If you are based in the US and live nearby a university they usually have good counseling services and the infrastructure to refer people even if you're not attending the school. Search "{school} counseling services" on google.

It's important to understand the economic pressures in psychiatry. I went to see a psychiatrist, who prescribed me antidepressants. They helped give be a baseline level of energy to get me out of my acute depression, but they addressed none of my underlying issues that caused me to get depressed in the first place, and a couple years later I was right back in the depths again. And I'm fine if my dr's economic model meant he couldn't do psychotherapy with me, but he never recommended I get therapy, and that's what I'm so bitter about regarding him.

I've heard it said that giving antidepressants to a depressed person, without any therapy, is like giving amphetamines to a tired person: yes, they may temporarily cure your "tiredness", but what you really need is to go to sleep.

So while I don't think OP should take detailed advice from random strangers, he should be aware of his options. Talk to a therapist first to see if they can uncover what some of the root cause issues are. Be open to medication - some mental issues really are largely organic in nature, but a good doctor and therapist will know they are just one tool to improve your mental health.

Heck, I stated off the bat that antidepressants did help me. I'm not "anti-antidepressant" at all. But I do understand the economic forces at play means that plenty of "medical professionals" are more than happy to charge $200+ for a 20 minute meds management consultation, simply because it's faster/easier than dealing with underlying issues.

As for your "This whole thread should be booted waaaaay off HN" comment, the anger people are responding to is lots of us have had horrible experiences, but we're just told to "shut up and listen to your doctor". How do you think the whole opioid epidemic came about? Huge parts of the medical establishment were more than happy to get their commission, people's well-being be damned.

Then a great experience with another psychiatrist who managed to get me to function just enough for me to go see a psychologist who not only "cured" me but gave me a superpower of being resilient against life's wraths.

So your mileage may vary.

To whom might be reading this: don't give up. It sucks but sometimes we get unlucky and need to change doctors.

how?

I live less in the future and more in the present.

I judge myself less and feel emotions more.

Intellectually I am already well aware that my frame of mind is often the main issue and that I could simply choose not to be bothered by something - but that realization is a "system 2" thought which doesn't arrive until "system 1" has already derailed my whole day.

This is the silver bullet in my opinion.

How do you define fairness, rethink it and tone down your expectations.

How do you define love / relationships? Rethink it and tone down your expectations.

How do you define work / career / success? Rethink it and tone down your expectations.

I honestly believe this is a huge help.

A therapist who is a good fit for you is very hard to find. Learning about the skills you need to reorganize the way you view yourself and the world, simpler and the solution which a good therapist will help you with.

As someone who has suffered from depression and been negatively impacted by bad medical interactions for this and other conditions, the only choice is to do the work myself.

This sounds absolutely terrible. Something not to far from victim blaming.

Don't have a home? Learn how to be happy homeless! Husband gave you a black eye? Tone down your expectations!

The correct quote is ”COMPARISON IS THE THIEF OF JOY.” – THEODORE ROOSEVELT

"Comparison is the thief of joy" - As quoted in Becoming a Great School (2013) by Cooper, Gustafson and Salah, p. ix"

Nothing wrong with expectations, ambitions, drive.

Oh I know a good story.

I know a woman who unfortunately isn't the most educated person in the world and happens to have a nasty health issue where both her feet are all swollen up and makes her hard to walk around.

She's been seeing doctors left and right to solve or mitigate her condition.

One time, when she went to an appointment at the local hospital, her doctor handed her a form for her to sign and told her just to sign on the dotted line and don't worry about it.

The form was a consent form to amputate both her legs.

I happened to come across her when she was going to get a second opinion with the very form in her hands, completely furious.

She still has both her legs, even though she still suffers from the same issue.

Oddly enough, the hospital which handed out the leg amputation form also had a malpractice suite where they amputated the wrong leg of a patient.

Moral of the story: even though medical professionals are expected to be more knowledgeable about health topics, they are still human and far from infallible. More importantly, ultimately you're the person responsible for your personal health, and you need to have a say on what's done with your life based on the info that medical professionals make available to you. If you do not take an active role on these decisions on your health, others will eventually make these decisions for you, and they may not be good or have your best interests in mind.

>"Death by medical error or accident is the nation's leading cause of accidental death"

Trust the "leading cause of accidental death".

Medical training is extremely limited. Physicians literally don't understand how any of the drugs they prescribe work, and the standard operating procedure is to memorize 2-3 drugs out of one class and never prescribe anything else in that class.

Physicians are constrained by: their hospital policy, HMO incentives, civil liability, criminal liability, boards, legislation, insurance rates, personal biases, past unique experiences, influence of their mentors, weather, bad knees, bad marriage, whatever. Sometimes they are just having a shit day. Some keep practising to the point they are so senile they attempt to sign a prescription with the syringe needle (witnessed that myself).

They are just humans. Rather greedy humans, most of the time. They will never be fully frank with you.

3rd opinion? People often seen 5+ physicians, and spend 10+ years to get a proper diagnosis.

Severe pain in testicles: ER doctor asks about blunt trauma, sees nothing, prescribes antibiotics. Family doctor later agrees. Year later, same pain! See a nurse-in-training, second question: "When was the last time you ejaculated?" ....oh... Sure enough, no antibiotics necessary.

Tapeworm-looking thing found wiping my bum: doctor ask about look and itchiness, consults a parasite specialist. They come back with pinworms, because tapeworms don't just come out. Prescribed a medicine that deals with both, and I look it up. I read the drug is perfectly safe, and also "do not use traditional remedies like pumpkin seeds, which contain trace amount of a substance that puts tapeworms to sleep" ...oh... I had just spent two days snacking through a 4 lbs. of pumpkin seeds on a nut-free whitewater trip, so it was a tapeworm.

Ball of foot hurts: Doctor stumped, sends to get orthotics. Orthotics get made custom. Years later, I try on a pair of EE wide shoes ...oh... right, wide shoes that makes sense.

Burning left side of face: wasted so much time with a few specialists, telling everybody that it doesn't really bother me I just want to be sure it's like a brain tumor. No answers from no body. Then one day, a bunch of wax falls out of left ear and ...oh... it clicks; my face burns when my ears get too full of all that wax I make.

So doctors don't always get the full picture either, because how could they surface every relevant detail in 5 minutes!

Like "I worry about your executive function" weird.

I basically got diagnosed online by 2 different people about 2 different issues, one is biological, and the other is mental. And they were right. This is nerds out there who read about topics constantly, way more than the average doctor, not even close. So a stranger can help.

Also depends on where you are located, doctors can be dogmatic, there is countries that give antibiotics before extracting teeth, and there is those who don't. Countries who believe ADHD can stay into adulthood and go undiagnosed, and others who believe it is impossible to have ADHD as an adult.

In the ADHD case, depends on who what countries are right, some group might be living a lie taking meds for an illness that doesn't exist, or the other group is suffering being undiagnosed with ADHD despite seeking help, the doctor just tell them its not possible to have ADHD.

I would rather research and try to solve my issues over hand my situation to the medical zeitgeist of my country. Also I am sure if I give myself days of research, thinking, talking to people, comparing situations over some doctor talking to me for 15 minutes then giving me the two meds given to everyone who enter that door (SSRIs and benzos), I might probably be up into something.

I will never stop researching my medical issues, I will never trust my doctors fully, I will always google, research, ask, ask second opinions. Some doctors care more than others, some doctors are capable more than others, you have no idea which ones the RNG gave you.

The only thing dangerous here is you, acting like people shouldn't advocate for themselves to every extent their intelligence allows.

I agree that someone should go to the doctor. But almost everyone agrees on that, and yet very few actually go. I didn’t, for a decade, and mostly out of laziness (not going is after all the default option). Going around commanding people not to do X is only going to make them X.

..is somehow always better...than everyone else? Always?

Professional opinion is just that, an opinion. Opinion of potentially the worst medical student, from the worst medical school. but because they got a prescription pad, they are now smarter than anyone else in America. Got it.

Health is ultimately our own decision, and ours alone.

