I have been struggling with depression for as long as I can remember.
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.
Unfortunately I'm not.
I wake up with a pit in my stomach that I carry around all day and no matter how hard I try I just can't shake it.
It also gets really bad in waves to the point where I nearly can't function but most of all it makes me procrastinate on almost everything.
I usually end up using all my effort just to be a functional member of my team at work.
The sad part is that I know that if I didn't have this condition and I was able to sleep when I wanted to I could be many times more productive, not only at work but also in life.
The obvious solution to these problems are SSRIs and other anti-depressants. These drugs are very powerful but have really bad side-effects for most people that take them.
For these reasons I am completely shit-scared of them. I see them as my option of last resort but increasingly I feel my options running out.
I have tried therapy, I have tried all sorts of coping mechanisms but nothing solves the problem permanently.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
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.
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!
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.
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.
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.
Firstly, don't feel stigmatised about taking medication. If you have an illness, then you shouldn't feel any worse about taking medication for it than you do for taking any other medication. Mental health is physical health
Most importantly, talk to an actual doctor. Ignore everyone who's shouting about doctors don't know anything, they do, and they know more than your average internet user.
Doctors would generally start you on a low dosage of an SSRI that doesn't have many side effects, like citalopram and increase the dosage over the course of weeks. If you have many side effects, it's up for you and the doctor to decide whether a different SSRI would work better for you.
The most important aspect of antidepressants for me, was that it helped calm me down and clear my mind. I wasn't ever able to actually focus on putting my therapy into practice because my mind was always going a mile a minute. On the antidepressants I felt much calmer and I could actually focus on improving my long term mental health.
Long term use is typically associated with the worst side effects - both the well known things as well as how some may (edit: at least partially) block one's ability to develop and change/grow (1). Further, long term use is not associated with any meaningful enhancement of quality of life (2) and can often be a crutch - because while it alters mood it does nothing about the underlying cognitive patterns which are so ruinous for one's social life.
(1) Through antagonism of 5-HT2AR - see the "cognitive flexibility" section of https://www.frontiersin.org/articles/10.3389/fpsyt.2021.6612... - and more generally through inhibiting natural regenerative processes https://www.amazon.com/Myth-Chemical-Cure-Psychiatric-Treatm...
(2) https://www.sciencedirect.com/science/article/abs/pii/S01650... and https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-5618....
Anyway taking meds feels lame but my marriage / kid / career are more important than whatever that feeling is probably.
Right on for asking HN and getting so many response.
[0] https://news.ycombinator.com/item?id=30334122
I have commented before about my efforts to help my friend get appropriate treatment. My latest filing, a petition for rehearing, has been distributed to the Justices of the Supreme Court of the United States [1]. Hopefully they'll talk about it at their conference on April 14 2022.
[1] https://news.ycombinator.com/item?id=30884187
Sometimes people benefit from the SSRIs' allepregnanolone boost [2].
As for the side effects, it wasn't too bad. Lower sex drive for sure, but not non-existent. Slight paranoia for a day or two in the first week, but not after. Towards the end of the year I was getting some fatigue during the day, but that might have been long covid as well.
After a year of taking them my doctor decided to try tapering them off over a month period. I did that and since January 2022 I've been feeling very well, libido is back. Probably no side effects of withdrawal, or slight enough to be indistinguishable from daily life. Now it's been ~3 months and I'm still feeling good, no relapse at all.
All in all - 9/10, would recommend to a friend. Although I'm just one person and surely other people have some horror stories to share...
My experience as somebody with Obsessive-Compulsive Disorder and clinical depression is that SSRIs are awesome. Do they have side effects? Yup. Do most either not get them or get mild side effects that often go away? Yup. For me, I can’t even function as a result of my mental illness without medication.
I’ve also been in therapy for many years, off and on, and therapy is no cure all. I do recommend it, and medications often help when first starting therapy (studies have shown therapy efficacy increases with medicated participants).
SSRI can be life changing for some people, in a very positive way. But definitely not for everyone or at the first time. Have a plan with your doc on what to do if things get worse, and if needed on how to stop taking the meds in a safe way.
2. Schedule a follow up
Maybe 1 month after you start taking the medication schedule a follow up to review the meds. You may need to change a couple of times before you have the right ones. Have a doctor who understand and agrees with this plan. Then schedule a follow up something like 6 months later and so on regularly maybe yearly if everything goes well. Don't see it as a one off thing. Psychiatric meds are often hit and miss.
3. Don't rely solely on meds
There are many interventions that help with depression, including psychotherapy, mindfulness, and lifestyle changes. All this should be considered for the success of the therapy. Meds at their best will help you with the change.
Also if you feel a tight stomach, after ruling out organic illness, you may consider massage therapy to help you with anxiety. Learning massage therapy actually helped me a lot.
I have had diagnosed depression twice, took ADs both times. But i see that it will come back, as there is an issue (others i removed/remedied) in my life which is out of my control completely, but which will be MOSTLY solved in abt 6y or so. So ive made a decision that i suffer this, take note when i get depressed, talk to my doc and get ADs. Disclaimer: im from EU, so it is really cheap for me to get ADs AND therapy (tho i might have to wait some for the therapy). Oh, and time and time again, vit D and C have helped to raise the gray curtain too, when the depression hits at the end of winter/beg of spring (living in N hemisphere, fairly dark and freezing for half a year)
Obviously not a majority of people. Otherwise they’d be illegal by now.
That said, you are right to be cautious. There are definitely people who have severe blowback from these drugs. But given the amount of misery you are in it might be worth reevaluating your reluctance.
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.
I am sharing my own experience, the topic being a taboo does not help people who suffer.
I was also shit scared of medication, and too apprehensive to go to a medical professional... until it was too late and it all collapsed.
I visited 4 different emergency psychiatrists. Only one of them managed to identify the condition and treat me accordingly. His goal: keeping me alive for 18 months. It worked. I did need strong medication, and it had to be carefully adjusted several times. This kicked me out of depression in about six to eight months, but did not solve underlying issues. Once the emergency psychiatrist rated that I was in a stable route for recovery, I switched to a regular psychiatrist that basically checks my medication once every two months.
