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

I took antidepressants for about five years at the suggestion of my primary care doc at a time when I knew the floor was about to fall out at work and I'd need help to cope with the stress.

I made it through until the project was over and then I quit.

In that time frame I was sometimes between jobs, sometimes trying to sell solutions for the financial services industry, sometimes doing consulting, sometimes working at startups.

The most obvious side effect I had was suppression of my sexual response. It wasn't eliminated, but it was reduced, it took me more time to come to an orgasm, and when the orgasm came it wasn't a single event but rather I could perceive a number of separate events... Sometimes the result was fantastic, sometimes it would fall flat. I was capable of having sex for an hour, not have an orgasm, having sex the next morning for 20 minutes and having an orgasm, etc.

After I had settled in at a steady job my primary care physician said I should try quitting. A few weeks after I did I had a few incidents where I'd get furious about messes that hadn't been cleaned up for years... One day I got 45,000 steps on a day when I didn't leave the house.

My libido came back with full force and then I started having conflicts with my wife about her being less interested in sex. That's still an ongoing misadventure.

I'm not sure if this totally out of left-field, but have you tried dietary change like a ketogenic or other type of restrictive diet? I know that for some people some foods can trigger horrible mood changes like bipolar, anger, feelings of fear, depression, etc.. Especially if you're sensitive to some foods like gluten, dairy, certain meats & veggies, etc. Also if you ingest any other drugs/chemicals it would be worth considering their effects too (nicotine, caffeine, alcohol, weed, etc).

I think if there is no other option SSRIs can help but I've also seen them have bad side effects (especially when taken long-term). Of course you gotta pick the lesser of the evils.. curious if you've looked into this at all:

https://pubmed.ncbi.nlm.nih.gov/34949933/ https://pubmed.ncbi.nlm.nih.gov/30075165/ https://pubmed.ncbi.nlm.nih.gov/31568812/ https://pubmed.ncbi.nlm.nih.gov/31336509/ https://pubmed.ncbi.nlm.nih.gov/30037619/ https://pubmed.ncbi.nlm.nih.gov/29914664/

My function and life satisfaction were dangerously low. I decided it was likely I'd enjoy my life more even though there might be additional issues from the medication. I was right. My memory isn't nearly as strong as it was, my libido is quite low, but I'm in far less pain than I was and, ironically, am able to function at a much higher level even though my raw capacity is diminished. Hope that helps.

> So HN, what has your experience been with depression? Have you tried the drugs? What worked or didn't? Have you been able to triumph without chemical assistance and what did that look like? Is my utter terror of these drugs warranted or should I just bite the bullet and try them?

A lot of friends have ended up on prozac or other drugs, with profoundly hit or miss results.

I've struggled at times, but found that vitamin D, magnesium, zinc, decent amount of protein, and good sleep did a lot for me. Regular outside activities, even if just walks, or exercise also a lot for me.

Keep in mind I live in Western Canada, so my walks often happen in -30C weather.

Also just finding something that produces joy was big. Not fun, not cool -- joy. Making less money and doing more things that bring me joy made a big difference. Most of the people I know making "the big money" are miserable people.

Anecdata but I have zero side effects after the initial two week adjustment time on a SSRI and feel a ton better. I would give it a try - I was skeptical for most of my life until I hit a low point and just felt like I couldn’t go on without some help. Probably a majority of people didn’t make it past the adjustment period and post negative reviews based on that

> These drugs are very powerful but have really bad side-effects for most people that take them

for people that take larger doses and for longer periods, you're going to be dealing with that more frequently. It's not quite binary - there's a number of different drugs with different results for different people. By not talking to a doctor you are only keeping yourself in the dark - this is fine, but you are limiting your field of options. If you've got some timeline/end goal where you can define your life as less stressful, you could go on them to buckle down (if alternatives arent working and the duration makes sense), but unless that timeline then results in another change to your whole health situation, you haven't done much but avoid the problem.

personal experience: needed them in order to get here, ran out of reasons to take them, dropped them (15~ years)

Eat healthy, go for walks, talk to a professional, open up to family and friends. Don’t be afraid of taking medication or changing your career. Don’t be afraid of admitting to yourself what you actually want out of life.

Don’t expect it to be easy.

The nice thing about medication is if you forget to take a pill today it is very easy to take one tomorrow. You can also stop when ever you want. Best case, they are a crutch that helps you until you can walk again. Worst case, you’ll live an undepressed life with them.

If you self-treat in the gym, it can be very difficult to haul your sorry ass back there if you miss a day.

> I have tried therapy

The worst thing about therapy is finding a therapist. It’s an awful process that one needs to do in a time in your life when you are not capable.

I don’t know you, but you asked for internet stranger advice: mine is to keep looking for a therapist you like and have them be part of your healing process together with medication. Don’t stop seeing a therapist just because you start to feel good when the medication kicks in.