I wouldn't discount design advice of a qualified engineer because of the musings of a random person, so why would I do the same for a doctor.

Too many people in this thread are just going "software developers don't know what they're talking about. I had a bad experience with software once, so no developers have a clue, they're just after money"

However, with supply management of physicians, comes responsibility to ensure reliabile supply to replenish ranks to avoid surprises, and thus all efforts are made to ensure that students can pass. You simply can't have 70% fewer graduates one year, and 170% next.

"With an admit rate of 7%, it is easy to understand why the Johns Hopkins School of Medicine is sometimes viewed from the outside as highly competitive."

"Massachusetts Institute of Technology/Acceptance rate - 7.3%"

If you have good memory, and not a total dolt, you can be a physician. Analytic ability is a tertiary concern.

Asking for advice on the internet is a very valid strategy, given the terrible state of mental health care in the US.

My psychiatrist was fairly clear on what was what and which things needed to be treated with therapy and which medication could help with. (Medication helps symptoms, it does not cure.) Finding the right medication would take months or years and will not solve everything. There will be side effects that I needed to monitor and report. And so on.

When seeing any doctor, you are your own best advocate. It helps to come prepared, knowing your family history, and things you are struggling with.

Researching medications can help, but most people are not qualified to use them without supervision, myself included.

Note: This is assuming you need medication. It was fairly clear in my case medication was absolutely required to at least treat psychosis.

I prefer to refer friends to a therapist or psychologist, who do not prescribe medication.

This type of side-effect is thought to be mediated by 5HT2C activation when initially starting SSRIs, however, over the period of about two weeks, 5HT2C receptors downregulate and reach an equilibrium that can cause the effect to diminish or go away entirely. As an aside, there's research that suggests that abnormal amounts of upregulated 5HT2C receptors are present in suicide victims.

One of the reasons Prozac is recommended as a first line of treatment, besides the fact that it has a long half-life, is because of its 5HT2C antagonism that can block 5HT2C from extracellular serotonin activation from SSRI effects.

There are also plenty of antidepressants that don't typically cause that particular problem, especially if they aren't typical SSRIs or serotonin agonists.

FWIW, my understanding is this has little to do with the drugs and mostly to do with the recovery process.

In a deep depression, you might have suicidal thoughts, but lack the will to take action on those thoughts (because depression takes away your motivation). As you a person comes out of depression, they tend to recover their motivation before their suicidal thoughts dissipate. This creates a situation where a person with suicidal thoughts now has motivation - which means they have the potential motivation to take action on their suicidal thoughts.

The important nuance of this is anti-depressants don't necessarily make your suicidal thoughts _more_ suicidal. In fact, it's likely, anti-depressants are making your suicidal thoughts _less_ severe. However, they do increase your motivation before they can fully eliminate suicidal thoughts.

I'm not saying you should take an anti-dpressant willy-nilly. It's just BS to be fear mongering like this without considering why this situation happens.

In a way, yes, there can be feelings induced that can provide the motivation and energy to go through with suicidal thoughts, but those unpleasant emotions aren't exactly triggered by an inherent will to die. Those who experience akathisia sometimes feel like the only way to rid themselves of the feeling is to end their lives.

I point this out because it might seem, or feel to those experiencing it themselves, that those suicidal thoughts are organic and what the person really wants, but they tend to be exacerbated directly by medication and can get better with time. I also point it out because there are ways to sidestep 5HT2C activation with different medications or combinations, it doesn't necessarily have to be inevitable.

[1] https://en.wikipedia.org/wiki/Akathisia

> Research indicates that some suicide victims have an abnormally high number of 5-HT2C receptors in the prefrontal cortex.[13] Agomelatine, which is a 5-HT2C and 5-HT2B antagonist as well as a MT1 and MT2 agonist, is an effective antidepressant.[14][15] It has been called a norepinephrine-dopamine disinhibitor because antagonism of 5-HT2C receptors by agomelatine results in an increase of dopamine and norepinephrine activity in the frontal cortex. Conversely, many SSRIs (but not fluoxetine, which is a 5-HT2C antagonist[16]) indirectly stimulate 5-HT2C activity by increasing levels of serotonin in the synapse although the delayed mood elevation that is usually typical of SSRIs is usually paralleled by the downregulation of the 5-HT2C receptors.[17] Many atypical antipsychotics block 5-HT2C receptors, but their clinical use is limited by multiple undesirable actions on various neurotransmitters and receptors. Fluoxetine acts as a direct 5-HT2C antagonist in addition to inhibiting serotonin reuptake, however, the clinical significance of this action is variable.[16] Several tetracyclic antidepressants, including mirtazapine, are potent 5-HT2C antagonists; this action may contribute to their efficacy.

> An overactivity of 5-HT2C receptors may contribute to depressive and anxiety symptoms in a certain population of patients. Activation of 5-HT2C by serotonin is responsible for many of the negative side effects of SSRI and SNRI medications, such as sertraline, paroxetine, venlafaxine, and others. Some of the initial anxiety caused by SSRIs is due to excessive signalling at 5-HT2C. Over a period of 1–2 weeks, the receptor begins to downregulate, along with the downregulation of 5-HT2A, 5-HT1A, and other serotonin receptors. This downregulation parallels the onset of the clinical benefits of SSRIs. 5-HT2C receptors exhibit constitutive activity in vivo, and may retain the ability to influence neurotransmission in the absence of ligand occupancy. Thus, 5-HT2C receptors do not require binding by a ligand (serotonin) in order to exhibit influence on neurotransmission. Inverse agonists may be required to fully extinguish 5-HT2C constitutive activity, and may prove useful in the treatment of 5-HT2C-mediated conditions in the absence of typical serotonin activity.

[1] https://en.wikipedia.org/wiki/5-HT2C_receptor#Function

And you think a random stranger knows any better? I know firsthand that the medical profession has serious limitations in its understanding of and ability to treat depression, but no way in hell am I taking some rando's advice over that of any of the many doctor's I've seen.

Anecdotally I've been to therapists and doctors that were no help and I've read an article online [1] which was a tremendous help.

[1]: https://kajsotala.fi/2017/07/how-i-found-fixed-the-root-prob...

Anyway in discussions like this I feel like what it lost is that you will actually respond to how compelling the thing someone else is saying is. Like, it's not "oh a bunch of opinions, I'll get influenced by one randomly and it's probably wrong". It's "oh, a bunch of opinions, which explain why they think they're right and how well it worked for them, I'll incorporate that into my own understanding".

I've found they're more often than not ignorant of the latest studies, as well. Doctors are put on a pedestal in our society that very few of them deserve. A solid 2/3s of the ones I've seen are over-confident, dismissive, and often peddling out of date information. The rare ones that truly focus on their field and put their patients above their egos are difficult to find and even harder to get to with average US insurance.

Having had a critical infection repeatedly misdiagnosed until I finally went out of my way to pick a better professional, I don't buy the "just have faith in your doctor" argument.

Doctors are more like plumbers than we like to admit. There are good ones and bad ones, and it's hard to tell the difference. They do best when you can give them direction (cooperatively) and when you are willing to get a second opinion.

Parent comment is not giving explicit medical instructions. All they're saying is "talk to a medical professional" isn't some miracle advice that always works, particularly for mental health. It's fine to give anecdotes as long as one holds them with a grain of salt.

People keep saying we should _normalize_ talking about mental health, and what you're suggesting goes against that. If we were discussing heart health and someone were to talk about their exercise, diet and medication online, would you say, "Hey, wait a minute! You're not a doctor. You can't say that." Of course not. What you're advocating for is an overly paternalistic approach to mental health issues, as if people are too dumb to listen to different viewpoints and come to their own conclusions.

My current OPINION is: Until you have read studies and got some plausible experiences from people with the same medication, one doctor alone isn't a good source for taking medication.

I will only take medication in the future if life wouldn't managable without, but not for issues that just take time.

Tapering SSRIs is the normal unless a provider has alternative indication it shouldn't be done.

Tapering doses for all sorts of medications are routinely done, and any pharmacy can handle such an rx. If they can't - you don't want to go to such a pharmacy anyway.