In parallel, I started weekly therapy with a psychologist. Also I tried two doctors and ended up with the second one. This one is needed to solve underlying issues. It took long time to get it really working, but it ended up great. It's been a year and I am still attending weekly therapy.
Its been 18 months since I started treatment. I am better now than I've been the last 10 years, but change did not come overnight, and I am still working on it with full energy. I wouldn't have made it so well without any off:
a) sport & good food & sleep. b) amazing doctors. c) medication.
> Have you tried the drugs?
Yes, quite a few actually.
> What worked or didn't?
What worked: medication + full trust in the doctor + lots of patience.
What it did not work: expecting to be back to "normal" fast.
> Have you been able to triumph without chemical assistance and what did that look like?
I really doubt I would have triumphed without chemical assistance.
> Is my utter terror of these drugs warranted or should I just bite the bullet and try them?
Terror is due to depression being taboo, and fear of the unknown. Medication is not to be underestimated. It has side effects, for me it was mostly feeling even less energy than normal. So I would not take them unless you have under close surveillance and you trust fully your doctor. On the other hand, they are very very effective. I am weaning-off medication slowly and I am experiencing no side effects.
These are all things I would ask myself, and try to tweak them in a better direction. This can be really hard though if you're already dealing with excessive procrastination. Maybe it won't work, but at least your body will be healthier for the effort.
You're right that antidepressants can be serious business, but you could say that about a lot of drugs. Their use is when the good effects outweigh the bad effects. My advice is to optimize the above things, and also find a trusted doctor and at least give them a braindump and let them practice their expertise upon you. You don't need to take a prescription if you don't want to.
https://dhubris.livejournal.com/14447.html
I don't know about your part of the world, but in Australia you may find a good GP (doctor who is a general practitioner) who can handle the medication process with you, or see a psychiatrist who usually has more expertise in this area.
Either way it can be a bit of a trial and error process until you find what works for you (which may be different than what works for me or others). Usually four to six weeks before medication reaches full effectiveness. If the medical professional writes you out a prescription without organising a follow up to see how well it is working, tear up the script and find another doc. Don't stop a medication cold turkey. Ramp down dosage under medical guidance.
Good luck!
I'm not a standard case, have a inherited combined anxiety and depression problem that behaves somewhat like bipolar disorder without ever going manic (see below for exception), it's "refractory" but I've found the two last out of three generations of anti-depressants to be very helpful, although far from cures.
I have no idea whatsoever what convinced you "SSRIs and other anti-depressants" "have really bad side-effects for most people that take them." That was certainly true for the first generation MAO inhibitors and I knew someone on one who had the usual food problem, but is much less true for the second generation of tricylics, and not at all true for the third which started with the SSRI PROZAC/fluoxetine.
If after all you've gone through you're still literally willing to live a miserable life without at least trying a third generation anti-depressant I don't see what we can say that will convince you. You certainly might have a bad reaction to one or more members of this class of drugs as I and a friend have had (PAXIL/paroxetine made me hypomanic, a friend had suicidal ideation which she simply recognized and fixed by stopping taking the drug), and perhaps as others note you may have to try several to see if one works.
Note one of the biggest mistakes made in prescribing them is not moving to a high enough dose quickly enough if a smaller one is tolerated but doesn't have much of an effect. Everything else you need to know about them is well documented, although you'll have to find better sources than whatever has convinced you these drugs are simply too dangerous to even try.
Delete social media.
Grayscale your phone. No phone usage in mornings and evenings.
Practice "Anulom-Vilom Pranayam" for about 30 minutes in the morning, empty stomach.
Go out in the nature, daily.
Notice and change your self-talk.
Try the Sedona Method: https://www.ecosia.org/search?q=what%20is%20sedona%20method
Try this for 30 days. Research on this topic a lot. A doctor is not going to help you much. Only you can do what it takes. People can downvote me here, I've no issues.
Check some Huberman's videos, one is this: https://www.youtube.com/watch?v=Xu1FMCxoEFc
Look up things around the term “sleep hygiene” if you aren’t familiar with it. But if there is something physical going on then you’ll need more assistance.
If you’re going to take medications, probably work with a psychologist in conjunction with the psychiatrist to have the greatest effect. You can ask one to refer some names for the other. Talk with a few different ones for the first interview to find one that hopefully fits you better. Some doctors are better for some patients than others so find one that is a good match for you.
It’s a journey and takes exploration, iteration, and practice to make incremental improvements.
I like the Rick Hansen Foundations of Well-Being program. But it seems each person’s depression is different and what is helpful is also different.
As usual, consult a real doctor about these questions.
So for me, it's a combination of things that work, the bare minimum being a low-dose of an anti-depressant. At my worst states, this is usually enough to lift me up to take care of my other basic needs like exercising, eating right, sleep, etc.
Once I'm at this point, therapy usually changes from crisis mode, to more exploration into what I want out of life, so out of the basic needs from maslow's hierarchy and into the psychological needs. Now, I haven't come to this realization on my own, but through years of therapy (and now multiple therapists).
I'd recommend sticking with therapy, and if you don't find your current therapist or their style to be meeting your needs, try investigating other therapists or therapeutic modalities.
> The obvious solution to these problems are SSRIs and other anti-depressants. These drugs are very powerful but have really bad side-effects for most people that take them.
I suspect you're referring mainly to the increased risk of suicide. Though, there are other less severe - but still not so fun side-effects. The way I've heard this explained (not through my wife), is anti-depressants help raise your mood. However, they can't and don't immediately jump you back to happiness. For someone down in the dumps, this means there's a short period on the way to recovery where energy and motivation levels are increasing, but they still have significant depression. This puts them in a zone where they're trending out of depression, but still have depression while having the motivation to take action on those
In other words, anti-depressants don't increase the severity of suicidal thoughts - but they can't give you increased energy. This can be dangerous since the drugs haven't had a chance to get you elevated to a point that the suicidal thoughts decrease.
