it's scraping the bottom of the barrel.
If you want to do more exercise/coding/tidying up/etc. set a 5 minute timer, do at least that much work on that, then reward yourself with some HN. You'll find that starting the activity is the hardest part.
Re: weight loss, you can't outrun your own fork. All the fad diets have a kernel of truth to them, a lesson to apply or discard in your own life. Intermittent fasting is quite effective IME. Besides calorie reduction, it also resets your hunger signals. For me, it got me over this irrational fear of being hungry that I had, and also revealed just how much I was eating out of boredom rather than hunger. Also, you have to pick a problem and focus on it. Mitigate the weight situation, but don't force yourself to fight a 2 or 3 front war.
If you have ADHD, you should be on an ADHD med, unless you literally can't trust yourself to take only one pill a day.
If you have treatment-resistant depression, you can also look into ketamine, either intravenous or now intra-nasal. Pay the price to have it administered professionally, as it's not a good idea to develop a black-market hookup for something so addictive.
I found medications ineffective, but my last therapist helped me tremendously. If your therapist isn't helping, find a new one. There's no shame in switching.
The most important thing in therapy is relational depth. Doesn't really matter what the method is.
"There is research to support common factors theory. One common factor is the client–therapist interaction, also known as the therapeutic alliance. A 1992 paper by Lambert showed that nearly 40 percent of the improvement in psychotherapy is from these client–therapist variables."
I am on my second therapist. The first was was a remote therapy based out of Israel. He was great and convinced me to quit my terrible job at the time and reorient my life. His therapy worked to an extent but I never could relay my deep insecurities to him. When I tried to explain deeper concepts to him it nver really registered. I just found myself wasting 120$ per session with no real payback. I continued with him on and off for 5 years before just giving up this year after my father passed away and I gained no comfort from talking to him about it.
A second remote but local(because of covid) therapist was assigned to me as part of this Wellbutrin trial. A total of 10 sessions are to be done with this trial. So far she has only told me what I already know: that I should keep trying little steps every day like increasing my exercise. She gives me little goals but I don't like the fact that since these sessions are 45 mins with no way to extend, there always seems to be a time crunch.
There are tons of therapists in my area with no way to evaluate the differences. This is an expensive proposition as it stands and so I don't know how I will find the perfect one without evaluating each and every different therapist in my area. :/
I wouldn't rely on answers from HN. I don't have depression, but I do have anxiety, and professional help changed my life. It would not hurt to get an evaluation if you feel like something is off.
I am increasingly confident I suffer from depression, rather than just being generically miserable.
How do you deal with the trust issues posed by that questionnaire? I have suicidal thoughts most days, but I'm concerned that revealing this to an NHS doctor would quickly result in my freedom of choice on what happens next being taken from me. Seems like one of the few cases where US healthcare (where you are explicitly a customer as well as a patient) has some advantages.
Involuntary admission works the same way in the US.
I have kinda the same problem. I've had depression for a very long time - stable, but consistently declining. I get the "... or I could just kill myself" xapata mentioned a couple times per week and the reasons I don't are basically "that sounds like work" and "that would make my mother sad". Which aren't exactly good reasons, I know, but so far I've done very little actual self-harm and I very much don't want to get involuntarily admitted. I really would like to get help to deal with depression. I've battled it out alone with it for 15+ years and I'm not exactly winning that fight. But- anyone that's qualified to offer that help is pretty much legally required to admit me if I answer their screening questions somewhat truthfully.
Not a doctor but have experienced something like what you're describing. It is important to be open with your doctor about this stuff because it allows them to accelerate getting you help. Differentiating between suicidal thoughts and intentions (the former of which I had, the latter I did not) made me comfortable enough to have the conversation.
Really though, seek help. It is unlikely you'd lose choices (eg be sectioned) if you're asking for help and engaging with that help.
That's a good point - thanks. "Thoughts" rather than "intentions" is definitely more aligned with where I am. Part of the trouble for me and presumably a lot of people is untangling those things - for example, would my thoughts be intentions if not for having a spouse, who I could never imagine hurting in that way by leaving? Moreover, does the mere presence of that kind of "blocker" represent a positive sign?
I pick at this stuff in my own head all the time, and just don't have enough confidence in doctors to believe they could tell me anything new. Being able to skip straight to pharmaceutical or other non-talking solutions via a disclaimer would probably mean a lot more people like me would seek help.
> Being able to skip straight to pharmaceutical or other non-talking solutions via a disclaimer would probably mean a lot more people like me would seek help.
Antidepressants are strong stuff. Some years ago I hit a bit of a snag and went to a doctor and got just this, a prescription after five minutes of talking with helpful advice like "get a girlfriend" or "study something else". Stuff really worked... except in the wrong direction. Not an exception either, common enough they put "suicide" as a side effect in the fine print. I think if you're gonna take something like that you need some kind of feedback/monitoring and test different drugs until you might find something that works right. A hands off fire and forget prescription like I got likely won't work for most people.
Yes, the presence of a blocker like that is a good thing. What ifs aren't the most useful thing though.
GPs have been enormously helpful to me with this stuff. Most are very understanding. If you can do an online appointment booking that might help too - so the immediacy isn't an issue so you can write the appointment reason very clearly and revise it as much as you want before hitting the button. Otherwise, tell the receptionist you'd like a phone appointment (for the distance that gives psychologically) and that it is for a mental health issue. The diagnostic criteria for depression are fairly easy to satisfy - it is mostly about low mood for 4+ weeks. Keep details to a minimum you need to get a prescription but be cooperative if they probe.
Whatever you do though, don't just suffer. Tell your spouse how you feel too. Get some help.
This doesn't control for the fact that the world sucks now, does it? I read a few months ago that ~25% of young adults had thoughts of suicide in the past year, so I think it's safe to say that the causes are more external than internal at this point.
Disentangling pandemic effects from "normal" life is complex but overall in the US suicide rates are actually down for 2020, though slightly increased for younger Americans. The trend in the US was upwards into 2019 so these are positive developments.
It is very difficult to properly assess 2020-2021 survey data both because the "you should be depressed" messaging is very strong in the media and the bias in who responds to surveys is complicated by the pandemic.
I am a Canadian and we saw an enormous drop in suicides, 30+%, in 2020 despite survey data (and wacky conspiracies) to the contrary.
I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue.
> the bias in who responds to surveys is complicated by the pandemic.
Many people have lost family members and been pushed into poverty. It is incredibly callous to think mental health can be discretely measured without accounting for the environment.
Suicide is not a quantitative measure of mental health.
If the claim that "Suicide is not a quantitative measure of mental health" means that such large fluctuations in the suicide numbers across many jurisdictions with differing underlying rates can't be used to inform any opinions about the impacts of the pandemic on mental health then I emphatically disagree.
I don't know who said you can measure mental health without accounting for the environment, I never made that claim! I literally said "I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue."
It's probably more likely that the internet is amplifying every problem in the world and since young adults grew up with it, it's more integral to their lives.
Additionally, there seems to be a stigma attached to not caring about a particular event, especially if doesn't affect you, all because of the slippery slope argument which is a fallacy.
> This doesn't control for the fact that the world sucks now, does it? I read a few months ago that ~25% of young adults had thoughts of suicide in the past year, so I think it's safe to say that the causes are more external than internal at this point.
How did you come to think depressions' cause must be internal ?
Yes - those things are closely related to some of the diagnostic criteria used by some of the tests for depression. The remission of those symptoms is a quite a good signal all by itself.
Yes. When you have depression you get basically nothing done. Even things that used to be fun aren’t fun anymore. You are miserable if you do something or nothing.
Lately I've been reflecting on the source of my low feelings and I have determined that in my case that alcohol is playing a key role. It is a de-motivator and its effects are pernicious in that it causes the user to become unaware that it is responsible for exacerbating depressed moods even after feeling intoxicated has worn off. I drink responsibly but think its time to cut it out to see if I feel better.
I've had depression for 20+ years and the best way I would describe it is like this:
Think of that little "kick" you get when you think of something you want to do. Maybe you like eating ice cream, maybe you like playing tennis, whatever it is... that feeling, that subconscious little mental boost that gets you up off your ass, and moving... is completely absent in the depressed mind.
That spark that initiates and sustains action, is simply not there. Tasks, even small ones, are giant and the future is hopeless.