Some people move permanently, in order to obtain medical care. Sometimes, to another country.

Most compounding pharmacies will ship, and most physicians will only require one visit in person in 12 months.

No one with depression is going to read this and go “Oh, you’re right.” It’s self gratification disguised as help.

Everyone knows they really ought to see a doctor. There are plenty of reasons to be scared to. An untimely hospital visit bankrupted me thanks to no health insurance. My sleep doctor had to cut me a deal of only $50 per visit instead of the usual $150, and she really cared about me. I was part of a lucky few.

I think what rubs me wrong about your advice is that it’s positioned at the expense of all other advice. No one’s allowed to have an opinion except yours. Smart people like OP see right through such things, and it tends to push them away. Which is particularly troublesome when the advice is good, like yours is here.

Yea it's mainstream and to be expected under legaleeze circumstances.

But it's not the kind of advice I would give to a friend whom I'm genuinely concerned about.

Have you known anyone who was depressed and managed to get better by following the advice of a generic "profressional"?

I haven't.

Quite the opposite. I've seen people get worse in one dimension or another by taking medication or following other professional advice.

It’s worked.

My advice to friends and family experiencing such issues is to take those issues seriously, and to see a doctor about them.

I think the increasingly common practice of forbidding medical advice in online forums is deleterious. For a lot of people professional medical care provides no solutions, hearing other people's personal experiences is helpful and comforting.

My opinion, doing both is good. Consult a professional and read about other people's experiences.

At the very least maybe somebody mentions a form of therapy that you've never heard of that you can ask your doctor about, or find a therapist that specializes in. If you ignored everyone's advice online you'd never even hear about that.

Personally, I'm starting Internal Family Systems therapy, which has seemed more promising for my psyche than many other modalities. But there are countless others. CBT is a good place to start, but doesn't work for everyone.

In reality, roughly 3-10% are good, the rest just go by standard guidelines only and/or punt you off to someone else.

What's the difference between mean and median in a Gaussian distribution?

Looking forward to your contributions to mathematics.

Are we talking about grades? Honestly when I see "50% of doctors are below average" I intuitively think of some other metric, such as the correct/incorrect diagnosis ratio, or the number of people that died because of their errors. Maybe it's just me but their uni (?) grades never comes to my mind.

I have learned way more useful info on online forums from people who were going through the same experience. Yes you have to be discerning but the advice “go to a professional” is thoughtless. There are a lot of incompetent people working in mental health. I am sure it’s easier if you have tons of money or just lucky to run into a good therapist. But already being down and then being disappointed by the professionals is devastating. At least it was for me.

For everyone who had their life turned around by medication I have met two or three who either did not see improvement or had negative side effects on all options tried so they gave up.

Some drugs, like the typical or atypical antipsychotics that treat bipolar or rapidly oscillating bipolar, have the side effect of reducing your energy and making you more passive. It's hard to pick out the effects of some drugs from actually solving the issue or just making you more likely to not cause a fuss.

I find this comment so overused, ignorant and dismissive. In my city it can take months to get a 20 minute appointment with a specialized doctor, while the internet is full of useful and scientific information and helpful people. That isn't even saying if the doctor really understands your problem or just dismisses it (had that often enough), like you dismiss other people's anecdotes. What are people supposed to do while they are waiting for an appointment for months with acute issues? I'd rather spend days myself and read the same information that a doctor (hopefully) would read in order to work on the problem before it gets worse or kills me.

So yes, try to talk to a medical professional at least once if you have the chance. If not or if it does not help, keep doing what you need to do and try to get the best information that you can find.

why ? they don't really have a solution for it other than prescribing anti depressants. I don't see why they need to see a doctor.

Depression can be caused by hormonal imbalances. It's tricky to get things right-- see a doctor!

By the way, is the Hunt library still open 24x7? I remember it being a fun time when it was. Spent many a night there.

If you were comp sci, Dr. Sturgill and Dr. Heckman are still making life hell for undergrads (for a good cause, of course)

Anyway, I see your point and don’t really have a better reply, so shrug I tend to agree that anything that can be attributed to ignorance rather than malice is correct, but the phrasing just seemed mildly aggressive to me. Not a big deal though!

asking for advice and personal stories regarding navigating an issue as complex as depression and the way it's treated is not only prudent, it's smart.

a good healthcare provider is one that is fully willing to discuss unorthodox strategies found via independent research. take advice from the internet and find a provider who is willing to discuss it with you.

My opinion (not a doctor): What is wrong in your life? Are you:

+ Working too hard

+ Commuting

+ Not exercising and taking care of yourself

+ Eating a diet with lots of processed foods

+ Using drugs and alcohol as a crutch

+ Overweight

+ Not resting regularly

+ Sleeping poorly

+ Have other health issues not addressed

+ Without genuine friends

+ Without a good partner

+ A certain age without kids

+ Spending too much time on social media

+ Spending too much time watching TV

+ Not engaging in hobbies, such as reading

+ Neglecting talking to family

+ Wanting to do something different in life but ignoring it

+ Harbouring regret, judging yourself and generally being cynical

+ Judging those around you too harshly

+ Not trusting people

Etc.

I fully understand that depression causes people to avoid addressing problems like I’ve listed. I’ve been there too, and it is not easy to climb out of the hole. It’s a positive feedback loop though: you start neglecting things (maybe due to time constraints), you lose a bit of happiness/stability, you neglect more things & so on. The hard part is to break out of the loop and start ticking these boxes. Start small and don’t judge yourself harshly if you slip.

Really do examine my small list and see if any of these things are pulling you down. If there’s something there you can’t fix, don’t beat yourself up on it. That’s the last thing to do. No one can be perfect, so don’t worry.

> + Commuting

Prior to 2020 this was the vast majority of all jobs, including tech. Most got by just fine. And today still encompasses the majority of jobs, so I would argue this is classist.

> + Neglecting talking to family

Many people have reasons not to talk to family that end up with positive mental health outcomes. Sure, it can be negative, but this seems exclusionary.

> + A certain age without kids

C'mon. This isn't the 1940s.

Please be careful when putting out lists like this.

This is juxtaposing genuine, universal indicators of depression alongside subjective ones, which when read by the wrong (misinformed, uncertain, etc.) audience, could lead to adverse outcomes.

I was in the same boat.

Don't listen to the haters. Anti-depressants are amazing. Most of the people who 'cured' their depression through some kind of cheap trick turn out to have been self-diagnosed.

Anti-depressants, if dosed and chosen properly, have basically no side effects. The only change is you get to experience life like neurotypical people. So like, exercise is fun, not a form of torture. Emotions are OK, not the harbringers of the apocalypse.

Living with depression is awful, and it almost never goes away. It's also extremely dangerous. Look at the stats: depression is a dangerous medical condition. Anybody telling you to take some herb or read a book is on the level of the people who prescribe smoothies to cancer patients. Get medical advice. Take drugs if they are prescribed. Depression massively increases your risk of death from all causes. Anti-depressants have like, a slight chance of causing dry skin.

That said, my first go-around with anti-depressants was a hugely overdosed prescription of venlafaxine from an overenthusiastic doctor, which is pretty side-effect-tastic, so my eyes were rolling out of my head and I was falling off chairs for a week and it was still far superior to being depressed.

Not taking anti-depressants because you're worrying about the side effects is like not wearing your motorcycle helmet because there might be a scorpion in it. The risk of dying from depression is really high. The risk of suffering from anti-depressants is fairly remote.

Antipsychotics are even worse but I’ll take the side-effects over psychosis and paranoia any day.

I also take methylphenidate (Ritalin) for ADHD and it is MUCH easier to stop stimulant medication in my experience compared to anti-depressants. And while stimulants affect sleep, I found the SSRIs to be much worse in this regard since they made me sleep poorly regardless of when I took the SSRI unless I skipped a day of the SSRI (and I was on the lowest possible dose).

Not only do these medications have side effects, they have severe side effects, at least for some people.

I get that's not everybody's experience. However, my feeling is that if you shop around until you can get the right dose and the right meds, the only side effect pain is when you start, and when you stop or draw down your dose.