----
I've learned that it can take a few tries to find the right anti-depressant for you. Different people react more positively to different drugs. If one isn't working, communicate with your provider to try a different one. Usually, within a few tries, you'll find one that works for you.
Relatedly, SSRI's aren't the only class of anti-depressants. SNRIs are an alternative class. Other drugs, like Wellbutrin, can also have anti-depressant effects while often having significantly less risk of negative side-effects.
----
Finally, therapy is critical. Regardless of your choice on drugs, having another human being helping you understand and process your feelings and emotions can be incredibly helpful to getting yourself to a better place.
Talk to a doctor you like/trust, see what they reccomend. The worst which can happen is it doesn't work ¯\_(ツ)_/¯
I have taken a plethora of mood-stabilizers throughout different periods of my life. I went with no mood stabilizers for a number of years after leaving a job that was unfulfilling. I had to get back on an anti-depressant last fall after the pan looked to be over and then we went into another lockdown. I resisted the idea when it was presented by my therapist because I didn't want to admit that depression was on top of me. I should have relented sooner. My life became much more manageable once I started taking an antidepressant again.
I'm not going to comment on what I've taken or what my personal results were. That's for a medical professional to help you sort. What I will say is that not all antidepressants / mood-stabilizers have the same set of benefits and trade-offs. Be ready to try more than one to find something that is the correct balance for you. Don't get discouraged when the first (or second, or third) isn't the right solution. I'm not advocating swapping out prescriptions for the rest of your life. Just acknowledging that it can take some time to find the right one.
Finally, I recommend asking your physician about a sleep aid. I used to take something that absolutely knocked me on my ass but that could be habit-forming. I never formed a habit. But my doctor recently suggested something milder that hadn't worked for me years before. My body's chemistry has evolved since, and the milder medication is now effective. I had also stopped taking sleep aids for years until the pan gradually degraded my sleep until my memory was garbage and my physical balance was affected. Operating on a perpetual sleep deficit is not tenable.
The plan is not to remain on an antidepressant and sleep aid for the rest of my life. They're there to help me get through a period of time when they are necessary. How long I take them depends on world and personal events. I'm not going to beat myself up if I'm still taking them longer than I originally anticipated. They help. That's what counts.
PS: while I've had some pretty bad side effects from various medications (one made me extremely aggressive and risked putting me in physical danger because of how I responded to provocation), the more common effects are things like weight gain, sleep issues, dry mouth, etc. Don't let your fear of SSRIs stop you from finding out if they can have a positive life-altering effect. Best wishes to you.
> For these reasons I am completely shit-scared of them. I see them as my option of last resort but increasingly I feel my options running out.
You don't have to take an SSRI. There are plenty of other medications out there, like mirtazapine or bupropion that don't have the same side effects that SSRIs have. Buspirone, as well, although it is indicated for anxiety, selectively targets receptor sites that mediate antidepressant effects compared to the shotgun blast approach of SSRIs.
There are now what are being marketed as SARI[1] and SMS[2] drugs, which often target the same sites as buspirone, but also have serotonin reuptake properties, as well, while blocking receptor sites that seem to induce undesired side effects. They seem to sidestep typical SSRI side effects, like sexual side effects and emotional blunting. Two drugs in this class are the only SSRI-like drugs that are allowed by the FDA to be advertised as having lower incidences of sexual side effects compared to SSRIs. Vilazadone and vortioxetine are those drugs. Trazodone can also be thought to be in the SARI class.
Then there are tricyclics and tetracyclics that are not necessarily like SSRIs, but have antidepressant effects. There's also agomelatine and low doses of atypical antipsychotics.
SSRIs are good at what they do, though. You might not experience the side effects that you're afraid of, either.
[1] https://en.wikipedia.org/wiki/Serotonin_antagonist_and_reupt...
[2] https://en.wikipedia.org/wiki/Serotonin_modulator_and_stimul...
There are many articles about this. Here's one. Feel free to google for more (try "serotonin hypothesis".) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405681/
*"work" in this context is a bit hard to define, and may be temporary, or may work for some and make other people worse, or may have side effects, etc.
My anecdotal experience is similar, it greatly helps some of my friends, while not doing much for others who were later turned out to not have depression to begin with.
See a doctor and _ask for therapy explicitly_. Get your therapist to then recommend anti depressants if they believe they will help you.
I did this a few years back. I was depressed, my friend pressured me into booking a doctors appointment, they scheduled therapy sessions for me, and then the therapist noticed I needed a bit more help along side the CBT and trauma dumping and gave a recommendation to my doctor.
Doctors don't know a lot about mental health, this is true. I think some of the bad experiences people here have are due to getting a doctors advice rather than using them to kick start the process.
(Disclaimer, I am in the UK, I cannot speak 100% if my advice works in the US)
The cocktails described in Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications 4th Edition¹ are particularly effective but you absolutely need to be under the care of a psychiatrist to attempt that kind of treatment.
Another thing to consider is that while medications can improve your quality of life, they're only part of the solution. I see a therapist weekly and a coach for ADHD on and off throughout the year. I have to exercise regularly or else my anxiety and depression become unbearable. It's hard work, but I know that consequences of not doing those things are far worse. In my case, my medications don't solve my depression and anxiety. What they do is bring me up enough that I can keep moving forward and keep improving, with the hope that one day I will untangle the mess of emotions and I may not need them anymore.
You mentioned that you've tried therapy. Did you stop because you felt better or because you didn't have a good rapport with your therapist? This is just my experience, but it took 2-3 years before my therapist and I were able to tear down all of the defenses I put up for decades. I'm at year 7 and I'm finally starting to push through some of my own behaviors and stories I tell myself to make progress and take back control of parts of my life I thought I had no control over.