It took me a while to realize that most people don't consider suicide as one of a few strategies to deal with everyday problems. Thought process: I don't want to do my homework. I could (A) get up and do it, or (B) kill myself. Happily, I've learned to dissociate myself from the part of my consciousness that thinks that way.
When the target of your objectively reasonable directive is self-admittedly of the mindset "I could (A) get up and do it, or (B) kill myself", you may want to reconsider the wording.
Don't worry, I'm pretty stable these days. And seeing a therapist helped. To your point, it was someone else who booked the first appointment for me. So, if you know someone who might benefit, it'd be good to help them out with the process of finding a therapist.
> suicide as one of a few strategies to deal with everyday problems.
That’s as much a solution to everyday problems as nuking the entire planet and the human race out of a existence is a solution to, say, Covid or hunger.
Why is wanting to stop pain and trauma is illness and wanting to continue in more of that useless suffering is normal? I am not talking about privileged here but most people who struggle whole life in world.
Because if suicide were typical, humanity wouldn't exist. Mental illness is merely abnormality, not necessarily something ethically wrong or illogical given one's a priori beliefs.
> Mental illness is merely abnormality, not necessarily something ethically wrong or illogical given one's a priori beliefs.
I agree, but what you're saying is not how the world see it. Many things that make humans exists are not necessary or makes life difficult now anyway. Like phobias, vomiting while travelling by car, allergies etc.
Nuking planet is different as it will nuke all other species. Removing only humans is a solution that actually works for better of everything else things.
Life is constant struggle for most humans (not talking about privileged here). In the end we all die horribly going through all that trauma, so peaceful suicide like hypoxia may be a solution to stop the suffering.
The thing about everyday problems is that they are every day. It isn't just looking at having to do your homework today, it's having to do your homework tomorrow, the day after that, and the day after that, out into what may as well be infinity.
Homework isn't a great example, but you can substitute anything that causes you suffering. For me, a lot of it is about my weight. I went through more suffering than most people can imagine to lose more than half of my bodyweight, and I was pretty happy with the result... until I started letting myself do the things I'd had to give up to get there: eating out with friends (or even attending any event with food), not doing intense workouts more than 3 days a week, having the occasional snack, eating something other than protein bars every meal, etc. My weight started increasing, naturally, and I realized: I never get to stop going through all that suffering if I want to maintain my weight. Ever. Ever. And without being able to maintain that weight I instead get to feel like a fat piece of shit for the rest of my life instead. Given those two options, the idea of just ending my life here and now doesn't seem so bad.
Given those two options, I'd end up choosing A. So thinking of B would actually be motivating. It wouldn't feel suicidal to think of both of those options.
The mental illness is when option B in this example seems preferable to small inconveniences and embarrassments, and when one doesn't think of things like, (C) forget about it and go hang out with some friends.
Life is full of small inconveniences and big ones time to time. It's not just one small one. So wanting to stop all that should not be considered illness, but forcing to continue the pain and trauma should be. Life is ultimately a meaningless thing, and most people suffer for it. Some people are privileged and they decide what is illness and what is not based on their own life.
One has to work 9-5 whole life that slowly kills their health and die horribly. That's normal, but if one does not want to continue that, it's illness. One must suffer. There is no other way whatever people here says, the real world does not work in any other way.
My thinking is slightly different in this case then yours:
Ending it today will stop having to do x today, tomorrow and rest of my life.
So it's not just the homework of the day.
But due to my thinking I would also not just go without consuming my money and doing only what I want as long as possible as it also freed me from certain social boundaries.
Like suicide is bad, you need to work, lifing as long as possible is good etc.
My thinking was always comparing it to a crappy movie at a middle of nowhere theater. Sure the movie may be bad, but it still beats getting up and leaving.
How many bad movies you gonna watch until standing up and leaving becomes the better choice?
One problem might also be that in my opinion lifing as long as possible is not the right answer. I'm not life positive like independent how shitty your life is as long as you are alive is good.
Now the question arrives what is a good time to leave.having already seen and done more than any other human who lived 50 years ago already puts me ahead on a experience level
.
So determine this answer is open for me to decide.
Not having kids and not planning some right now also makes me more 'flexible'
I'm dealing with something like this too. It's come up a lot while watching shows where some protagonist's friend turns psychotic and they suddenly must fight to survive. I keep thinking to myself, "just give up and let them kill you, it will be better that way!" I can't quite pinpoint the theme that seems to permeate all of these and how much of it is my own perspective versus some specific genre. I think of it a lot while watching The Future Diary, and also Higurashi: When They Cry.
"You asked me how depression felt, and this is all I could come up with.
It feels like I’m walking upstream through a current strong enough to pull me under four times over.
There are others with me but they are walking along the banks telling me to “just get out of the water.”
But instead of extending a hand in help, they just move on and leave me behind.
Every once in a while I find a rock that is strong enough for me to lean on, And I can rest for a bit.
But the rocks always get tired of holding me up, and when they let go, I’m left drowning, thrown 50 feet back again.
And nothing is harder than standing up in that current when everything in you is telling you how much easier things would be if you just let yourself get dragged under."
Does that apply to things you 'have' to do as well?
I don't really like shopping for groceries, but I'd rather do that, than order take out that's expensive and probably not very healthy.
If I'm going to cook something, I'd rather cook something with a different taste than eat pasta again.
I don't really want to do laundry, but I do want to have clean clothes that don't smell.
If I could afford to do so I wouldn't work, but until I retire that's not possible, so I might as well make the most of it and increase my earnings/time ratio.
I don't really want to go see my family, but I feel I have a duty to do so.
I'm not a doctor, but from what I've heard and seen: many depressed people manage to put up a good facade.
(Of course, that doesn't mean that putting up a facade means that you are depressed.
Also going out and doing stuff is probably better for you than sitting at home, no matter if you are depressed or not. And if that drive to make you go grocery shopping or meet people is less than healthy, that's still better than losing all motivation for everything, I guess?)
Have you tried a delivery service? Walmart as an example charges $100 or so a year. And then you pay a tip to the delivery person. I think it's worth it to avoid shopping in person, and cheaper than ordering delivery from restaurants.
My wife suffers from agoraphobia and is autistic. We (honestly: she, as she arranges it) do something similar, but we don't live in a country with tipping culture, so its a flat 100 EUR or so (you can also pay per delivery then the price fluctuates, a decent way to evaluate). Sure, it has cons. Sometimes stuff isn't fresh (report, and get your money back), or the expiration date doesn't suit our planning. Sometimes stuff isn't available or its not included. But it really does help, especially if you have difficulty leaving the house for any reason (we got little kids as well). I also find covid-19 a good reason to not go to the grocery store. However, you miss out on the fresh air and increase lack of movement. Get your little children out, for example to the local playground. A dog can help with that, too. And finally, have a buffer storage esp. with regards to non-perishables, just ensure your house or apartment can deal with the extra storage (e.g. we got an American fridge/freezer).
Yes. Depending on the severity of the depression, a depressed person might have problems with even basic things as brushing teeth and showering regularly and being able to do household chores.
Yes, that's how symptoms generally work. Symptoms are signs that may or may not point toward a diagnosis. A diagnosis such as depression is something separate that is determined from the collection of symptoms on an individual by a doctor.
I used to feel the same. What I found was that thinking of chores as a "duty" made it into a something I wanted to avoid. Instead, making these into a fun "mission" turned it into a positive thing I look forward to. Something about adding a good sound track, makes all the difference.
Some examples
- Going groceries. Used to hate it. Stressful. Too many people, I'd get social anxiety. Now, I smoke some weed, put on Michael Jackson on my headphones, cruise through the store with a smile on my face and a dance in my step. They say Mediterranean cuisine is one of the healthiest diets. OK. So I bought the best Turkish cookbook (https://www.amazon.com/gp/product/0714878154/ref=ppx_yo_dt_b...), and decided this is my new food bible. "Good luck, me! You're gonna need to figure out Eggplant." I've been eating grape-leaf wrapped rice, humus, pita bread, and that kind of thing all week - have never felt healthier. The recipes are easier than you think, and are good for leftovers, meaning you can food-prep and still eat healthily.