The real danger of starting meds is that it can give a severely depressed person the motivation and wherewithal to commit suicide, so I do think it's worth starting them in a setting where you're not going to be alone. Still, I'd say that's less a 'side effect', and more just an effect of having severe depression and suddenly not feeling so debilitated that you can't do anything about it.

In general, I just find the conversation around anti-depressants completely unhelpful and baffling. People focus on the extremely long-tail side effects, and ignore the massive bump in the bellcurve that is a depressed person either committing suicide, or just living a totally miserable life until they die from some substance abuse problem. People who are diagnosed with depression do not live good lives without medication. The statistics for life expectancy, etc, are just awful (it's worse with stuff like schizophrenia or bipolar). So all the stuff about antidepressants making you fat or whatever is just totally irrelevant.

My advice is try it. Talk to a psychiatrist and go on a minimal dose for a few months. Get therapy while you're going. If it doesn't work, it doesn't work. But it really could change your life.

What should be said though is that there are some great anxiolytic out there, it's just that no one knows them, e.g opipramol, emoxypine, etifoxine

  1) MAOIs are safe, and Parnate specifically is extremely effective. However, requires a special diet to adhere.
  2) Stimulants ARE prescribed very frequently to augment antidepressants in difficult cases, especially in people with serious illness.
  3) Moclobemide has every effect of an MAOI in effective dosages, including diet restriction. There are no effective drugs without side effects. Moclobemide is not thought to be particularly effective(mostly because on-label dosage is far too low), there is a reason why it's used infrequently.
  4) Etifoxine might be great for some, but it has significant risks of liver injury. There is a reason why Valium is still one of the most common anxiolytics prescribed worldwide.

Please be careful; this attitude places the blame on the person experiencing depression, and feeling guilty about being depressed is a vicious cycle that can have catastrophic effects.

There are some for whom depression is a product of their environment. For some of those, a "tough love" approach may work. But there are also those for whom depression is a physical condition that requires medical treatment

I did not put blame the person experiencing depression, like OP described, he finds SSRI questionable and is open to be without it and he is justified in doing so. He is completely in his right to question and trust his intuition by seeking second advice on here, most of which I'm appalled to say reads more like logical, academic explanations.

I simply described an alternative that has been increasingly viewed positively by the scientific community lately and there is nothing in that suggests I am guilt tripping them for being depressed.

Coming from SSRIs, I can tell you that the alternative I suggested that has already been downvoted into oblivion created a lasting change and it is consistent with other people who have previously been exposed to SSRI.

If depression was the product of their environment then there really is no need for any SSRI, the external situation can be changed. Doctors would be prescribing plane tickets to Bangkok but instead they hand you out pills. It does not appear to be what OP is describing and your argument is shaky at best.

Finally I will add, go ahead and try SSRI but it is not something you go on and off on without paying penalties for it. You don't know what you will be like weeks, months, years after it. You don't know what habits, lasting side effects you might develop during and after. It's not the job of the drug to know or care, it does what it is described as.

Just remember at the end of the day, your doctor is more than happy to prescribe you whatever anti-depressants sales rep incentivize them to. It's not his job to care nor is he is trained to by profession.

If you have a specific stressor like a horrible job or abusive family member, leaving that situation can vastly improve your mental health. But otherwise, just flying somewhere else won't do much.

Medical professionals have been finding that in cases of clinic chronic depression, the patients brain doesn't produce nearly enough endorphins compared to others. Also, antidepressants are from a time where we didn't yet produce problems to sell the solution and they have helped millions of patients.

But I guess you know something we don't?

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.

Also, avoid caffeine like coffee etc. Caffeine can make things worse.

EDIT: why the downvote?

However, caffeine does heighten my anxiety (with or without the impact on sleep). Maybe I should quit caffeine, but I like my morning coffee ritual so have no plan to right now. Instead, I take periodic breaks from caffeine to make sure I'm not addicted again. If I can go a few days without caffeine and without getting a headache, then I'm good. If I can't, then I'm probably consuming too much and it will (or already has) exacerbate my anxiety.

https://www.hartgrovehospital.com/relationship-anxiety-depre...

And it’s common for the same medication to treat both anxiety and depression.

Note: I’m not a doctor and wouldn’t recommend the OP to take advice from anyone other than a medical professional.

I’ve heard plenty of people say it doesn’t work for them. I have to assume they’ve actually tried it for a length of time and it’s true. But it’s at least worth finding out of it works for you before resorting to medication.

https://pubmed.ncbi.nlm.nih.gov/24026850/

Even if you can't stand, you can get health benefits from bouncing while merely sitting on it. Even people who are paralyzed can benefit by sitting on it and be bounced by another person.

You can watch videos or chat while doing it. You don't have to worry about bad weather. It's almost silent so you can do it even while others are sleeping in the same room. You can hold or wear weights while doing it to increase strength. It doesn't take much space and some have folding legs for storing behind or under other furniture and some even fold the frame for storage or transportation.

Treatmills and stationary bikes are boring; going for a run or hopping on a bicycle works much better.

I went through a couple different psychiatrists and multiple combinations of meds before I found something that was mostly effective and without major side effects for me. Along the way I went through times where I was severely overmedicated and couldn't really function but quickly recognized that and worked with my psychiatrist to move onto another treatment. You have to give stuff a shot and see how it goes for you, chances are the first thing you try is not the thing that's going to work.

The psychiatrist that I stuck with was the one that suggested I should also see a therapist. My take is you need both. I went through a few different therapists before I found one that worked for me. They helped me develop the tools I needed to break out of the cycle and take control of the anxiety and depression.

Ultimately starting to take care of myself physically was the biggest impact and the thing that really got me off the meds and "graduated" from therapy. But I wouldn't have been able to get started on that without the meds and the therapy.

So I got some exercise. I bought a bike and put it on a trainer. I rode a few times. I loved riding my bike when I was young. That helped, a little. I think it helped me take my next step.

I'd been coaching my 9yo son at soccer for a year or so, but I never played soccer myself. So I decided I'd try playing a local soccer pickup game.

That was the trick for me. I don't know why. But suddenly I found motivation. Just enough to play soccer. Once a week, and then twice a week, and then three times, and now as many times a week as I can fit into my schedule. I lost 10#, 20#, 30#, even made it to 40# before the pandemic and found more motivation in other areas of life as well.

Soccer hurts. A lot of games I can barely shuffle through my garage after driving home. I was 39 when I started playing and I'm 41 now. I'm no spring chicken. But the mental and physical engagement of playing soccer, even just pickup soccer, has thoroughly enriched my life.

I have a friend who's a psychiatrist. I talked to him about this. He told me that I correctly anticipated my doctor's response. Exercise is the first line of defense and the first treatment suggested for depression. And it doesn't take much to try it and see if it helps. Your depression sounds worse than mine. Maybe you can walk before you run.

You shouldn't be afraid of the drugs: let the doctors handle that. But if you prefer to try something before drugs, exercise is the clear choice.

If you look for the 'solution " to most chronic ailments, exercise is usually at the top of the list.

So OP, if you dont exercise at least 40 mins every day, start with that. If you already do that, then your condition might require antidepressants

I tried exercise, read Feeling Good book, took different vitamins etc. None of this really helped.

What finally worked was giving into my depression. I would come back from work, listen to sad songs, cry like a child, pray, and drink until I passed out. Within a few days, I would wake up without pit in my stomach. Hangover was another story. Within a couple of weeks, I was not depressed. Depression turned into anxiety. And anxiety was a lot easier to deal with than depression.

Once depression was mostly gone, then I was able to use CBT methods to deal with my anxiety.

It is really hard for people who never experienced depression to understand what it feels like. It is worse than hell. I am sorry you are going through it. Just take one day at a time.

I have defintely had periods of unexplained very low motivation and lethargy. I've done the "listen to music and get really drunk alone" thing a few times. It did seem to help, though I didn't do it with that intent. It kind of slapped me in the face with a "you are pathetic, get over it" message that really sunk in. It has been a few years since I have done that.