I can't tell you what you should do. What I will say with absolutely certainty is that it is not weakness to want help. It is not weak to want to live a productive life. I would talk to your doctor about what you're experiencing to have another opinion about your situation. Medication for some people is the complete answer, but that's not always the case. I would strongly encourage you to find a therapist that you have a good rapport with and stay with them. Once again, at least in my case, the medications balanced me enough to deal with my mental health issues. Dealing with depression takes a lot of time and energy, but now I know the issues I'm really fighting, I don't feel helpless anymore. Take care of yourself. You are worthy of having a good life.
2. I took Prozac for a 3-4 years and felt like it helped a bit, and I had very limited side effects - even good side effects. A close friend is trying Zoloft/Stratera and is having annoying side effects like muscle spasms during the first month, but those are reducing.
3. Therapy even more important than medication. Try a different therapy methodology. If it doesn’t stick for you, try adding SSRI or similar. You can always stop taking the drug.
https://www.health.harvard.edu/blog/ketamine-for-major-depre...
> In MDD, larger effects were found for moderate intensity, aerobic exercise, and interventions supervised by exercise professionals. Exercise has a large and significant antidepressant effect in people with depression (including MDD). Previous meta-analyses may have underestimated the benefits of exercise due to publication bias. Our data strongly support the claim that exercise is an evidence-based treatment for depression. https://pubmed.ncbi.nlm.nih.gov/26978184/
I remember watching this video https://www.youtube.com/watch?v=drv3BP0Fdi8
Two points I remember clearly taking from this lecture:
- Omega-3. Make sure they are 1) high quality 2) high EPA content 3) over 1000mg of EPA per day
- Walking. If you can spend more than one hour walking, do it.
The other things I sort of knew, like sunlight and social connection. They are also very important, obviously.
So, try to find a way, any way, to have some sort of social connection. Nothing deep. Just very casual and occasional.
I used to go to meetup.com and look for things that interested me. At the time it was: pickup soccer, and language exchange. Not only I was interested in them, but they don't require social skills to participate in. You don't need to approach anyone. For language exchange, there's usually seat arrangement so the organizers will decide for you who you will talk to. So it's not like you're in a bar and have to work up the courage to approach people. This is very important. Same with soccer. There's no social skill required. The organizer will manage assigning you to a team.
One thing to keep in mind: when you go to a meetup, do not talk about having depression. It's not a positive/welcoming topic. Keep it light and casual.
And finally, this is just my personal take. It's possible that your job itself is a source of depression. If you are not in desparate need for money or can live off your savings for a few months, I would consider quitting. Obviously since I don't know anything about your life, it's possible that if you quit your life will turn out very bad in a number of different ways. But at least it's something to consider. Given that you visit HN you're probably in the tech sectore, and if so, I think it's reasonable to assume that you won't have a hard time finding a new job in a few months after taking a short break.
i) How does one identify that they have anxiety or depression? (vs. the shit happens feeling that can be brushed off over a period of time)
ii) How to identify when professional help is the required (vs. running up on hourly bills for random pointless "talk therapy")
iii) When are meds required and what they do?
I feel many would be inquisitive about these (taboo) questions. Many thanks for inputs.
I've been on Welbutrin for about four years now; absolutely life-changing; not an SSRI, so really minimal side effects. 10/10, will take again.
Welbutrin is really special. It's not an SSRI, it's not a TCA. It's an NDRI https://en.wikipedia.org/wiki/Norepinephrine%E2%80%93dopamin... and there aren't a whole lot of others like it.
I used to view taking prescribed drugs as a weakness, mostly due to how my mother viewed them as moral failing or something. I needed more God :/
They won't cure you but they will help you do the other things to make it through the day. For some, like me, depression can be a lifetime affliction due to brain chemistry.
I saw a quote the other day that seems cliche but still relevant.
"It's ok if you can't make it yourself, store bought is ok too"
On the other hand, a tiny dose of a well-tolerated SSRI medication helped me. That + therapy at the same time. IMO, the medication is useful to reduce the acuity of the depression/anxiety just enough so that you can start to make productive (and depression-reducing) changes to your life (such as establish an exercise routine etc).
Luckily we’re also discovering that drugs that target the glutamate pathway can often reverse these changes within a matter of hours or minutes.
Check this video out from Therapy in a Nutshell for some basic info: https://m.youtube.com/watch?v=zECMyPdXS1A
Anecdotally, from my experience, it was like an antidote or a brain reset.
Seriously, there's lots of treatments. Lots of different side-effects. Between you, you'll experiment until you find something that works, and you may manage to be in a much better place than you were.
Right now, you really have no idea if you have depression or severe anxiety.
This isn't like cancer. You won't be dead in 5 years. Go get treatment, and keep your life and your job.
From my experience dealing with depression, it's likely connected to unprocessed feelings. Stuff that was too painful to face and therefore was shoved down. The problem is that they don't stop hurting you just because you ignore them.
Drugs will mostly mask the problem from my experience, unless you intentionally use them as a bridge to get to a point where you can solve it.
I can only speak to my personal experience, but my personal experience is that SSRIs saved my life. Please talk to a doctor and be frank about your fear of treatment.
Depression is a bitch, but it’s also surmountable. And there’s nothing wrong with using every tool at your disposal to surmount it.
My sister is on SSRIs. It took a couple of different meds but she is pretty happy now. You need to do both meds and therapy for good results.
Aside: Get yourself tested for the MTHFR gene mutation.
for me - I went the medication route and it didn't work for me. It may seem cringe but watching these videos changed my life.
https://www.youtube.com/watch?v=xt-cnPHBcBM
https://www.youtube.com/watch?v=Qv0oTrpFOPM
So for me the solution was
* exercise
* motorcycles
And after hanging out with other bikers I've learned a lot of people are dealing with issues.
Good luck on your journey!
Always better to see a pro but we can try finding a root cause.
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!
Once you're comfortable- take the training wheels off.
Meditation and/or psychedelic drugs (microdosing or macrodosing) are tools that will help you on your journey immensely.