Laundry - You might laugh, but I find that on the days where I imagine I'm going to go on a hot date (LOL one day), or meet an important client, or honestly - when I feel most badass (and comfortable!), those days - cool stuff happens. I make a cool connection, have a good conversation, experience something different... So, doing laundry has been a positive way to ensure that my favorite shirts/outfits remain ready for duty, instead of uselessly in a basket.
Work - I was in a bad work situation a couple years back. Failing in-place, in slow motion. I tried to be honest during a review with ny boss, and listed all the things I felt I needed to work on (honestly, coming clean on what I was failing at). My boss took me aside and told me, "Why not get better at what you're already good at, rather than improving on what you're not". It kinda blew my mind... I honestly took a look at one of those "find your dream career" Ven diagrams. What is the intersection of your Passion, What You're Good at, What People Pay for (https://www.authentic.com.au/wp-content/uploads/2015/08/pros...). I broke the seal, asked my friends, "Hey. I'm looking to make some career changes, and could use the perspective. You know me. What do you come to me for?" I was surprised what kind of great answers I got. I'm quite self critical, so hearing this type of feedback was very encouraging.
I find t fulfilling to identify the people in my life whom I truly admire, learn about their life goals, and help them achieve them. It's a really great feeling, and leads to getting to know your friends at such a different level.
Family - Lately, I have been calling my grandmother on the phone. She's 95. I asked her, what gets you up in the morning? Without missing a beat, she told me: "Music." She loves Singing, playing piano, dancing. I decided to learn to make music. I'm not going crazy with it, but I bought a MIDI keyboard, plugged it into Garageband, and have been learning chords to songs I like, taking lessons. I'm telling you - it's such a wonderful soul feeling. I've since found out that many of my family members - some I had "written off" - are into so music. We've truly been able to connect in ways that excite us both. One of my cousins, we've gone from a "I see you once a decade" to the the true feeling of "family"- sharing each other's cool songs we've discovered, favorite bands & albums, to even video clips of our playing music attempts, telling st...
Does that apply to things you 'have' to do as well?
For some folks: This is the reason for a shower becoming a monumental victory in one's day: Sometimes just getting out of bed is a struggle for folks. I'm in a few cooking subreddits, and often get folks looking for "depression food": Food that takes no effort (cooking at all can be too much effort) yet is still a bit healthy. At this point, you probably aren't enjoying food anyway. I've known someone that literally bought new underwear because laundry was the more difficult option.
Not everyone has all of this, and folks are pretty good at hiding it from others and putting on a happy face.
I have seen a person so depressed they didn't even care to get out of bed to have a bowel movement. They just stayed there in it until someone else came to clean it all up.
I am the same way. My depression isn’t severe enough that I CANT do the things that need to be done, but rather, they take immense effort and personal discipline.
Of course everyone (even non depressed people) sometimes struggle to do things they have to do, but don’t want to do. It’s all about how severe that struggle is, not whether or not that struggle exists at all.
I just wanted to follow up on this as well. I also have my groceries delivered because grocery shopping is incredibly overwhelming for me and I suffer from several mental disorders. Something that I have learned is part of learning to live with mental disorder is giving yourself the grace that even if you can force yourself to do something that is very hard on you it is totally valid to find a hack to help you out(like getting your groceries delivered). This might sound like a no brainer for a neurotypical person but allowing myself access to tools to alleviate stress was seriously difficult for a long time because I felt like to be a "healthy" person I had to force myself to do things for myself that I thought "normal" people did. I forced myself to do things that were actively destructive to my mental wellness in part as punishment to myself for not being neurotypical.
That's just one of many symptoms you're describing here (loss of interest). For me the main symptom is depressed mood, which essentially feels like someone you cared about a lot died recently.
Years ago I was recommended a book written by a Dutch psychiatrist who had developed depression himself. The tagline was sort of "here's a professional who suffers from it, this will be insightful."
I couldn't relate to his condition for one iota (let alone finish the book); as he had mostly feelings of guilt and shame, and dark, weird mental images.
I guess depression is a sort of blanket term by now for many things, which probably complicates diagnosis and most of all, treatment.
Plus, I recently discovered the term "sh*t life syndrome", which is apparently getting to be known as a well-known term in the US/UK psychiatrics system (at least it has a Wikipedia page claiming that). It describes people who are poor or lonely because of the system surrounding them (prime example: they live in an area with raging unemployment). In that case, it's argued, symptoms of depression might actually be the logical response to an outside stimulus (or lack thereof). Yet, it appears many of these people are referred to psychological treatment because, well, society doesn't come up with any better option.
But what rubicon33 describes is certainly one way of depression, and I think a common one. But I'd go one step further even: Yes, people lack that little "kick" to get them going and do something entirely. But I don't think that's the root cause.
The root cause, to me, is that this kick has been subconciously "unlearned". Because when people with this sort of depression DO force themselves to do some of these things (and man, do they need to force themselves, with rational arguments and all sorts of tricks), they are not enjoying it. To stick with the example of playing tennis: Non-depressed people come back and say: "That was fun! I powered myself out on the tennis court, maybe I even won, I feel good.". People with this particular sort of depression come back and say: "That was physically, but mostly mentally exhausting. I want to sleep or procrastinate now and reset my thoughts to the baseline of being emotionless."
Disclaimer: Yes, I think I can also kind of speak on this subject. I've been repeatedly diagnosed with childhood PTSD and depression possibly ever since that (which makes it 30+ years); which doesn't mean that I'm not questioning this all the time, because the biggest trick played by depression is to make you think that everything may be just normal sadness/exhaustion/"not trying hard enough" ...).
I think symptoms of depression are reduced to too few dimensions (these being all disorders names coming from a science which cannot reproduce most of its results).
Imagine Einstein. He can't figure it out and solve the constant problem. Somethings not right. He's not happy, not sleeping well. He's thinking hard.
But then, he takes a pill. Suddenly, no more thinking during bike rides. "I'm just looking around and dopamine rushes in, it's great".
(I'm not discouraging treatment if you have a problem !! Positive feedback loop of negativity can kill you.)
I just mean that if you have high standards you may be less easily satisfied. I do think it's good to be able to step back and really enjoy a walk or music without a care in the world, but I also don't think there's something wrong with people who don't, and instead just focus on their problem. Or even are just looking for a problem or a puzzle interesting enough to solve.
It's all in the context. Sleep is important, you should sleep well. But maybe if you are lunching a rocket tomorrow it's fine to have a problem sleeping. Respect to others is the most basic thing, but maybe if they keep distracting you from work which can improve everybody's life it's ok to say something harsh but effective. And so on.
I don't think you can truly change the world if you sincerely enjoy its current state.
OK, in too much simplified version: you not being content with the state of things may not necessarily be your fault - it may be the things fault.
Of course you can change yourself, all problems are within you, they are created by your optimization function. Apocalypse is not a problem unless you don't want it to happen. Without people who don't make themself content with the state of things right now it's not a nice place to be. But without people who are not content and are trying to fix it it's not getting better.
Just to be too verbose because of sensitive topic: it may be you, it may be chemical imbalance, I'm not saying it's a happy pill and long story short if you haven't experienced happiness in a long time go see a doctor yada yada.
You can be happy during apocalypse when you are making progress towards ending it, you can not like things and accept it. I'm just making a case for unhappiness being the sane reaction in specific contexts.
It's really hard to have a meaningful discussion about this topic without being seen as a murderer while providing a decent information density. Even on HN.
I don't think it's ever the thing's fault. If you're actually depressed about not solving a really challenging problem, this results from a process that works differently in people who aren't susceptible to depression. For instance, maybe you get depressed because you thought you could solve it much more quickly, and you're realizing your self-assessment is entirely wrong, and this starts negative thought spirals that maybe your abilities to do anything are over inflated, and that you'll just experience frustration and negative emotions in tackling anything, and this sucks the drive and enjoyment you used to experience from any of your hobbies.
If you weren't susceptible to depression these spirals wouldn't take hold, you might just say, "huh, now that I've learned more, I realize this is a harder problem than I first thought" and you just carry on.
It is never the thing fault. But it may be the thing fault given your optimization function.
Imagine a kid drowning in front of you (that somewhat happens but on the other side of the world so you can't see directly). You can be unhappy about it, but that's within you. If you don't care about the kid you have no reason to be upset.