I also started exercising (weightlifting) about 2 years ago, which is something I never did before. I have tried other exercising (biking, running, swimming, etc.) but none of it ever stuck. Weightlifting did for some reason. Barbells, not machines. Squat, bench press, deadlift. Read or watch some videos from Mark Rippetoe "Starting Strength." I can't say I enjoy doing it, but for some reason I have kept at it and I do like the effect on my body. I'm 55 and have the best muscle tone I've ever had in my life.

I also take a regular multivitamin every day, along with moderate additional C, D, and Zinc. I don't get headaches anymore and I hardly ever even get a cold. I don't eat fast food or drink soda, I eat mostly chicken, steak, and salad and drink water, coffee, or tea.

After 5 or 6 months of suffering, I decided, at some certain point, that I need to do something about it and that I need to get over it and not waste my life. I started small, step by step, waking up, taking shower, going out for a walk, etc. I used to WFH, but I reversed the habit and started to go to work place everyday.

Then, I got a gym membership and started exercising almost everyday (after so many years of physical inactivity. I am 25 BTW). I started cooking and eating healthy. I take multivitamins everyday with an additional dose of Vitamine D and Magnesium. I eat only vegetables (lots of them), rice, chicken and fish and sometimes beef steaks. I also take fruits everyday (usually Oranges, Bananas and Apples). I also drink Coffee (one cup in the morning and sometimes another in the evening) and Tea with Ginger.

I feel much better. Now, I have a routine, I am more active and I get some work done. However, I still suffer from a slight lack of motivation and happiness. I still feel a bit unhappy and I am not as motivated as I was before the whole depression thing hit me. I don't know why and I have no idea how to solve this part to become the super motivated, super focused and super productive person I used to be.

The thing with depression is that one is unable to properly think. Nothing really matters. So suggestions like go for a walk or eat healthy are really hard to put in practice.

I used to run 5K almost daily when depression hit me. It was induced by trauma. Initially, I kept going out to run, though my pace was slower and I didn't run as far. Like how they say about going broke; slowly first and then suddenly, that's how my depression progressed.

Also you reminded me about weekends. I did same thing, spend whole weekends in bed, avoided any social contact. Just drank, ate, prayed, listened to music, and cried out loud. I tried playing video games and watch movies but they could not hold my interest. Stopped running. If friends invited me, I made excuses. Luckily for me, it lasted only a few weeks.

I don't think it was any of healthy suggestions here that helped me. I already had some healthy habits like running and eating right. Maybe if I had gone to doctor, it would have helped me faster.

Just like how it started, that's how it ended. First, I started a to feel a little bit better and then suddenly I was not depressed at all. Then I had really bad case of anxiety, which I still suffer from a bit but CBT methods really helps me here. I am back to running, working out, taking vitamins etc. And feel great now.

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.

To clarify, it’s important antidepressants are not stopped suddenly, but rather gradually reduced over a few weeks. Stopping suddenly can lead to withdrawal symptoms [0]

[0] https://www.nhs.uk/mental-health/talking-therapies-medicine-...

I feel like the majority of the effort I have to put into things is overcoming my own brain. Whenever I get my brain to agree with what I want to do and that doing it it is worthwhile, the rest is easy. It's ignoring the billion stupid reasons my brain generates why I should not do something I want to do that is exhausting and difficult.

That’s not easy either…but it’s the best I’ve got at a certain point

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/

I've had great luck with antidepressants. They don't "solve" the problem, but they give me a bit more space to operate and work on my mental health. As others have said, symptoms of SSRIs can be managed.

Mindfulness meditation--clearing your thoughts and focusing on breathing--for 15min a day can feel transformative after a couple months. I've fallen off that, but I'd like to pick it back up.

There's lots of little things that can contribute to better mental health. Meditation, exercise, diet, sleep: all are factors. But it's not worth suffering through, and it's worth giving medication a shot (in my opinion).

Medication is not a commitment for life, it's an experiment to see if you can find something to help your symptoms.

I do _highly_ recommend sustaining a therapy relationship, and simultaneously working with a psychiatrist. I haven't found therapy very transformative, and it certainly hasn't solved my problems. But it does give me some support, and that's yet another helpful factor in getting by.

Make sure you have a doctor who shares this view and is honest about withdrawals. While antidepressants may have saved my life, my doctor from the get-go had me planning to be on them for the rest of my life. Fortunately, eventually I didn’t need them anymore, but I was not prepared to get off them either.

But also as you said there should be an entire intake / triage conversation to understand things like family psychological / medical history, and to make informed decisions before trying any medication.

The truly dangerous ones - and this is also not as bad as it sounds most of the time - are MAOIs. They're reserved as a last-line treatment in most cases, and it's because SSRIs are quite a bit safer the vast majority of the time.

So don't let the bad rap SSRIs get scare you off; talk to a doctor before you come to any conclusions whatsoever!

Worst side effect I ever had on an SSRI was from paroxetine, and it actually worked to my benefit, at least until I had to get off the medication for financial reasons. Let's just say the woman I was dating at the time was REALLY happy to never find herself "unsatisfied" if you know what I mean! I was never satisfied, though, so yeah that was kind of a bummer, but that was honestly the worst side effect I ever experienced. And I've been on nearly every one there is (at least in the US anyway).

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.

I’ll put it this way: You’re already miserable, you don’t have much to lose.

People have horror stories and people have success stories it’s true, but even some of the people I’ve known with horror stories still found the end result to be positive/worthwhile.

Nothing is going to change if you do nothing and you’ll stay miserable. Alternatively you can do something and you may just improve your life.

I was at a colossal low point when I finally began to receive the mental healthcare I needed. It was worth it even though it took time to get the right medications for me.

Maybe you still feel like you have something more to lose than gain but I didn’t.

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.

Legal disclaimer: This is not medical advice- just my personal anecdote to encourage you to seek an opinion from a psychiatrist or your primary care doctor and discuss whether medication is/isn't right for you.

So far experiences seem to have ranged from the medication did nothing, it supported them through therapy or completely changed their life. Overall though hearing that for most people any side-effects were either minimal or worth the improvement in quality of life has given me a renewed energy to seek treatment again.

So thanks again, everyone here has been so very kind.

I'm not sure it's true that SSRI's have "really bad side-effects for most people that take them." I know some people have mild side effects, medium side effects, or really bad side-effects. A few people have no side effects. I doubt that most people have really bad side-effects; most people with really bad side-effects probably stop taking them.

If you feel like it's a last resort, why not try it? If you don't like it, you can always stop. I think your "utter terror" (in your words) is related to your struggles for emotional health, yeah -- there's no reason for utter terror.

I'd also look for a therapist you find more useful.

I'd also consider meditation.

I'd also consider talking to a doctor about your sleep problems specifically, since you mention that as a particular concern.

Once you get to the point that you are desperate that you just don't want to live that way -- and I've been there -- why not try, literally, anything? What do you have to lose?

I think these are the important takeaways:

* Talk to a medical professional, like a doctor / GP

* Keep talking to your therapist if it helps. Look for a new therapist if your current one isn't a good fit.

* Work with your "care team" (therapist, doctor, loved ones) to create a treatment plan. Agree on ways to check in / track, so you can adjust the plan.

"Treatment plan" might include medication, but also combination of diet/exercise/practices like journaling.

Mental health and wellbeing is a spectrum. Nothing about health is permanent; it all requires upkeep.

You probably take lots of other supplements without thinking about it, like enriched flour or fortified milk. SSRIs supplement insufficient serotonin production (the causes of this are very complicated).

The contraindications, lifestyle changes, side effects that accompany SSRIs are not trivial. Your fears are valid.

Remember that you're in control of your treatment plan though. If you feel worse or decide the trade-offs aren't worth it, you can keep tweaking or remove mediation entirely.

Don't give up!

This got a lot more responses than I anticipated but by and large they have been very informative, supportive and I'm very grateful for everyone that has shared their journey.

I’ve always wondered if I simply lucked out. But the usual caveats apply: talk to your doctor, I am a datapoint of one, etc.

But they do work for some lucky people, and there is a chance you’re one of them.