We’ve been using psychedelics for thousands of years. Nothing to write off about this powerful medicine.
- PsychOLOGIST: therapy, talk, feelings
- PsychIATRIST: drugs, neurotransmitters, ECT, TMS, etc.
If your neurological chemistry isn't working right in the first place, no amount of therapy is ever going to help you. That's when you go for the drugs through a qualified psychiatrist. Once that's in place, THEN you go see a psychologist for therapy on a regular basis, both to mend the damage long-term and hopefully help you establish the tools necessary to prevent it happening again. But if your brain is fundamentally jacked up because it doesn't have the right balance of neurotransmitters in there, nothing that therapist does is going to matter. So if you tried therapy and nothing's moving the needle, talk to a pschiatrist to see if medication is a good option in your case.
Above all, remember that his is medical science, not witchcraft. We're still learning about how the brain works, but it isn't casting bones or shaking a magic 8 ball either. There's a surprisingly strong amount of science backing this stuff, especially when you consider the human brain as a quantum computing device that is both affected by, and can affect, its own neurotransmitters on an internal and external basis simultaneously. (And that's just the tip of the neurological complexity iceberg...)
> UPDATE: Since you're worried about the drugs, talk to your psychiatrist about TMS. Short for "transcranial magnetic stimulation", it's an evidence-based treatment that is usually reserved for when the drugs don't work, but if your insurance covers it (assuming you're in the US like me, hope you're better off than that though!), it's a non-drug based therapy that can help. Not guaranteed because everybody's different, but it's worth a discussion at the very least. > > There's also ECT (electroconvulsive therapy). Yes, electro-shock. No it's not AT ALL like you see in the movies. It's remarkably safe and effective according to what I've read, though not without some risk. You don't want average run-of-the-mill idiots doing it either, and you sure as hell don't want med school students learning on you. But with the supervision of a skilled physician and team, it's helped people where nothing else has. Also worth a discussion with your doctor, though I honestly advise SSRIs first (I'm not a doctor though so take that with a grain of salt). > > Neither of the above relies on medication whatsoever. Both use external energy sources to influence neurological electrical transmission and (hopefully) stimulate production of the same.
So here's my internet stranger recommendation.
First, Cognitive Behavioral Therapy is the "gold-standard" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/) in the therapy route.
> "(1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behavior (e.g., information processing)."
But often when people go to see a "therapist", either they don't do CBT, or the patient or therapist does not realize that all the worksheets and exercises really actually need to be done. CBT is a lot like physical therapy, if you don't do the exercises, you likely won't get better. If you have not tried CBT before, or are not sure, the book "Feeling Good" is the thing to pick up.
Second, to answer your specific question on SSRIs: SSRIs do have side effects. They're not that bad. I was on them for some 6 years. However, I would rather have not have had the side effects, and not taken the drug, in part because SSRIs also didn't make me in particular feel any better. That said, on average, SSRIs do work while you're taking them for most people. SSRIs + CBT at the same time tends to be the most effective combo.
Finally, here's my non-scientific advice from an internet stranger who has been where you are, and is no longer there. Take it as you will.
In your head there's a little voice. It's the one reading this right now! You can make it talk if you want. Here, make it say "purple octopus fiddly pop". See? That's not you. You're the thing _hearing_ that voice.
That voice talks all the time.
When you roll over at night, maybe it says "oh god, maybe I'm going to get fired". Maybe says "oh, I bet I deserve to get fired". Maybe it says "oh gosh, I can't even get this depression under control, and if I don't, everything is gonna collapse". You aren't that voice!
Sometimes it plays a little movie, like the last time an embarrassing moment happened, or what you could have said as a witty come back. When the movie plays, you're not really there, but your body doesn't know that, and so it builds up all physical sensations of emotion.
That voice is a reflex in your head. When someone taps your knee, and your leg kicks into the air, it wasn't you that kicked. It's just a reflex.
Here, I'll prove it to you. Set a timer for 3 minutes and try and not think about anything. Just pick a point on the wall, or maybe watch your breath. I'll bet you can't do it. The moment you try, there's the voice again. Maybe it's saying things like "oh why I am doing this" or "this is boring". It doesn't need to be articulating words; sometimes it's just a feeling. When you wake up every morning, "with a pit in my stomach that I carry around all day", that's the voice.
Most of the time, when that voice talks, it's wrong. It might say "oh, I'll bet so-and-so hates you". But did you check? Did you ask so-and-so directly? Out loud? Did they tell you to your face?
Or did you implicitly believe the voice?
The way out of the trap that you're in is to notice when the voice is happening. It's happening _all the time_. It's probably made a comment while you were reading this. Did you realize? If, when the voice happens, you immediately assume it's correct, and act as if it's true, you train the voice to say more things.
It's gotten into such a habit that you don't even realize it's happening. It's like biting your nails; your hand moves before you even realize.
CBT is one way of breaking the habit. The most common CBT exercise ("the 3 column technique" or sometimes "catch it, check it, change it") has you write down when that automatic thought or feeling happens. And by doing this, you train your brain to catch the thought before it leads you down a spiral.
Importantly, by writing down the thoughts, you hold the voice in your head accountable. When it says "some terrible thing is going to happen tomorrow", you get to see that, actually, the voice in your head has no idea what is going to happen.
Another way is meditation. Meditation is not a calming exercise. It's a way to practice watching your voice for a period of time. Over time, you build the muscle and train your brain out of the habit of constantly blending with the voice every time it has some demand.
A few years ago now, I went through the most traumatic experience of my life. In a moment, all of my thoughts about how life was, is or was going to be were shattered.
I didn't sleep a full night for about a year following. From that moment on, I was in the grips of the most terrible depression - mixed with anxiety - I've ever faced. I woke up every day feeling that my life was worthless. I wanted it to be over. I cried most days. I was trapped in endless rumination (and I mean endless - nearly all my waking days, and nightmares continued on the same themes). I felt that I may be going insane. I could not imagine how I'd ever move forward. I felt like I was in a hellish 'Groundhog Day', nothing changing. Barely making it through work, through time with my children. I'd cry just thinking of how terrible it was to be this way around my children - that they'd be subjected to a father who couldn't pull himself out of the darkness.