Most probably would agree that maybe doing something to yourself to make you less upset about the kid drowning is not optimal. Reality is somewhere between this and somebody living a perfect life and wanting to kill himself.
Depression and other disorders are primarily described by being disproportionate responses to stimuli. The astronaut isn't clinically anxious being up at 2am before the launch, but if they were because they had to drive to the post office tomorrow that would be. That's not a world solving problem that's keeping them up at night, it's just trying to live. That's the difference.
Unless there would be something big at the office. Or they hated they job. Or they get burned out because it offers them no life-work balance and space for other activities and relationships outside of it.
In all cases above it's not the brain chemistry that you probably want to fix. But you probably can do just that..
I remember reading a while back a article on how a US military research group was looking at improving focus and some particular test scores using TCS. Which sent me on an investigative rabbit hole of people that are using it at home in a diy manor. So I don't think you are too far off!
Searched comments for this. Found at bottom, battered and faded, but yes, that is exactly what it would be, I agree. However, I also accepted that being glib about it and calling it soma ignores what it's like to live with clinical, total physiological depression and that this is real hope.
I'm not scolding either, I literally laughed at this myself and came here to say something along those lines, but giving a generous sop to some people I fundamentally disagree with - it was a laugh that signalled an opportunity to empathize with the subject of it. Feels gross even saying that, and I believe the soma thing is a legit question, but even at the risk of arming enemies, it's worth elevating the commentary a bit because of what is on the other side of it. We don't make b-movie zombie references whenever there is a new chemo treatment with promise against cancer, and if someone depressed said to me, "hey thanks and f-you for making my need for the first viable treatment just as stigmatized as the disease," I would have earned the criticism honestly.
I also realize this is what only a truly master soma propagandist would say as part of a campaign for the coming change, but my realization was sincere, and anyway, there's also no way they're this good.
Soma, in Brave New World, made you more passive (as well as happier). Curing/alleviating depression makes you more active. It gives more meaning to life, not less.
Huh, I've been talking to my therapist about my antidepressants not being terribly effective anymore. Is there a way to sign up for a clinical trial for this?
Or you could look into psychedelic medicine. On the legal side, ketamine has helped a lot of people with treatment resistant depression. You could also look into participating in clinical trials of MDMA or psilocybin. The clinical trial results for those medicines are phenomenal, too.
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.
I wonder what the underlying mechanism is. With the prevalence of magnetic fields in everyday life, I wonder if these could be affecting people negatively from prolonged exposure at lower doses or frequency.
Hey! I didn't under go SAINT TMS specifically, but I have undergone TMS therapy. Reading this article I'm not sure how different what I received actually is compared to SAINT, but TMS absolutely changed my life.
I was referred to TMS after a rash of different medications and years of talk therapy fell short on relieving the worst of my symptoms. Many of the benefits the patients in this article discuss are ones I received as well. I really do suggest it to anyone who is able to access it and suffers with severe depression.
Very interesting. And there are tDCS home kits for $149, e.g. https://apexdevice.net/shop/apex-type-a-4ma-std/. This is low cost enough that I'm willing to give it a shot. Worst case, I end up with a decent DC current source that I'm sure I can find a use for at some point.
Okay, sounds like some people trying this at home have had seriously bad side effects. So will definitely have to do some reading before giving this a shot.
Hi! TMS is at a baseline very expensive. Luckily(hah, sort of) because I had both suffered terrible side effects with several medications and I carry a sustained diagnosis from a very young age that was documented as being massively detrimental to my ability to function, my insurance was willing to cover the treatment. The head coordinator of the program actually advocated very heavily on my behalf for me and spent a lot of time working with my insurance to get me covered.
The main downside of TMS is simply that you have to be fully dedicated to the treatment. For six weeks I had to go Monday through Friday to a special clinic that was a half an hour drive from my house. This was a point that they brought up repeatedly in my interviews to get the treatment, so I think it must be common that people decide that it is too much dedication. For me though, by the time I was interviewing to receive TMS I had really tried everything and I was absolutely desperate to follow any path that would offer relief from my symptoms. I had gone through multiple medications, had been in talk therapy for several years, tried CBT, DBT, self medication, meditation, yoga, exercising three times or more a week, different diets, spiritualism... Really the works. I could sometimes stave off my symptoms but eventually I would suffer a huge crash and totally burn out again.
One of the other possible side effects is also seizure during treatment(very rare) and because of this they ask that you abstain totally from substance use during the time as it can lower your seizure threshold, which I agreed to happily. While the idea of having a seizure was scary, I had already experienced so many horrible side effects from medications that didn't even alleviate my symptoms I was willing to try anything.
I am not an expert in the field but I do think that there is a lot of use that could be gained for any person who decided to try TMS, for me some of the things I noticed was that my brain fog started to lift and suddenly I was able to learn much more quickly. I started practicing languages and instruments to really help foster this growth in my brain. The TMS helped me break the patterns of my mental illness and start forming healthier ones...I really do credit it with saving my life.
Really happy to read about your positive experience. TMS changed my life also. It ushered me out of a nearly 5-year depression.
It was interesting to talk to the technicians/clinicians about how they came to be working at a TMS clinic. Several told me they'd been working in mental healthcare for decades, and were excited to work with TMS because it was the only thing they'd ever seen be truly effective in treating severe and persistent depression. One told me she had been helping patients through the 6 week program for three years and had not seen it fail to help a single person.
When I read the paper for this study it brought tears to my eyes. To think that it's possible to apply a lasting treatment to someone stuck in their own personal hell over the course of five days, and to have the effects persist for six months, is practically a miracle.
My treatment was over two years ago and I have not relapsed. There is hardly a day that passes where I do not feel deep gratitude for that burden to be lifted.
Wow it's so great to hear from another person who had a life changing experience with TMS! The clinicians were really blown away by how quickly the TMS started to help me and even though it's been over two years since my treatment I really do feel as though it is still helping me now. The clinicians that I talked to at my clinic were similar in their experiences. It really does drive home for me how debilitating depression actually was for me and still is for so many people. I spent years taking all the "right" steps to feel better and following advice from different doctors, and I still was often overwhelmed. I am happy that now when I use the skills I had built up over years with my therapist they are a lot more effective.
Looks like it is just more tailored to your particular brain neurocircuitry and give more pulses but instead of in 1 session over ten small sessions in a day. Sounds like it only makes sense that this works even better!
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[ 3.2 ms ] story [ 280 ms ] thread> “Twenty-nine people with treatment-resistant depression participated in the study: About half received SAINT, and the rest underwent a placebo procedure that mimicked the real treatment. After five days of treatment, 78.6% of the participants in the treatment group were no longer depressed, according to several standard methods of evaluation. “It’s quite a dramatic effect, and it’s quite sustained,” said Alan Schatzberg, MD, the Kenneth T. Norris, Jr. Professor in Psychiatry and Behavioral Sciences, who was a co-author of the study.”
Makes me wonder what percentage of the placebo group improved?
> The transcranial magnetic stimulation treatment currently approved by the Food and Drug Administration requires six weeks of once-daily sessions. Only about half of patients who undergo the treatment improve, and only about a third experience remission from depression.
From the article further on.
Who says it won't last? Most depressions actually do get better by themselves.
How do you think humanity has survived so far?
(Most, but not all. And even if it eventually gets better without meds, there was still a lot of suffering.)
Empirically, most clinical depressions get better by themselves today.
Similarly, most alcoholics improve by themselves.
(Of course, effective treatment is still useful!)
No clue whether it's the depression itself, or whether that's just a side-effect of something else that's useful.
But what about other chemicals, Glycine contributes to an increase in 5alpha Reductase which helps reduce Cortisol one of the stress hormones. It can be used in place of sugar in hot beverages and food, how much does stress contribute to depression? https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conv...
And then there is Glutathione which increases light sensitivity, could this help reduce Seasonally Affect Disorder (SAD) also known as the winter blues, knowing that it also helps management of ROS, peroxides, lipid peroxides and heavy metals? Glutamine, N-Acetyl Cysteine and Glycine help to increase Glutathione in the body.
I wonder if fMRI has a similar effect on the brain to homogenising milk, namely it softens the fat walls in milk. Is fMRI having an effect in the brain or in the vascular system with plaques that contribute to atherosclerosis, because induction hobs or magnetic induction reduces inflammation https://peerj.com/articles/929.pdf does this demonstrate that depression is caused by a variety of factors not just one's linked to serotonin even though serotonin plays a part with the immune system?