“Walking around with a pit in my stomach” is a feeling I vaguely remember having before 2016, but at the time it felt like endless doom. Perhaps in five years your pain will feel like a distant memory too.

It seems to be true that not-Prozac might be a bad idea. The anecdata is pretty strong that Welbuterin and Lexapro have side effects that offset any benefit. Everyone reacts differently, but the side effects for me have been quite tolerable.

If you do try it, note you won’t experience any effect unless you take it every day for 30 days. I almost missed the benefits because of giving up too early.

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.

Find a psychiatrist and see them regularly so they can monitor your mood and response to the drugs. And stick with the therapy while doing this.

The combination is key, the meds will make getting through the day easier, and the therapy will help you find coping mechanisms and be more self aware of your emotions in a productive manner. This sounds hard and dumb but will be easier with the meds.

Then as you feel better you can work with both providers to adjust your meds or test removing them if that's something you want.

But at the end of the day, you need to talk with professionals. They're trained to help and will allow you to talk about specifics in ways that could identify triggers. Take it from someone with years of therapy and psychiatrist visits under my belt. It feels like it's not working at first, but you need to keep with it and follow through.

Good luck and I hope you find the help you're looking for.

Talk to your doctor or psychiatrist about everything before making any decisions. I am not a doctor. This is not medical advice.

When I started anti-depressants, it started as nothing happening, but when they kicked in, for the first time in, basically ever, I spun myself up into actual, genuine happiness. I hadn't felt actual happiness in ... possibly decades, and I didn't even know what I had been missing.

I have a long battle ahead; but at least for me, anti-depressants showed me a little bit of what can be and I am so, so grateful for them.

edit:

Sorry, I should also add: before I was prescribed anti-depressants, I was journalling (I still am); and, before that, I had been using exercise to help handle the anger and sadness in me.

If your depression is causing a lack of sleep or other unhealthy habits that can exacerbate depression and anxiety it is worth talking to a doctor to see what your prescription options are.

Ketamine's been working wonders for me, though it's only been a month. That said, the research on it has proven fascinating, and it really is helping me to fundamentally reevaluate some beliefs that, evidently, were in need of reevaluation.

Still a loooooong road I suspect, but it's the only thing that's ever helped me.

Normal meds never touched it, lifestyle changes are a nice platitude to make neurotypicals feel smugly helpful, and while societal structures definitely play a larger role than we care to admit, they're absolutely not going to change in our favor.

Anyway, something to read up on and ask your psychiatrist about. :-)

Happy to answer questions if you have any, though again - I are not doctor.

One thing that I was surprised worked well was SAM-E, a supplement that has shown results in treating both ADHD/Depression. I don't give too much credence to supplements, but this dealt with 2 things I struggle with and since taking it I have made progress feeling better. (Now, whether it was just coincidence or it did anything I can't say).

The other thing is that Vitamin D is incredibly important and most people are deficient, and there have been a lot of studies recently showing that we should be getting even more than is already recommended. I've been taking a form of D3 (started around the same time as SAM-E).

(Some will say to run to doctors and therapists, and if western medicine had a better track record for curing mental anguish I’d be inclined to believe them.

https://www.thecut.com/2016/03/for-80-years-young-americans-...

This is my own experience. If you trust western psychiatric treatments for yourself then go for it.)

- Not all doctors are created equal. I’m very glad I got some second opinions on medication regimens. If you have access to that level of care, try talking to more than one doctor about your options.

- It was tricky but necessary for me to balance a medical professional’s superior knowledge in certain areas against my own intuition and internal awareness. I have (correctly) chosen to decline proposed treatments that I felt were inappropriate based on the experiences loved ones had had on similar regimens. I don’t have an easy answer on this one, sometimes the doctor may know best. For me I had to feel the medical professional and myself were working as a team, and they should treat me as a team mate. If this wasn’t the case I had the (immense) privilege of being able to find a new doctor even if it took a while.

- My journey to find the right treatment was essentially trial and error and that seems common among my friends as well. Some had crappy side effects. None of them were dangerous for me or permanent. I have tried many different medications and none of the experiences I had were scary or risky, even if some side effects were really unpleasant.

- I found the right medication with a doctor I trusted. It has changed my life. I made the right choice for myself by pursuing treatment.

- It’s possible I could have toughed it out, but with medication all the energy I spent staying alive could be spent thriving and that has made all the difference. I am glad I made the choice to use meds to manage my mental health.

- I have found a lot of healing with the use of psychedelics, which some have mentioned. In Oregon they’ll be approving them for therapeutic use in specific settings soon and I’m hopeful this will be another option that could help some people. The impact can be unpredictable which is why I like the idea of someone providing guidance instead of individuals taking it alone. So while I see a lot of potential, I also think it can be risky to try solo without a strong support system.

This is hard work you’re doing and good for you for exploring and trying to find the choice that is right for you in this moment. I hope you find some relief <3

A few years ago, I had fatigue. My doctor tested my blood and found extremely low vitamin D. I started taking vitamin D3, magnesium glycinate, and vitamin B. My fatigue mostly disappeared about three weeks later.

About a year ago, I had brain fog. I took 75mg pure CBD (FreshBros.com gummies) every night for two weeks. The brain fog went away.

After taking caffeine or alcohol, I usually have increased anxiety the next day. Avoid these drugs.

After a 5-mile walk, my mood improves for a day or two. I listen to audio books to avoid ruminating. I enjoyed th Culture series by Iain M Banks. Downpour.com has a decent iOS app. Bose SoundSport bluetooth headphones are comfortable and practical. Darn Tough Merino Full Cushion socks are very comfortable and last 150 miles. I use a backpack to carry water, snack, sun hat, sweater, and rain jacket.

During the worst of the pandemic, I found it difficult to concentrate on work during the day. I added some very bright lights to my workspace. Afterward, I noticed a significant improvement in focus and mood. I use two IKEA floor lamps with FEIT PAR38 55W LED 5000-lumen bulbs illuminating the ceiling and wall around my monitor. I also use three FEIT OM200 25W 3000-lumen bulbs in a ceiling fixture.

I hope you find good solutions to your mood problems.

Others have mentioned deep breathing, you may also want to look into Holotropic Breathwork. Maybe a bit woo-woo for you, but I had a fun experience, though I don't suffer from depression.

We were looking at depression treatments a little while ago for our work in neurotech/sleeptech. There is very solid research on sleep deprivation for treatment of depression. We decided to not pursue that avenue because we're focused on improving sleep, AND it can be a dangerous treatment. Specifically not to be used if you are manic depressive, as it pushes you right into mania.

However, when I was researching depression and sleep, and talking to people with depression, one person mentioned that when he feels himself sliding, he makes sure he gets exercise, and keeps it up for a few days. He says that normally keeps him from sliding. He doesn't take SSRIs, but was diagnosed by a psychiatrist, so not a self diagnosis.

----additional---- Lastly, don't apologize about depression being a taboo subject. It is becoming much less so, and it's important to talk about it. Pushing it under the rug and ignoring the problem hasn't helped over the last 50 years (or longer).

I've had one bout of anxiety that I went on medication for. Normally I have other ways to cope with depressive/anxious times, but in this case, there was nothing to cope with; everything was going well for me by every metric. When it started to seriously interfere with my life, I decided to give SSRIs a try. For the first week, I woke up a few times in the middle of the night, but other than that, I didn't experience any side effects. It addressed my anxiety and I was on them for about 5 months. The side effects could have been quite a bit worse and it still would have been better for my health than the constant anxiety. I know people that have had issues with antidepressants, but nobody I know has ended up completely fried because of them.

Talk to a doctor about what's best for you, but don't write off medication because of the possible (they are not guaranteed) side effects. If you are depressed to the point you are struggling to function in absence of anything actually going wrong in your life, the risks of continuing with that could very well be worse than the side effects of medication.

Thank you for sharing your experience.

I've tried quite a few antidepressants over the years. Lexapro was the one that's actually worked, and kept working. You have to start at a half dose and acclimate to it, and it really doesn't kick in until you're on the full dose for a bit.