After a few months of agony, I decided to try Zoloft. I couldn't make it past the 3rd day. The anxiety was too much, and I was terrified of what would happen to me on "ssris". Instead, over the ensuing months, I did multiple solo and guided mushroom experiences. I tried MDMA (in therapeutic sessions). I tried Ketamine. I did almost 2 years of therapy. I tried Buproprion (which I remained on, on the lowest dose, at the request of my doctor - despite it having no discernable impact). Countless books, supplements, diet, exercise, sleep. Nothing made the slightest difference. I woke up every day and viscerally felt that I hated my life.
I was terrified to trying SSRIs, because of the fear of sexual side effects, and all of the nightmare stuff I'd read countless sleepless nights reading medication reviews (brain zaps, etc).
Then, a few months ago now - after speaking at length with a friend who suffers from bi-polar, who depends on medication to function (and is grateful it's available) - I made a decision: I was not going to let fear of unknowns decide my future. I decided that, if there was a chance my life might improve - that I might be able to reduce my suffering be even 10% - that it'd be worth it. Not just for me, but for my family.
I decided to commit to trying Zoloft again - this time at the smallest dose available (25 mg). I figured, the worst that could happen is that it wouldn't work, and that I'd stop taking it.
I had no side effects to speak of. Within 3 weeks, I noticed a slight change. I wasn't ruminating as much. I found myself wanting to go out for a walk. I was able to play with my daughter for an hour - and enjoy it. I felt something might be shifting, but I didn't want to "jinx" it.
However, by the 6-8 week mark, it was undeniable. I was laughing again. I was able to sit down and watch a movie, without needing to saturate myself with intense stimuli (ie: competitive video games) just to keep the rumination at bay. I was able to read for pleasure. It was remarkable.
Now, 3 months later, I almost don't remember what I felt like before. While I have moments in each day where the traumatic experience rises up, it just passes. I can let it go. I'm not riddled by anxiety. My therapist is blown away by the change. I actual look forward to my job now. I enjoy things. I have my life back. It feels like a miracle.
I'm still on the smallest dose, have encountered zero side effects, and feel no need to increase.
I would never tell anyone what to do with their life and health. But for 2 years I listened to the fear instilled in me via internet forums, articles, etc - people all demonizing SSRIs. I went through absolute hell.
I wish I'd committed to giving them a shot earlier.
I am so insanely grateful for SSRIs. They have saved my life.
What do you mean specifically by "I was able to sleep when I wanted to"? You have profound insomnia? Any serious enough sleep disorder will give you depression, and if sleep is an issue - address that first. Sleep medicine is quite involved, and often if it's something subtle you'd have to travel to get expert advice. Stanford is a pretty good sleep medicine centre, both in respiratory and circadian disorders.
Both are fairly safe, and have no discontunation/withdrawals symptoms. You will be screened if it's appropriate for you, and it will always be administered under medical supervision the entire time. Ketamine is extremely successful, most in nearly instant remission that least at least a week or two, but the effects do not last forever, and most patients require ongoing treatment. At least you may know what it feels like to be not-depressed.
SSRIs are fairly safe in hands of a competent and most importantly caring prescriber. SNRIs however, at least anecdotally, many prescribers no longer use. Look for someone who truly cares and wants to help. Discontiuation is real, but any competent prescriber will know how to taper it, often a compounding pharmacy is used.
You should have any and all thyroid issue ruled out definitively, all nutritional deficiency ruled out, all allergies/intolerances, no matter how seemingly insignificant eliminated. Full in-lab polysomnography and sleep endoscopy should be done to rule out any sleep issues. Actigraphy might be helpful too, if you have a circadian disorder.
The best proven au-naturel anti-depressants is lots of exercise and lots and lots of social interaction. Did they help?
If not, and you have so called endogenous depression, some sort of medication will be more than likely needed, but in such cases SSRIs will be tried and are often found insufficient. You may need MAOIs, most of the time Parnate will be used. It is safe, but it comes with absolute contraindications to a few foods, and requires a dedicated diet (no cheese, and no fermented foods, not that difficult to maintain), and you'd need someone with an experience using this medication, it's a bit of an orphan drug at this point. I'd try ketamine or psilocybin first.
I never heard of anyone with lifelong depression recover with therapy alone, usually a combination of medication+therapy, and very, very often an underlying condition was found too.
You should. This is very powerful stuff & most doctors can’t understand the danger.
Avoid at all costs. Search for other solutions like your life depends on it.
Eat raw foods (veggies + fruits) only for 21 days
Then decide.
Also remember psychiatrists often have crushing medical school debt into their 40s. Think about that.
Before you take meds please read this https://slatestarcodex.com/2019/05/22/the-apa-meeting-a-phot...
I have enjoyed depression (quite severe is an understatement) for about 14 years now. I'm 26, so that's a little over half of my life which has been interesting. It came about from some abuse here and there, some neglect there, and a lot of desperation as i had no support structures.
Never used SSRIs or any anti-depressants, never got therapy; currently a smoker and a recovered alcoholic. Alcoholism was one of the most destructive and damaging things I have ever done, it is why i smoke as it's deeply damaged my body and mind, it took years from me, i feel twice as old as i am and there doesn't seem to be anything i can do other than try to smoke less and take better care of my body, though i feel both physical pain and emotional turbulence every day.
I currently, at this point in my life, realize that while I may not be able to ever be cured, but i can improve my condition, one day at a time. I think life is beautiful and I think that while my illness is crippling at times, i try to remember to hang onto what is beautiful. When i start spiraling i have trained myself to listen to music i find calming, to move myself outside (i'll often lay in the grass just breathing in the smells and looking into the sky, it helps when you distract yourself from the pain). I'm dedicated enough to it at this point that even if i can't get out of bed, i will crawl just to get that fresh air, to see the beauty around me.