I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it.
Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.
It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.
The FDA approved treatment is "aim at the middle of the dorsolateral prefrontal cortex". Getting more activity and connectedness improves its regulation of overall emotional activity.
This research implies that aiming instead slightly differently and a different dosing regimen may be more effective.
This is no different from any other medical treatment, where we find refinements in how and where to apply basically the same treatment to get better results.
To get some perspective on iterations of treatment, read this account of the work of August Bier.
He pioneered spinal anesthesia, something used all of the time today for epidurals during childbirth.
His experimental treatments he both performed and had performed on him by his assistant will, at the very least, raise your eyebrows.
https://en.wikipedia.org/wiki/August_Bier#Spinal_anesthesia
Then again, the stuff shows benefits in trial, and presumably we get most practitioners trained up and doing the thing that's the standard of care well enough...
But in practice people just take two 500mg tablets and call it a day. Works well enough most of the time, even though it might be 'wrong' in some platonic sense of the word. (Eg you might have been helped enough with a slightly lower dose. Or perhaps 1250mg would have been better and suppressed slightly more of the pain. Who knows?)
I'm just not sure what the margin for error is, the failure modes for this magnetic therapy, or what makes a good magnetic therapist.
Not a reason to stop developing it though.
That’s what gives me pause.
How happy would you choose be if you could consciously decide how happy to be?
For future reference, assuming this is a clinical trial, data from clinical trials is available online. This is the kind of statistic that you'd be able to find.
Eg. "We'll poke this red hot poker into you 10 times to cure your depression"... Many painful screams later... "So, is the depression any better now, or should we do more treatment?".. "Yes, yes, I'm pretty much cured!".
How can we be sure that this 'torture effect' isn't whats being measured here? Especially when the treatment appears to have unpleasent side effects, and the success of the treatment is measured with patient feedback...
Part of being depressed is you don't even have the will to resist being treated in a way that you don't like.
In fact, I'd say that feeling powerless against conditions that you don't like is the core of what depression is.
It's why someone who is depressed doesn't feel like doing anything, because they feel like no matter what they do nothing will ever change so nothing they do is ever worth the effort.
Just mildly uncomfortable .. for a period of time longer than one would be willing to tolerate.
Something like being at the dentist when you have many cavities in your teeth.
You can tolerate one or two sessions. But the idea of doing it every day for two weeks straight is unbearable enough that you decide on the third day to report feeling well.
With a sample size this small I don't think it should be in the news at all
- Building upon mounting evidence of TMS efficacy in patients with severe, intractable depression.
- 79%-- 11 of the 14-- no longer meeting diagnostic criteria for depression after treatment, and another was improved.
- It's an RCT showing both massive efficacy and statistical significance. (2 of 14 in placebo group entered remission).
I know we like to chant "more n"-- but this is very likely to be both real and a clinically useful finding.
More n is required, yes, but small n results like this are a noteworthy step in the right direction.
There is often good reason why n is small. Statistically significant results like this one pave the way to future experiments with larger n.
Small n studies are often the most exciting. If you get a p<0.01 effect in 10 people vs. 10000 people... the lower bound of the effect size is similar, and so for the same prior each study should change our belief by a similar amount... but the upper bound of effect size is much larger in the large study.
The only thing that messes this logic of mine up a bit is publication bias. There's a much larger chance that small studies sit on the shelf unpublished if there's no clear effect.
It seems that running these 'small batch' studies/trials can be tremendously helpful to inform and refine the approach before executing on a larger scale. Of course if it takes 3 years to reach an endpoint it probably doesn't make sense to serialize them, but to my layman perspective there appears to be clear value (and in this case encouraging results).
Sure, though one aspect of the depression scales is (self-reported) ability to go about daily activities, get normal sleep, etc-- not just "feeling down". That is, it's self-reported information on functionality, too.
It's also extremely expensive, and unless you're a god at writing grant proposals, most uni research labs are cash poor.
There's a reason most studies don't have lots of participants, and in most cases it's not laziness on the part of the researchers.
Internet comment sections however are not great at nuance, and the difference between a bad study and a study leaving unresolved uncertainty is often beyond them.
Makes you wonder whether they'll go into remission for a while and then slip back into depression if the environmental factors are still there. I guess if it can knock you out of a depression where the trigger is no longer present but the trauma persists, that's incredibly valuable, even if the mechanism seems very strange.
Anyway Doctor was explaining the damage to lungs and odds of survival, but I was totally chill about it thanks to Prozac.
Plus side doctors finally believed me that I wasn’t making up stroke symptoms.
Sometimes depression has a real cause that needs dealing with.
Actually being depressed can worsen environmental factors. Depression can make it hard (or impossible) to maintain work, relationships, hygiene, sleep, diet, and exercise. Losing the things can make the depression worse.
Every mind issue is also a brain issue, and so there is no actually boundary between the "real you" and an ailment --- it's an arbitrary division influenced by social norms.
I am no expert but I understand medical ethics is more trolley problem type stuff than issues like this. Similarly is the fact the many psycological ailments are highly culturally specific but the DSM just sort of assumes American context and doesn't go into this.
This is TMS but they specifically targets the subgenual cingulate uniquely for each patient with help of fmri . Usuially they target a location at r13 which is easier but the location of the subgenual cingulate is unique to each person sometimes u are lucky and it's r13 sometimes it's not
Unfortunately for SAINT it looks like you also need fMRI to correctly target the therapy...that's going to be a bit tougher to DIY.
You can also search this TMS FB group https://www.facebook.com/groups/285541688306686 for "saint" and find other people's experiences.
Edit: Apparently, the clinics that claim to be offering it might just be doing something that is loosely based on what is publicly known about the SAINT protocol. Dr. Nolan Williams hasn't released full details, so it's not possible for clinics to replicate it exactly. This clinic https://www.cambridgebiotherapies.com/accelerated-tms/ talks about how they've tried to reverse engineer the protocol at the bottom.
There are also a few antipsychotic-like drugs that are used at low doses for antidepressant effects along with other antidepressants, but I'm not sure if the newer ones are indicated for depression, or if the newer ones are just reformulations of existing medications. It looks like there's a newer olanzapine combination on the market.
Here is a great comparison between different noninvasive brain stimulation techniques for depression: https://www.bmj.com/content/364/bmj.l1079
https://www.frontiersin.org/articles/10.3389/fpsyg.2015.0021...
wow, ouch.
Serious question: are these typical signs of depression? Now I'm wondering if I have depression.
I’m just conscious of this because I’ve seen this argument used to justify delaying actual treatment in favour of ‘alternative medicine’.
Basically the counselling/therapy part of the process would be identifying if there's a "real world" root cause to address ahead of going the pharma route and facing potential side effects, and/or the reality of having to go off it later and immediately regressing because the root cause hasn't been fixed.
In any case, I'm obviously not a doctor; neither this post nor the GP should be construed as medical advice.
If you're experiencing those, it might be worth talking to a psychologist or your doctor (to get a referral): you don't have to tough it out. But people who don't have clinical depression also have those issues too, which is why the diagnostic criteria is a little more involved.
For me, a short 3-4 month course of a particular SSRI lets me beat back the worst of it, and Cognitive Behavioural Therapy keeps it at bay. I haven't had an episode in years now
Screws up your sleep cycle, is time consuming, causes you to not leave the house, makes other hobbies fall by the wayside.
That said, it does also exacerbate clinical depression, so this gets confusing quickly!
otherwise most of them wouldn’t want to socialise at all.
I have on many occasions beaten back total anhedonia and a desire to die with a few drinks. It's not an optimal solution obviously, but when your options are limited it is sometimes quite preferable to not drinking.
As someone who has suffered major depression, I agree totally that recreational drug use can be helpful in managing some symptoms of mental disorder. I do however feel like moderation is a very important aspect of this which can be harder for folks when they are already feeling down
Can you elaborate which one are you using? I was prescribed Wellbutrin/bupropion (along with some therapy sessions) about a month ago and I seem to notice no changes. I'm going to continue to be hopeful but it seems like this wasn't the one for me so just wondering what you were using.