Beyond simply finding a medication that works, having a therapist to talk to was surprisingly important for me. I didn't think I needed one, but as my moods went from black and blue to optimistic (normal?) I was worried it was doing too much to me.

Being able to talk to someone without fear of being judged, or marring social or family relations, helped me realize what feeling normal was actually like.

Long story short, side effects are real. Don't panic, but don't ignore them either if they interfere with your normal routine. Expect that the first medication may not be the one; mental illnesses are poorly understood, so it will take time and be totally worth it if you put in the patience and effort

Finally, learn what triggers you. Feeling shitty temporarily is natural, but when your mind has been conditioned to spiral that into long term funk, it'll take more than medication to fix- this is where your therapist can help big time.

My advice is to get an actual psychiatrist. Your PCP will prescribe antidepressants, but in my experience you'll be way better off relying on the expertise of a specialist, especially if you need to sort through which medication is best for you personally.

If you should be in utter terror of anything, it's depression. It is a potentially fatal illness.

Also, seriously, don't get medical advice on the internet. Would you ask a random sample of strangers on the street to direct your medical care? I'm guessing no, but that's exactly what you've done here.

I'm not asking for advice, I'm asking for anecdotes, success and failure stories, etc. Real experiences with tackling these problems and the medications that professionals prescribe or ways people have come to "beat" or manage their depression without said medications.

I'm not going to self medicate and I'm not going to make a decision on a specific treatment based on what I read here, I will consult a professional when taking that step.

Thank you for the rest of your advice and thoughts however, it's gratefully received.

FWIW I am terrified of depression. I've seen my greatest heroes all die from it and deep down I know if I take no action I will be among them someday.

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!

I was put off by the title (self-coaching) but boy was I wrong and I now highly recommend it. For my own story I came to terms with being "smart enough" for life. This is after years of anxiety and depression from high school onward. I am amazed given my suffering that I did as well as I did!

Also medication does work. I ran the gamut of them until I settled on Wellbutrin XL. It also took me 25 years to figure out that alcohol, while it relieves my anxiety and depression in the moment, just makes things 10x worse. That and I need to eat properly. So I limit my drinking as much as possible and I know not to drink when stressed.

It gets better my friend.

Depression is bad enough that you should attack with all of those.

If you are going to try meds it is fine to see a primary care doc, but to get the best results you are probably going to try something, wait two or three weeks, change the dose, wait, change the dose, maybe try a different medicine if the first one doesn't work for you.

You get much better results if you do the above then if you just try 1 prescription.

My wife suffered a combination of depression and PTSD caused by a very bad childhood since basically middle school.

Under the stress of a newborn child it started to escalate to dangerous levels so she seeked help. After many failed therapy attempts she landed on Sertraline, which caused her symptoms to almost completely vanish and had only very mild side effects.

In the beginning she could not believe that neurotypical people feel like that all the time because she could not even remember a time anymore without depression and anxiety.

It fundamentally changed her and after 2 years of taking it, for the first time since she can remember, she is worried about the future and looking forward to it instead of hoping that she may die soon.

Talk to your doctor, get good advice, but don't be too afraid to try medication because it could potentially vastly improve your quality of life.

Then I moved to Seattle and the insane lack of sunlight gave me a ton of seasonal depression. A huge sun lamp and megadoses of vitamin D kept it at bay but it still kept creeping up, I felt like I had about 3y left before the suicidal urges won when I moved somewhere sunnier.

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)

The test of this comment will be about my personal experience.

I have/had depression (its hard to say if its well and truly gone). SSRIs did not help me. They're effects were somewhere between doing absolutely nothing, placebo, and just making me extremely irritable.

What did help me? Its hard to say. Therapy definitely helps a lot, getting things off your chest. Therapists won't tell you how to think - they'll teach you how to overcome the way you're feeling. I sometimes feel like I just learned to live with depression, rather than being cured of it. Maybe that's not what you want to hear, but that's my experience.

Also just wanted to address a point I'm seeing repeated in this swarm of replies: from what I know not all professionals go the SSRI route. I think many of them are aware of the lack of trust in the pharmaceutical industry.

A professional who doesn't suck will take your concerns over SSRIs seriously. A lot of people here are essentially saying "the professional is right because they are a professional"; I call BS. The professional is right in so far as they show themselves to be right over time

At the same time, it's important to not wait or delay getting help if you're in a downward spiral. Just make sure it's from someone who's trustworthy and respectful of your concerns for your own well being

It almost sounds biological only nature if it’s been this way your entire life, unless you’ve also been constantly stressed your entire life.

So what I would recommend is just trying to check off the basics. This is going to be trial and error if you’re serious about solving your problem.

A bit like making sure the computer is plugged in.

A very common cause of depression is Vitamin D insufficiency for example. I’d order some supplements and see if that helps. Followed by magnesium. Because that’s also a common cause of panic attacks (at least anecdotally).

I’m not saying this will cure you. I’m just providing it as an example of where to begin since it’s relatively common and I don’t know much about you.

Don’t give up. Make a checklist if you have to. This is going to be a long process of trial and error.

This is an exaggeration according to the statistics I've found. Most people have _some_ side effects, maybe. Certainly _some_ people have really bad side effects. But not most.

Just try the drugs. If you experience bad side effects, stop taking them (weaning off properly of course).

My longtime partner has dealt with fairly severe depression and anxiety since she was a young. She finally started on SSRIs two months ago and they're working remarkably well. Like... life-changing kind of well, if this keeps up (and there's no reason to expect otherwise with these drugs, AFAICT). She was very concerned about side effects, but has had essentially zero besides mild discomfort the first two or three days while getting acclimated to the dose.

YMMV of course.

No, the side effects are not "really bad". Especially not for "most people". Your post says to me you are self-diagnosing and working of a warped set of information from who knows what kind of sources. Ask professionals to diagnose and treat you.

Dance in particular changed my life more than once. It's exercise, it's social, and partner dances give you a lot of physical touch, which is great for helping balance your brain. If you can find a class to commit to for a few weeks, that commitment really helps get me out the door if I'm feeling down or numb. Two one hour classes per week was enough to dramatically help.

The best part is that if it doesn't work for you like it did for me, you still have a new skill and new community that can support you while you keep looking for what does.

How old is your daughter? Is she on birth control, either for being a fertile woman who doesn't want to be pregnant (i.e., to sabotage her fertility) or to treat dysmenorrhea?

My friend's health was sabotaged with depot provera, the time-release endocrine disruptor. Progesterone is a very important brain hormone. Progesterone USP is a synthetic version of what the body makes for itself.

Sometimes all a person needs to improve their metabolism is real b-vitamins from whole wheat sourdough bread (slow yeast -> natural b-vitamins, instead of synthetic b-vitamins).

You can contact me through Twitter - I have more ideas about solving depression. My username is at the bottom of my Mad In America essay (link in my other comment).

[edit]

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.

As an aside, if you think talking about depression is hard, try getting people to admit that their parents were less than perfect. We were completely dependent on our parents growing up and we idolize them. People are imperfect. Parents are people. You can do the math from there, but it's still super hard to say out loud.

Adult Children of Alcoholics and Dysfunctional Families (commonly called ACA or ACoA) is a twelve step support group that focuses on this. They started because children of alcoholics were having a number of problems, even though they never touched alcohol themselves. Addiction was an obvious way for parents to be emotionally unavailable, but there are many other dysfunctions that affect children in a similar way. Search for the ACA Laundry List to see the common characteristics. If you relate to even half that list, then ACA will probably help you.

ACA is a support group. You can learn a lot just from reading the books, but there is more value in regularly talking to people who have dealt with the same issues. There are local groups in most areas (search for ACA groups), as well and zoom/phone groups.

There are many different approaches to therapy. If you are in the ACA category, then looking for a therapist that understands childhood trauma and neglect can be much more effective then the common CBT approach. Asking around at a group meeting can be useful to get references. A good group plus good therapy is more powerful than either alone.

I dealt with depression my whole life. I had some improvement with St John's Wort (a herbal SRRI), Vitamin D3, NAC, sleep, and exercise as others have already written about. But I had to discover ACA to get at the core issues.