Antidepressants are a hit or miss. You need to find one that works for you. If you don´t like them you can quit them. And until you go to the doctor you won´t know what the treatment will be. Maybe they will give you Bupropion. Who knows?

Don't overthink this or spend too much time researching. Improving mental health is very much trial and error.

If you're uncomfortable taking anti-depressants, start with therapy and improvements to diet and exercise. For a lot of people this is enough.

If after a while, you're not getting the results you want, try an antidepressant. You may have to try a few since they work differently for different folks.

If you're taking the anti-depressants and don't want to anymore, try reducing the dose or stopping altogether. A lot of people only need them temporarily. Some people find them useful long-term.

This is gonna be very different from the rest, but looking at a wide variety of options prob won't hurt: I struggled with depression for several years, and what got me out was a combination of understanding myself better and improving the most important relationships in my life, basically personal development. If you're interested/open to this, I can talk about it in more detail. Don't want to just start sharing a bunch of stuff if no one wants to know lol.

EDIT: Sorry maybe that's a bit too vague. I meant things like figuring out my thought patterns, my specific pain points, past traumas/wounds, etc. and also things like my (and my partner's) personality traits and tendencies.

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

https://www.health.harvard.edu/blog/ketamine-for-major-depre...

Have you looked into non-pharmacological treatments like tDCS or rTMS? brain stimulation is safe and often as effective as drugs but without the side-effects.

https://pubmed.ncbi.nlm.nih.gov/30917990/

After using lots of antidepressants and therapy, i solved it with meditation. I recommend the book "practical insight meditation" by venerable mahasi sayadaw. I applied the technique he teaches to the feeling of being sad, however it manifests physically.

I have had depression for years.

Slowly creeping in.

Last year three things happened:

1. I got a light antidepressants

2. I switched from smoking weed with tabacco to without tabacco

3. I took ecstasy for the first time

Number one lifted my mood. Number two reduced my lethargic and number three Reminded me how it feels to be happy and it gave me back human empathy as well.

I was wearing glasses for a long time and that always made the idea of needing help for my brain easy to accept. Why do I accept that wearing glasses is normal and just necessary but my brain has to work 'normal enough' without help?

On a side note though: mote depressed you get the less you have to loose anyway right? After all hard depression leads to doing nothing and thriving to end it. You need to realize that this mental state already gives you the chance to do whatever you want.

After all if you really fuck it up, you still are at the same point of ending your life.

Good luck!

Most cases of depression are not single isolated episodes but part of a recurring pattern. Sometimes even the intervals between episodes are characterized by mildly depressed mood, mild anhedonia etc., the so-called dysthymia.

I point out the relapsing and remitting behaviour of mood disorders because it shines a light on other ways of managing it. The effect size of SSRI’s is not all that large to be honest. But characterizing the risk of adverse effects as terrorizing is probably over-pessimistic and unwarranted. That said, I’ve taken meds - tricyclics, traditional SSRI’s, atypicals and I can’t say that any were terribly effective. Working with a skilled and trusted therapist has been practically life-saving though. It took a long time to find the right person. Before my current therapist I saw someone for 2-3 sessions and she seemed like she had never even had any experience in clinical interviewing let alone any insight into the sort of existential troubles that I was facing. I am an MD but I try to keep that out of the fray because it can skew the therapeutic relationship in odd ways. I don’t know. Just was “off.” But current therapist is awesome.

I also have two checklists that I review weekly. The first is titled “What’s going on?” It just lists some of my early warning signs. If those start pointing in the wrong direction I look at the second list which is about 60 things I know that have helped me in the past. Exercise or just being outdoors is near the top.

The expectation/anticipation of adverse medication effects is known to increase the risk thereof. The nocebo effect. If you are that agitated about the risk my advice is to work really hard on finding a compatible therapist.

I don’t think you can brute force your way out of depression but you yourself and especially with a therapist can begin to identify patterns of thought and behaviour that can keep you stuck. It’s just a nudge.

Check out the book feeling great by David Burns, known for popularizing CBT.

It's an updated handbook of some of the most recent techniques for managing the way you feel. It also has some good tips on how to find a therapist to work with if the book isn't enough.

The book leans towards avoiding antidepressants but stresses that in some extreme cases they might be best.

Sorry you've been feeling that way. Good luck!

If you did not take meds, do it asap. I regret not taking them sooner enough.

I would like to focus on two things you wrote:

> Beating depression with or without anti-depressants?

Depression is never really beaten, it's controlled, mitigated, kept at bay, and sometimes resurges and you start again. In my case, I haven't had a severe depressive episode in years, but have had minor ones most years since my late teens with several year and multi-year episodes. I haven't had suicidal ideation in over a decade, but I know that it's something that could happen again. I don't fear it, I just acknowledge it at this point and keep vigilant for the signs of a depressive episode. I don't use medication, I primarily use therapy (specifically cognitive behavioral therapy) and found ways to restructure my life which seem to have helped. But a lot of it is fragile, a move right before COVID restrictions left me in a very bad state 2 years ago (though not my worst, it was not good). Fortunately I have learned to recognize the onset of these episodes and my wife also helped by calling me out and I went back to therapy and I restarted the process. But it's never really "beaten".