Another thing i would encourage, i doubt it's a popular opinion but i do care, and this is what works for me. Stay away from pr0n if you view it; i find that when i stay away from it I can feel spasms of genuine happiness as it's almost like by not scheduling my daily, or every-other-day, dopamine rush... even WITHIN a week i will feel more energy to achieve that reward through making music or exercising.. or even just an embrace from someone i love. It all means so much more when i'm not scheduling that dopamine hit, it's like I HAVE TO DO SOMETHING! :) Anytime i slip back into it i find myself loosing ground. I'm just saying, if this is something you do, try it; you might find you feel better.
But most importantly, whether you listen or not, or try anything i'm suggesting; you need to remember that you are not alone, and even when you are at your lowest that you can imagine, you are never too far gone to reach out and ask for help. And don't push yourself past your means, the worst thing you can do is take anyone's advice and hurt yourself in the process, ease into something, don't go full hog, you know?
Another thing i noticed is that you said you find that nothing solves the problem permanently. I can say for me personally that i don't think i can solve it permanently, however i stopped fighting for perfection and just had to learn to try to improve how i think about things. Once i learned a healthy way to not just cope, but to actually live (not just survive) with it, it started to become more like background noise, even though it still affects me daily, it seems easier. I do more, a lot more than i ever imagined, but i'm always tired, though it's worth it.
It might sound a little strange, but as someone who has suffered from chronic depression since i was young, suicidal for the first 10 but now i'm (finally) safe, I've stopped treating it as something i have to "fix" and more like something i learn to treat in my own way.
I'm now an insomniac who works ridiculous hours (at a great job), i have a nice car, i love my music, and i guess has finally learned that even though it's not optimal, it's the best i can do with what i've been given. I think it's wonderful that you are still being a functional member of a team; try to appreciate those achievements, people appreciate your hard work.
There are still many days that i find myself not being able to get out of bed for hours, so i set the alarm to wake me up earlier. There are days i don't want to see people, so i work myself up to go see my friends. I've learned to ignore my own emotions to some extent and just push, but not TOO HARD. Know your limits, know what is "uncomfortable" vs. "destructive" to your mental health.
This is just me, that's just what works for me. I'm an expert in the depression experience, nothing else, and there are those around me who have better ideas i'm sure.
I hope something i said can be of some use. Best of luck to you.
Back pain is fascinating. Rarely, there is an immediate and obvious cause and obvious treatment that will work, wham bam, lickety split. Far more often, there isn't.
Intense pain starts in your spine. So you go see a doctor. Doctor says, "Here is some Vicodin, take this and rest up." Fixed!
Nope. It helps for a while, but you still have pain. This happens to the vast majority of people with back pain. It's the normal doctor first step.
So you go see a back surgeon. How do surgeons fix things? With surgery. So the surgeon does an MRI, finds a herniation (which is, after all, a source of pain!), and performs surgery and cleans out the herniation. Fixed!
(Mostly) wrong. A small — something like 30% — percentage of people find relief. The remaining people continue to have pain. They also now have a lengthy recovery, ~$10,000 less dollars, and a growing hopelessness. (These aren't fake examples, feel free to look them up or ask a doctor friend.)
These options seems to be attractive because they fit the standard Western model of disease, and also of care. Our (Western) minds tend to like this model and expect that it works. Diagnose obvious thing, do seemingly normal surgery or just take this pill, problem solved. Except not.
Had the back pain person asked an orthopedist, the orthopedist might have prescribed conservative care. Chiropractic, physical therapy, Pilates, yoga, strength training, massage, ice, heat, anti-inflammatories, etc. A surprisingly larger number of people find relief from that.
However, this approach is more annoying. It takes time and effort. It admits that maybe we don't know the exact cause, but maybe here are some things that work for a lot of people. With enough effort and time, they might work, slowly.
Had they seen a somatic or functional practitioner, the practitioner might have started looking at what else is going on with the person. What kind of psychological trauma might they have in their past? What is their desk setup? How stressful is their job? What is their diet like? What is the connection between the patient's mind and their body, and how does that relate to pain? They would then prescribe a course of treatment that might be modifications to lifestyle, healing trauma, etc.
Depression is very similar to back pain. It is complex, and is a mind-body problem. You may have an immediately obvious cause and thus an immediately obvious solution. And even then, that first solution has a fairly good chance of not working.
Moreover, you can predict with a fairly high degree of accuracy the solution you are going to be prescribed based on who you ask. Ask a general doctor or a psychiatrist, either get a pill or a referral to a talk therapist. Ask a talk therapist, get a lot of talk sessions. Ask an Eastern medicine practitioner, get some herbs, a change in diet, and acupuncture. Ask a shaman, get ayahuasca. Etc.
Depression happens for a whole bunch of reasons. What works for one person almost certainly won't work for the immediate next one, at least entirely. It often has to be addressed by looking at the individual as a whole and unique person, and using a multi-pronged mind-body approach.
If you have tried most of the normal stuff, then it's time for some not normal stuff. You have to be your own advocate in this, and keep track of what has worked and what hasn't, and move on when you have exhausted your options. I know that can be hard in the midst of severe depression, but at the end of the day it is really the only option. If what you are doing isn't working, don't just keep doing it. Find another competent professional, do your research, have your conversations, take a leap of faith if necessary, and try something new.
Again, I really hope you find healing, OP. Whatever it is that atheists do instead of praying, I'm doing that for you.
To speak to your drug question, SSRIs are first line treatments that have a lower success rate but are moderately successful. I recommend talking to a doctor and starting on _an_ antidepressant earlier rather than later. This way if you're antidepressant resistant you can go for a treatment modality that's exceptionally effective -- Ketamine infusions. Expensive but if you're able to extend at home supervised with troches/nasal and follow the rules you should be fine. ~70% for IV Ketamine and ~60% for esketamine nasal treatment, in terms of success rates.