If there is interest, I can post my list of ACA related books.

> As an aside, if you think talking about depression is hard, try getting people to admit that their parents were less than perfect. We

Wow this hit me hard. Not because of my own expectations, but because of the expectations my ex had during our relationship, and looking at her family and their relationships it makes much more sense. You hit the nail on the head. Thanks for posting this.

My take is taking or not taking SSRIs is depends on your situation. If you are in a position that YOU HAVE TO, then do it. Example of you have to: you have a toddler, not much money saved, partner is a stay home, you are risking losing your job and not getting another one.

If you have the privilege of sorting your issues out without SSRIs, go for it. Trying doing something exciting, something you love the most in life, for me its going to Japan, nothing else interest me right now.

The issue with SSRIs, is that they might not work. I won't avoid them to much as much as Benzos tho.

Have you tried the drugs? > Yes, Ask your doctor which doctor is best for you. I took them for about a year. It takes about a month to get it into your system, this is important.

Is my utter terror of these drugs warranted or should I just bite the bullet and try them? > Try them. Talk to your doctor. The first step for me which was the hardest, is be as open as possible to my therapist. It took me a year or so to get this going. I don't go to therapy anymore, but I am more open to those around me.

Also, if a therapist doesn't work for you, try another one. There is no reason why you need to stay with one, it is like dating, you need to find the right one.

Another this is taking a big break and spending whole time in the nature, even just a week or two will help. For me even 1-2 days in the mountains hiking hard tends to fix a lot of issues. Nothing gives as much joy of life as sun rising in the mountains when it cold and you woke up 2 hours before and been hiking up.. those first few rays of warmth are special. I guess the advice is to have joy as the animal in us wants. I never feel depressed in the mountains angry, tired, cold miserable, paranoid etc but never depressed.

Good luck

I couldn’t even take ibuprofen or daily vitamins at a certain point of being depressed out of fear it would make it worse. There were a few things that helped me calm the storm:

1. Exercise (30 mins elevated heart rate each day)

2. Talk about it (Friends, family, strangers on the internet)

3. Moderation (screen time, work, diet, etc)

4. Read about different philosophies (stoicism, buddhism, taoism, etc)

5. Sleep (Make it a top priority to get the right amount 8+ hrs)

https://news.ycombinator.com/item?id=29776038

The thing you need to know most of all is that you may need to check yourself into a mental health unit if it gets worse, so try to get this emergency plan together with the help of others who are thinking more clearly.

I was locked up 3 times before I finally got better. There's no shame in doing what it takes to save yourself.

I’ve been on Sertraline for around two years. It was the first drug I was given - normally you try a couple till you find one that works - and it did it’s job. I started to come off them last Friday which involves a fairly lengthy multiple-month tapering process. Obviously slightly anxious that my anxieties will come back once I’m off them but they’ve gotten me out of whatever hole I was in and out the other side for the last year or so. Altogether I feel 10x better than at my lowest. I’ve also made lifestyle changes that helped - I cut drinking down to only holidays, I exercise frequently (just did a half hour swim and hour cycle), and I make sure to listen to my body more to try and avoid stress. However I doubt I could have made these changes without the jumpstart sertraline offered me.

Regarding side effects - I had nausea when I started and on any dose increase. I’m more prone to napping. And I put on maybe 30lbs, which I’m starting to shift now (I’m 6ft3 and male so this isnt as big a percentage change as it might sound). I’ve yet to have any side effects tapering down.

Whatever you choose, I wish you the best. Just don’t let stigma or your anxieties get in the way of getting better through meds.

And if you feel suicidal remember to call 911/999 straight away, or any other helpline, because that feeling will pass but the alternative won’t.

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

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

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

a bunch of wiki-google-doctors that think they know more than the people who actually studied for at least a decade; get away while you can.

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

This is bullshit. Antidepressants have mild side-effects for most people who take them. Some people have bad side effects and then they try a different one with a different side-effects profile and that usually helps. The only thing I have on Zoloft are annoying night sweats. Without it I was unable to function and had chronic anxiety and panic attacks.

> Is my utter terror of these drugs warranted or should I just bite the bullet and try them?

You said it yourself. You tried therapy, you tried all sorts of coping mechanisms and nothing helped. So yes, find a psychiatrist and talk to him about taking drugs.

There's absolutely nothing wrong about drugs. Some people need blood pressure medication their whole life; the brain is just another part of you that responds to medication.

It is a fact that the mechanism of almost all of these drugs are not completely understood, but fully understanding the mechanism of a drug is not a requirement for it to be therapeutic. Sometimes you just find that stuff works and then you spend a whole lot of time trying to understand why it does.

It's like plane crashes, rare events get lots of focus and thus some people are terrified of flying, but really it's quite safe.

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.

I also discovered that Rhodiola is extremely effective against psychosis and paranoia, and it saved me more than once from this funk in which you see everything negatively, or where everything feels empty. I take Rhodiola when I know I'm not thinking straight, am paranoid, or when everything around me becomes anxiety-inducing. It works.

The last tool I discovered is St. John Wort. Billed as a natural anti-depressant, I found that it does tend to put me in a good mood when nothing else does. It takes a few hours to take effect, and weeks to get the full benefits, but it works and I always have some in my pharmacy.

Without these 3 tools I'm not sure I'd still be here to write code every day. PM me if you want to chat.

Imagine you have a heart condition. It is treatable with some tried and tested keyhole surgery, but there’s another problem.

You were bitten by an insect and the bite became infected. You can’t go into surgery with a fever, but if you take some antibiotics then the infection will pass and you can get back on track for your surgery. The bite hurts a lot. An antihistamine cream will help.

One body. Three different problems with it, all linked together. The way your mind’a chemistry works, the way you think, and how you got there are three very similar things.

SSRIs are there to help bring you stability. They don’t make life magically better. That requires a lot of hard work on your mindset. Talking therapy (CBT) is the best place to start. It’s custom coaching to help you look to the future and move forward in life with tools to hold back the demons of anxiety and rumination.

When you have those two things under your belt — the bite stops hurting and the infection clears up — then you can turn around and look back on your past, with Analysis. Finding a good psychoanalyst is time consuming and expensive and not always even a necessary or desirable step. You can live with a heart condition if you accept that you are willing to drop your plans to climb Everest.

That’s the outline. Don’t be scared. Be brave and talk to a doctor*. They will help you with all of these steps.

*…or two, or more if you want to five-space-shuttle-computer-votes your medical care! I once took three eye tests in the same day because I was convinced opticians were quacks!

Personally I've been depressed for as long as I remember and I've had incredible results from (medical) Ketamine. It was pretty much an overnight cure that lasted about 6 months. On the other hand CBD doesn't seem to be doing anything for me.

The thing to understand with heavy depression, and anti-depressants if you haven't taken them before, is that when your depression is chemically treated, it's like a veil is lifted from your mind. You suddenly are lucid, everything is no longer miserable and you didn't realize how truly miserable it was before. I would highly recommend you at least try something if it's been going on for as long as you remember and nothing else works. It's normal to be scared but give yourself a chance. It is transformative in ways you can't imagine.

If you seek medical advice, as would be wise, don't trust a single doctor, seek multiple opinions and take them with a large grain of salt, not as absolutes.

So about a year ago I decided to try St. John's Wort, which you can purchase without a prescription (in the USA). It can help manage mild-moderate depression per the literature, and per my experience. It took six weeks before I felt a difference, and since then the part of me that wants to lay in bed and shut out the world, or distract myself through hours of living through other people's lives (reddit, HN, twitch, etc) has 'grown up'. I've only had couple days over the last year where the old me threw its weight onto my back, but the next day I was back to normal.

St. John's Wort doesn't come without caveats. You need take your dosage 3 times a day (with each meal). If you don't, you'll likely wont be able to drink alcohol for awhile (stomachaches), and the wort may be less effective. It also interacts negatively with a lot of other drugs (check online).

I take 300mg extract (0.3% Hypericins) 3 times a day.

https://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380...

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