> Life has taken me on ups and downs but as far as I can can tell I'm fairly lucky, well-off and have every reason to be happy.

This is a self-judgement, and when I am dealing with depression one I often make about myself. I'm married, have a house, relatively little debt (the mortgage itself), a job that pays well and likely won't get laid off from ever (if I choose to stay), I have my health, friends, and family. And then one of my best friends lost his mother last year and will likely lose his father this year and... I start to feel guilt and shame about my depression.

There are two ideas of depression that often get conflated because we use the same term:

1. Depression the emotion. This is what a grieving person feels, or the way someone who got skipped over for promotion describes their feelings (too extremely different feelings!). This is a valid way to describe how you feel, but is mostly a temporary thing (though "temporary" can be very long for something like grief). The advice to toughen up or "just be happy" is not helpful here, but it's not as harmful. Often it's usually "just" obnoxious and may end a friendship, at least for a time, but won't send you spiraling. But, importantly, this kind of depression often has at least one obvious causal factor. The loss, the humiliation, the pain, etc. It can be explained by circumstances.

2. Depression the disorder. This is what you are describing, what I have experienced (and will likely experience again). That sort of statement, "Look at your life, you have it good, you should be happy" is more likely to cause a downward spiral than "just" annoyance. It becomes an earworm, nagging at you and eating away at what willpower you have and what positive mood you may occasionally be able to muster until you're stuck in the hole. It's not the only thing that does it, but one of many. Some come from outside, some from inside. The painful element here is that this sort of depression has no obvious causal factors (though it may have exacerbating ones, grief from losing all my grandparents in just a couple years certainly made my college-era depression far worse, but it was not the cause).

This is one of the things that CBT, in particular, helped me with. I learned to recognize both the cause of these thoughts (in particular the self-generated ones, versus someone trying to be helpful but failing) and my reaction to them (and how they spiraled). Sometimes you can't find a cause, but you can still examine the reaction. This has helped me to stop the downward spiral (not always, and not usually immediately, but it's helped) so that I can at least still function well enough to acknowledge the need for help and get it. In some cases, those thoughts now just disappear almost as soon as they appear in my mind. This is the id...

There's nothing to be ashamed of or frightened of.

First, get on really good probiotics - 30-50 billion CFU. Try that for about 2 weeks. We have recently learned that a lot of brain chemistry originates in the gut. Also get tested for an MTFHR mutation, this is a very common condition that looks like (and gets diagnosed as) depression. Get exercise, speak to a therapist.

> I have been struggling with depression for as long as I can remember.

My psychiatrist indicated that my condition is termed "endogenous." This means that the source of my depression originates purely from chemistry, although it can be affected by exogenous (events around me). I'll be taking pills for the rest of my life. Some people simply need the drugs to fix the chemical problem.

Everyone will experience exogenous depression at least once in their life, and a temporary run on anti-depressants could help them over the hump. It's just like taking pills to address common cold symptoms until you overcome the disease.

One thing to keep in mind is that people have vastly different reactions to certain anti-depressants. The first ones I started taking definitely helped with depression, but I wanted to sleep all day. You need to raise any issues, if you have any, with your doctor so that you can look at other options.

> These drugs are very powerful but have really bad side-effects for most people that take them.

The notion of pumping a chemical into your body via a permanent implant seems pretty extreme on the surface too, doesn't it? Sure, unless your body isn't producing the insulin it needs: https://www.hanselman.com/blog/hacking-diabetes. Your brain is [possibly] not producing the seratonin it needs. If you honestly can't find an anti-depressant that works for you, then you can always stop taking them (after speaking to your doctor). If any of your family members are on anti-depressants that are working well for them, mention that to your doctor.

My experience is that you should meet with a professional. There are more medications that just SSRIs. There are various skills they can teach that will help, and programs that can help if you don't want medication. They can also help you test what works for you, because this is not an area where everyone lands on the same answers -- you can collect piles of anecdotes of what did and did not work for others, but ultimately your solution will be unique.

I don't think asking hn for medical advice is a great idea. Find a qualifed doctor please. Every case is unique! It can be really hard to find a good therapist. I went through like 5 before I found one. The key was finding a therapist that actually specialized in CBT (a lot of them say they so and they are just lying).

For anyone not looking for a prescriptive answer, but just a way to put words to your experience, and some proof that you’re not crazy, I highly recommend the book _Reasons to Stay Alive_ by Matt Haig.

I almost forgot: sleep.

For a long time I refused to think this mattered, because when one is chronically sleep-deprived, the baseline of feeling like pure crap will start to feel normal.