It took me months to find the right one for me though. Worth talking to your doctor about it if it’s not helping much!
Unfortunately, the side effects were so bad I gave up after a week. Horrible nausea all the time. Such extreme fatigue that i'd sleep 16 hours and still feel exhausted. Not to mention other side effects that are not appropriate to discuss here.
I am considering trying this nightmare of a drug again because I still remember that productivity but man that first experience literally felt like poison was seeping into all areas of my body.
But the side effects (and primary effects!) are also why I only ever stay on it for 3 to 4 months. The sexual side effects alone are enough to impede my recovery, let alone some of the other ones.
So I use it like a bandage to get through the worst parts, rather than a “take every day for years” drug. The “take every day” bit for me is CBT exercises to rewrite my mind, and it’s worked :)
The physical sides for Lexapro at least for me disappeared. I also got the nausea initially. It’s rough, I know.
There are other more modern SSRIs that might be worth trying too, but if escitalopram seemed to work then it might be worth trying to stick it out to see if the sides get better. They usually do
I gave up after the Lexapro until this year where I am trying to tackle this issue again with the Welbutrin. I keep reading that maybe ayahuasca or psilocybin might be the miracle key that solves the underlying issues.
I will say that the effect is permanent. It's rewiring your brain when you use it.
If it's helping you to spend some time on harder but more important self-improvement, then great.
If not, you should consider switching drugs.
I currently take ADHD medicine, which is helping in many ways, but a mixed bag in others.
All the drugs are going to grease the wheels in some way, but you'll have to experiment to find the one for you.
That would be a miracle if it did that. My doctor put me on this precisely because it is less strong than other drugs like Adderal. He does not want me going down an addicting road unless necessary. (my summary of what he told me)
So far I have been taking it for about a month although I have missed days here and there and while I try to take it at the same time, sometimes the window varies by +/- 1-3 hrs. I am on the 150mg XR version. What is typical time frame we are talking about before we notice changes? 1 month? 6 months? How long did it take you?
The fact that I am on HN/Reddit/youtube for a couple hrs each day instead of exercising/coding/tidying up/working on my life seem to indicate that no reward loops have been broken thus far. In fact I am slowly sinking in the other direction(but i'm not sure if buproprion is causing it). I have broken another all time record for weight gain despite increasing my exercise regime somewhat.
Was considering stopping treatment after a month if no changes are noticed and wait some time to clear it out of my system before trying something like ayahuasca or psilocybin.
I'm currently on Adderall. If you have ADHD, it has more benefits than drawbacks in my opinion, and the effects are not as subtle. It does give you focus for tedious tasks, though it's up to you to assure that those tedious tasks are actually important and not a rabbit hole.
Neither drug is going to make you stop browsing Reddit or HN. If you want to reduce browsing Reddit, turn off all the default subs and then subscribe to specialized subs catered to real, specific interests of yours. You will not miss the default subs. HN is only good for about 1 page usually, then it's scraping the bottom of the barrel.
If you want to do more exercise/coding/tidying up/etc. set a 5 minute timer, do at least that much work on that, then reward yourself with some HN. You'll find that starting the activity is the hardest part.
Re: weight loss, you can't outrun your own fork. All the fad diets have a kernel of truth to them, a lesson to apply or discard in your own life. Intermittent fasting is quite effective IME. Besides calorie reduction, it also resets your hunger signals. For me, it got me over this irrational fear of being hungry that I had, and also revealed just how much I was eating out of boredom rather than hunger. Also, you have to pick a problem and focus on it. Mitigate the weight situation, but don't force yourself to fight a 2 or 3 front war.
If you have ADHD, you should be on an ADHD med, unless you literally can't trust yourself to take only one pill a day.
If you have treatment-resistant depression, you can also look into ketamine, either intravenous or now intra-nasal. Pay the price to have it administered professionally, as it's not a good idea to develop a black-market hookup for something so addictive.
"There is research to support common factors theory. One common factor is the client–therapist interaction, also known as the therapeutic alliance. A 1992 paper by Lambert showed that nearly 40 percent of the improvement in psychotherapy is from these client–therapist variables."
Quote from https://en.m.wikipedia.org/wiki/Dodo_bird_verdict
This has been my experience as well, both personally and through friends.
An important point is that a therapist which works for someone might not work for you, it's rather personal.
A second remote but local(because of covid) therapist was assigned to me as part of this Wellbutrin trial. A total of 10 sessions are to be done with this trial. So far she has only told me what I already know: that I should keep trying little steps every day like increasing my exercise. She gives me little goals but I don't like the fact that since these sessions are 45 mins with no way to extend, there always seems to be a time crunch.
There are tons of therapists in my area with no way to evaluate the differences. This is an expensive proposition as it stands and so I don't know how I will find the perfect one without evaluating each and every different therapist in my area. :/
Depression is surprisingly common. Most people kick it after a month or so of meds (the individual in the article clearly has chronic depression).
The PHQ-9 is a pretty standard depression screening questionnaire that you can complete in a minute or two. https://www.mdcalc.com/phq-9-patient-health-questionnaire-9
going to bring this up with my therapist tomorrow
How do you deal with the trust issues posed by that questionnaire? I have suicidal thoughts most days, but I'm concerned that revealing this to an NHS doctor would quickly result in my freedom of choice on what happens next being taken from me. Seems like one of the few cases where US healthcare (where you are explicitly a customer as well as a patient) has some advantages.
I have kinda the same problem. I've had depression for a very long time - stable, but consistently declining. I get the "... or I could just kill myself" xapata mentioned a couple times per week and the reasons I don't are basically "that sounds like work" and "that would make my mother sad". Which aren't exactly good reasons, I know, but so far I've done very little actual self-harm and I very much don't want to get involuntarily admitted. I really would like to get help to deal with depression. I've battled it out alone with it for 15+ years and I'm not exactly winning that fight. But- anyone that's qualified to offer that help is pretty much legally required to admit me if I answer their screening questions somewhat truthfully.
Damned if you do, damned if you don't.
Really though, seek help. It is unlikely you'd lose choices (eg be sectioned) if you're asking for help and engaging with that help.
I pick at this stuff in my own head all the time, and just don't have enough confidence in doctors to believe they could tell me anything new. Being able to skip straight to pharmaceutical or other non-talking solutions via a disclaimer would probably mean a lot more people like me would seek help.
Antidepressants are strong stuff. Some years ago I hit a bit of a snag and went to a doctor and got just this, a prescription after five minutes of talking with helpful advice like "get a girlfriend" or "study something else". Stuff really worked... except in the wrong direction. Not an exception either, common enough they put "suicide" as a side effect in the fine print. I think if you're gonna take something like that you need some kind of feedback/monitoring and test different drugs until you might find something that works right. A hands off fire and forget prescription like I got likely won't work for most people.
GPs have been enormously helpful to me with this stuff. Most are very understanding. If you can do an online appointment booking that might help too - so the immediacy isn't an issue so you can write the appointment reason very clearly and revise it as much as you want before hitting the button. Otherwise, tell the receptionist you'd like a phone appointment (for the distance that gives psychologically) and that it is for a mental health issue. The diagnostic criteria for depression are fairly easy to satisfy - it is mostly about low mood for 4+ weeks. Keep details to a minimum you need to get a prescription but be cooperative if they probe.
Whatever you do though, don't just suffer. Tell your spouse how you feel too. Get some help.
It is very difficult to properly assess 2020-2021 survey data both because the "you should be depressed" messaging is very strong in the media and the bias in who responds to surveys is complicated by the pandemic.
I am a Canadian and we saw an enormous drop in suicides, 30+%, in 2020 despite survey data (and wacky conspiracies) to the contrary.
I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue.
Many people have lost family members and been pushed into poverty. It is incredibly callous to think mental health can be discretely measured without accounting for the environment.
Suicide is not a quantitative measure of mental health.
I'd say a population with high suicide rates is more afflicted by mental health issues than one with lower rates. What would you say?
Simply put: I could purposely crash my car and it would not be counted as a suicide or homicide.
While there are a lot of reasons for that to be the case, my point is the numbers are not representative of our current position.
A more holistic approach measuring alcohol and drug abuse, domestic violence, social media sentiment, and workforce participation.
Unfortunately, all of which are indicating that the majority are collectively suffering.
I don't know who said you can measure mental health without accounting for the environment, I never made that claim! I literally said "I don't think it is "safe to say" much of anything about suicide rates or individual motivations, it is a complex issue."
Additionally, there seems to be a stigma attached to not caring about a particular event, especially if doesn't affect you, all because of the slippery slope argument which is a fallacy.
"Lottery winners and accident victims: Is happiness relative?"(1978) https://psycnet.apa.org/record/1980-01001-001
How did you come to think depressions' cause must be internal ?
See for example https://www.medscape.com/answers/286759-14692/what-are-the-d...
And consider “ Diminished interest or loss of pleasure in almost all activities (anhedonia) “
— his ability to enjoy guitar for its own sake is a great sign.
And “ Sleep disturbance (insomnia or hypersomnia) “
…he addresses that directly.
But the presence of those symptoms doesn’t by itself mean that a major depressive episode is the best or only diagnosis.
But having some of those symptoms is enough to indicate you should talk to a medical professional, as they are very troubling symptoms.
Think of that little "kick" you get when you think of something you want to do. Maybe you like eating ice cream, maybe you like playing tennis, whatever it is... that feeling, that subconscious little mental boost that gets you up off your ass, and moving... is completely absent in the depressed mind.
That spark that initiates and sustains action, is simply not there. Tasks, even small ones, are giant and the future is hopeless.
That’s as much a solution to everyday problems as nuking the entire planet and the human race out of a existence is a solution to, say, Covid or hunger.
I agree, but what you're saying is not how the world see it. Many things that make humans exists are not necessary or makes life difficult now anyway. Like phobias, vomiting while travelling by car, allergies etc.
Life is constant struggle for most humans (not talking about privileged here). In the end we all die horribly going through all that trauma, so peaceful suicide like hypoxia may be a solution to stop the suffering.
Homework isn't a great example, but you can substitute anything that causes you suffering. For me, a lot of it is about my weight. I went through more suffering than most people can imagine to lose more than half of my bodyweight, and I was pretty happy with the result... until I started letting myself do the things I'd had to give up to get there: eating out with friends (or even attending any event with food), not doing intense workouts more than 3 days a week, having the occasional snack, eating something other than protein bars every meal, etc. My weight started increasing, naturally, and I realized: I never get to stop going through all that suffering if I want to maintain my weight. Ever. Ever. And without being able to maintain that weight I instead get to feel like a fat piece of shit for the rest of my life instead. Given those two options, the idea of just ending my life here and now doesn't seem so bad.
One has to work 9-5 whole life that slowly kills their health and die horribly. That's normal, but if one does not want to continue that, it's illness. One must suffer. There is no other way whatever people here says, the real world does not work in any other way.
Ending it today will stop having to do x today, tomorrow and rest of my life.
So it's not just the homework of the day.
But due to my thinking I would also not just go without consuming my money and doing only what I want as long as possible as it also freed me from certain social boundaries.
Like suicide is bad, you need to work, lifing as long as possible is good etc.
One problem might also be that in my opinion lifing as long as possible is not the right answer. I'm not life positive like independent how shitty your life is as long as you are alive is good.
Now the question arrives what is a good time to leave.having already seen and done more than any other human who lived 50 years ago already puts me ahead on a experience level .
So determine this answer is open for me to decide.
Not having kids and not planning some right now also makes me more 'flexible'
There are others with me but they are walking along the banks telling me to “just get out of the water.”
But instead of extending a hand in help, they just move on and leave me behind.
Every once in a while I find a rock that is strong enough for me to lean on, And I can rest for a bit.
But the rocks always get tired of holding me up, and when they let go, I’m left drowning, thrown 50 feet back again.
And nothing is harder than standing up in that current when everything in you is telling you how much easier things would be if you just let yourself get dragged under."
—Unknown
I don't really like shopping for groceries, but I'd rather do that, than order take out that's expensive and probably not very healthy.
If I'm going to cook something, I'd rather cook something with a different taste than eat pasta again.
I don't really want to do laundry, but I do want to have clean clothes that don't smell.
If I could afford to do so I wouldn't work, but until I retire that's not possible, so I might as well make the most of it and increase my earnings/time ratio.
I don't really want to go see my family, but I feel I have a duty to do so.
(Of course, that doesn't mean that putting up a facade means that you are depressed.
Also going out and doing stuff is probably better for you than sitting at home, no matter if you are depressed or not. And if that drive to make you go grocery shopping or meet people is less than healthy, that's still better than losing all motivation for everything, I guess?)
Have you tried a delivery service? Walmart as an example charges $100 or so a year. And then you pay a tip to the delivery person. I think it's worth it to avoid shopping in person, and cheaper than ordering delivery from restaurants.
Some examples - Going groceries. Used to hate it. Stressful. Too many people, I'd get social anxiety. Now, I smoke some weed, put on Michael Jackson on my headphones, cruise through the store with a smile on my face and a dance in my step. They say Mediterranean cuisine is one of the healthiest diets. OK. So I bought the best Turkish cookbook (https://www.amazon.com/gp/product/0714878154/ref=ppx_yo_dt_b...), and decided this is my new food bible. "Good luck, me! You're gonna need to figure out Eggplant." I've been eating grape-leaf wrapped rice, humus, pita bread, and that kind of thing all week - have never felt healthier. The recipes are easier than you think, and are good for leftovers, meaning you can food-prep and still eat healthily.
Laundry - You might laugh, but I find that on the days where I imagine I'm going to go on a hot date (LOL one day), or meet an important client, or honestly - when I feel most badass (and comfortable!), those days - cool stuff happens. I make a cool connection, have a good conversation, experience something different... So, doing laundry has been a positive way to ensure that my favorite shirts/outfits remain ready for duty, instead of uselessly in a basket.
Work - I was in a bad work situation a couple years back. Failing in-place, in slow motion. I tried to be honest during a review with ny boss, and listed all the things I felt I needed to work on (honestly, coming clean on what I was failing at). My boss took me aside and told me, "Why not get better at what you're already good at, rather than improving on what you're not". It kinda blew my mind... I honestly took a look at one of those "find your dream career" Ven diagrams. What is the intersection of your Passion, What You're Good at, What People Pay for (https://www.authentic.com.au/wp-content/uploads/2015/08/pros...). I broke the seal, asked my friends, "Hey. I'm looking to make some career changes, and could use the perspective. You know me. What do you come to me for?" I was surprised what kind of great answers I got. I'm quite self critical, so hearing this type of feedback was very encouraging.
I find t fulfilling to identify the people in my life whom I truly admire, learn about their life goals, and help them achieve them. It's a really great feeling, and leads to getting to know your friends at such a different level.
Family - Lately, I have been calling my grandmother on the phone. She's 95. I asked her, what gets you up in the morning? Without missing a beat, she told me: "Music." She loves Singing, playing piano, dancing. I decided to learn to make music. I'm not going crazy with it, but I bought a MIDI keyboard, plugged it into Garageband, and have been learning chords to songs I like, taking lessons. I'm telling you - it's such a wonderful soul feeling. I've since found out that many of my family members - some I had "written off" - are into so music. We've truly been able to connect in ways that excite us both. One of my cousins, we've gone from a "I see you once a decade" to the the true feeling of "family"- sharing each other's cool songs we've discovered, favorite bands & albums, to even video clips of our playing music attempts, telling st...
For some folks: This is the reason for a shower becoming a monumental victory in one's day: Sometimes just getting out of bed is a struggle for folks. I'm in a few cooking subreddits, and often get folks looking for "depression food": Food that takes no effort (cooking at all can be too much effort) yet is still a bit healthy. At this point, you probably aren't enjoying food anyway. I've known someone that literally bought new underwear because laundry was the more difficult option.
Not everyone has all of this, and folks are pretty good at hiding it from others and putting on a happy face.
I am the same way. My depression isn’t severe enough that I CANT do the things that need to be done, but rather, they take immense effort and personal discipline.
Of course everyone (even non depressed people) sometimes struggle to do things they have to do, but don’t want to do. It’s all about how severe that struggle is, not whether or not that struggle exists at all.
Years ago I was recommended a book written by a Dutch psychiatrist who had developed depression himself. The tagline was sort of "here's a professional who suffers from it, this will be insightful."
I couldn't relate to his condition for one iota (let alone finish the book); as he had mostly feelings of guilt and shame, and dark, weird mental images.
I guess depression is a sort of blanket term by now for many things, which probably complicates diagnosis and most of all, treatment.
Plus, I recently discovered the term "sh*t life syndrome", which is apparently getting to be known as a well-known term in the US/UK psychiatrics system (at least it has a Wikipedia page claiming that). It describes people who are poor or lonely because of the system surrounding them (prime example: they live in an area with raging unemployment). In that case, it's argued, symptoms of depression might actually be the logical response to an outside stimulus (or lack thereof). Yet, it appears many of these people are referred to psychological treatment because, well, society doesn't come up with any better option.
But what rubicon33 describes is certainly one way of depression, and I think a common one. But I'd go one step further even: Yes, people lack that little "kick" to get them going and do something entirely. But I don't think that's the root cause.
The root cause, to me, is that this kick has been subconciously "unlearned". Because when people with this sort of depression DO force themselves to do some of these things (and man, do they need to force themselves, with rational arguments and all sorts of tricks), they are not enjoying it. To stick with the example of playing tennis: Non-depressed people come back and say: "That was fun! I powered myself out on the tennis court, maybe I even won, I feel good.". People with this particular sort of depression come back and say: "That was physically, but mostly mentally exhausting. I want to sleep or procrastinate now and reset my thoughts to the baseline of being emotionless."
Disclaimer: Yes, I think I can also kind of speak on this subject. I've been repeatedly diagnosed with childhood PTSD and depression possibly ever since that (which makes it 30+ years); which doesn't mean that I'm not questioning this all the time, because the biggest trick played by depression is to make you think that everything may be just normal sadness/exhaustion/"not trying hard enough" ...).
Imagine Einstein. He can't figure it out and solve the constant problem. Somethings not right. He's not happy, not sleeping well. He's thinking hard.
But then, he takes a pill. Suddenly, no more thinking during bike rides. "I'm just looking around and dopamine rushes in, it's great".
(I'm not discouraging treatment if you have a problem !! Positive feedback loop of negativity can kill you.)
I just mean that if you have high standards you may be less easily satisfied. I do think it's good to be able to step back and really enjoy a walk or music without a care in the world, but I also don't think there's something wrong with people who don't, and instead just focus on their problem. Or even are just looking for a problem or a puzzle interesting enough to solve.
It's all in the context. Sleep is important, you should sleep well. But maybe if you are lunching a rocket tomorrow it's fine to have a problem sleeping. Respect to others is the most basic thing, but maybe if they keep distracting you from work which can improve everybody's life it's ok to say something harsh but effective. And so on.
I don't think you can truly change the world if you sincerely enjoy its current state.
Of course you can change yourself, all problems are within you, they are created by your optimization function. Apocalypse is not a problem unless you don't want it to happen. Without people who don't make themself content with the state of things right now it's not a nice place to be. But without people who are not content and are trying to fix it it's not getting better.
Just to be too verbose because of sensitive topic: it may be you, it may be chemical imbalance, I'm not saying it's a happy pill and long story short if you haven't experienced happiness in a long time go see a doctor yada yada.
You can be happy during apocalypse when you are making progress towards ending it, you can not like things and accept it. I'm just making a case for unhappiness being the sane reaction in specific contexts.
It's really hard to have a meaningful discussion about this topic without being seen as a murderer while providing a decent information density. Even on HN.
If you weren't susceptible to depression these spirals wouldn't take hold, you might just say, "huh, now that I've learned more, I realize this is a harder problem than I first thought" and you just carry on.
Imagine a kid drowning in front of you (that somewhat happens but on the other side of the world so you can't see directly). You can be unhappy about it, but that's within you. If you don't care about the kid you have no reason to be upset.
Most probably would agree that maybe doing something to yourself to make you less upset about the kid drowning is not optimal. Reality is somewhere between this and somebody living a perfect life and wanting to kill himself.
In all cases above it's not the brain chemistry that you probably want to fix. But you probably can do just that..
Also the "just do it" mentality is very damaging to admitting people can be depressed.
A quick google pulls pack a couple of interesting links: A subreddit https://old.reddit.com/r/tDCS/ and an article https://www.wired.com/2014/05/diy-brain-stimulation/
I'm not scolding either, I literally laughed at this myself and came here to say something along those lines, but giving a generous sop to some people I fundamentally disagree with - it was a laugh that signalled an opportunity to empathize with the subject of it. Feels gross even saying that, and I believe the soma thing is a legit question, but even at the risk of arming enemies, it's worth elevating the commentary a bit because of what is on the other side of it. We don't make b-movie zombie references whenever there is a new chemo treatment with promise against cancer, and if someone depressed said to me, "hey thanks and f-you for making my need for the first viable treatment just as stigmatized as the disease," I would have earned the criticism honestly.
I also realize this is what only a truly master soma propagandist would say as part of a campaign for the coming change, but my realization was sincere, and anyway, there's also no way they're this good.
This is something to snap people out of depression.
Some medications can also cause mania without any predisposition.
https://www.yalemedicine.org/news/ketamine-depression
A basic search for clinical trials that are recruiting for TMS + depression are in the hundreds.
(You need to further filter by location, etc)
If you're interested in participating in a study, please email sainttmsstudy@stanford.edu.
[1] https://www.youtube.com/watch?v=NOAgplgTxfc
Having tried TMS pretty extensively, I do not think this will help me, but I am hopeful that it might prove useful for others.
[1] - https://news.ycombinator.com/item?id=29562785
[1] https://www.uptodate.com/contents/unipolar-depression-in-adu...
But wifi is much weaker and not inside a faraday cage. So it doesn't cook you.
To continue your analogy, there is inconclusive data showing that RF exposure could reduce sperm count or be a risk factor for certain cancers.
I understand the inverse square and that this is a very strong field. I was wondering about chronic exposure to weaker fields.
https://youtu.be/vhmbnsXOhx8
Was it expensive?
Are there any downsides?
Do you think TMS is, like psychedelic therapy, potentially useful for people without depression (i.e. the "betterment of well people")?
Here is a great comparison of noninvasive brain stimulation techniques for depression treatment: https://www.bmj.com/content/364/bmj.l1079
A company that offers tDCS as a home treatment for depression can be found here: https://flowneuroscience.com/
The main downside of TMS is simply that you have to be fully dedicated to the treatment. For six weeks I had to go Monday through Friday to a special clinic that was a half an hour drive from my house. This was a point that they brought up repeatedly in my interviews to get the treatment, so I think it must be common that people decide that it is too much dedication. For me though, by the time I was interviewing to receive TMS I had really tried everything and I was absolutely desperate to follow any path that would offer relief from my symptoms. I had gone through multiple medications, had been in talk therapy for several years, tried CBT, DBT, self medication, meditation, yoga, exercising three times or more a week, different diets, spiritualism... Really the works. I could sometimes stave off my symptoms but eventually I would suffer a huge crash and totally burn out again.
One of the other possible side effects is also seizure during treatment(very rare) and because of this they ask that you abstain totally from substance use during the time as it can lower your seizure threshold, which I agreed to happily. While the idea of having a seizure was scary, I had already experienced so many horrible side effects from medications that didn't even alleviate my symptoms I was willing to try anything.
I am not an expert in the field but I do think that there is a lot of use that could be gained for any person who decided to try TMS, for me some of the things I noticed was that my brain fog started to lift and suddenly I was able to learn much more quickly. I started practicing languages and instruments to really help foster this growth in my brain. The TMS helped me break the patterns of my mental illness and start forming healthier ones...I really do credit it with saving my life.
It was interesting to talk to the technicians/clinicians about how they came to be working at a TMS clinic. Several told me they'd been working in mental healthcare for decades, and were excited to work with TMS because it was the only thing they'd ever seen be truly effective in treating severe and persistent depression. One told me she had been helping patients through the 6 week program for three years and had not seen it fail to help a single person.
When I read the paper for this study it brought tears to my eyes. To think that it's possible to apply a lasting treatment to someone stuck in their own personal hell over the course of five days, and to have the effects persist for six months, is practically a miracle.
My treatment was over two years ago and I have not relapsed. There is hardly a day that passes where I do not feel deep gratitude for that burden to be lifted.