There are many atypical antidepressants that are hard hitting. You can get creative with the dopamine system. Fisher Wallace and other brain stim devices are out there. Barring all that, deep brain implants and ECS (ecs is not too terrible I've heard compared to what it seems) are options. If much fails you might be able to access psychedelics through right-to-try laws or in a locally legal state.
You'll need therapy as well. It will probably take you 4-5+ therapists to find one you click with. If you plateau for a few months then move on to a new therapist, but try to find one with a goal of staying for a few years.
I say this as the person who would be near the tip of the most resistant category. We have Dissociative Identity Disorder (officially diagnosed), which is one step beyond complex PTSD, as well as both subclinical NPD and diagnosed Borderline Personality Disorder. BPD sucks like nothing else.
Obviously these make a huge impact in our day to day life but we've been able to crawl out of the hole and are well on our way to rebuilding friendships, relationships, and a relatively content life, just with a good foundation this time. I still have a few years left but am so much different. Ketamine helped me so much, as well as personal value reshaping.
If it helps -- the similarity between morbid depression and the most enlightened person on earth is the knowledge that nothing truly matters and that there is no meaning in anything. The difference is that the enlightened person has let go of putting value in finding the meaning of anything.
Integrating the above paragraph has probably done the most overall in relieving the pain and symptoms of my cluster B disorders.
If you want a good workbook I know several, Janina Fisher's "Healing the Fragmented Selves of Trauma Survivors" is generally excellent.
One hard thing is for people like you and me who have been in pain for a long time, our brain does this beautiful thing to try to reconcile it by finding meaning in pain. Unfortunately that shapes our identity and makes a fixed global attractor around pain -- i.e. we can run from it, but our identity always wins out against our actions. The endless hill always wins out against the man pushing the stone.
You can do all the work you want to heal but if you do not let go of finding meaning or value in pain, or being hurt, or whatever collection of meaning-making beliefs you have, the hill will be there and thwart your efforts.
Even positive feelings like "love" as a core value can cause pain, this is because the world contradicts and clashes with it. Dysphoria is not just for gender issues, it is for all identities. And dysphoria is stronger than pain aversion, hence why some people like you and I seem "permanently broken". But it's all an illusion.
If you've had a spiritual awakening moment at any point, "The End of Suffering" by Adyashanti is really, really good. If you haven't feel free to read but it may feel like hippie dippie nonsense.
If you're looking for something to find a compass of where you should move emotionally when you're stuck, whenever you're despairing if you commit to reminding yourself that you're no longer a person who needs meaning to live, something will move or hurt. Keep repeating that to yourself whenever you get stuck and it'll give you a good GPS direction on where to go next.
But if you're super deep in the depressive slump, just survive. Your mind is your worst enemy right now, it will lie to you and limit your options. Just keep going. Even if in the worst case the above is a bad roadmap (I certainly don't believe it is a bad roadmap), at least it's a roadmap. I'm six, almost seven, years into what feels like a near full time journey trying to survive what has felt like hell on earth, and I'm well past the worst point. The reason I'm so detailed is probably because when I was alone and crying out to God for help that I wish someone reached out to me. So I think it's to amend for my own past hurts on that front.
Much love and we're happy to answer any questions.
T,S&company.
Major depression recurred frequently for most of my life and I was suicidal in my 30s. I asked every physician and health professional I could find for advice and was willing to try just about any therapy or treatment. None of them were helpful in the slightest and after a particularly frustrating experience with a useless, hostile, and expensive psychiatrist I gave up on getting any assistance from the health industry.
Since no one was willing to help I needed to figure this out for myself. I read everything I could find about depression that was not overtly pseudoscientific or superstitious, including hundreds of anti-depressant drug trials of wildly varying quality and power. The breakthrough was realizing that major depression is not a disease or "mental illness"; it is in fact adaptive behaviour shared by all mammals which has become maladaptive in humans due to our modern environments and societal interactions being so far removed from the ones our species evolved in.
Mammals cannot prosper under chronically stressful conditions, e.g. many predators or much stronger rivals in our local environment. Chronic stress from such fears and concerns is what triggers the depression, which alters our behaviour primarily by suppressing dopaminergic pathways. This shuts down normal motivated behaviour like the drive to explore our environment or find a mate and makes us stay at home where we feel safest, recuperating as if sick or injured. This is adaptive because it takes the mammal away from the sources of stress. With environmental stress sources gone the depression will slowly pass, and after a while the mammal is ready to leave its nest, making another attempt at living in its natural environment.
Depression has become maladaptive in modern humans because many of our sources of stress are abstract and long-term concerns that cannot be evaded by staying at home in bed: we worry about losing our source of employment, armed conflicts in neighbouring countries, global warming, and how our stock portfolio is doing. Many human disorders (e.g. anxiety) also predispose us to chronic stress and therefore depression. In my case the root cause turned out to be undiagnosed autism spectrum disorder. I can now manage my depression quite well, but I have had to make large sacrifices – like avoiding most normal social interaction – to achieve this.
You may be able to find the solutions you seek if you can learn the reasons why you are depressed.
The depression was so bad it profoundly effected my vocabulary and cognitive function.
We're talking a 20 point drop in IQ. I was so deep in the well I no longer had depression but depression had me. I was fortunate to be going to a therapist at the time who recommended I go on anti-depressants and I agreed but I made a deal with him first.
The starting dose he was going to prescribe was something I saw had similar impact to vigorous exercise so I asked if I could try biking every day for the next 4 weeks and if I wasn't better I would start taking anti-depressants.
Because my fathers depression severely negatively and permanently impacted my life I had a pathological talisman to always get out of bed everyday.
I rode a bike every day in the Texas 100 degree heat, a minimum of 16 miles and usually 20, I would drink over a gallon of water on each ride.
I would sing songs from my childhood and pray out loud (I was ~religous at the time) as I rode and talked to myself and about what was happening in my life almost the whole time... while absolutely flogging myself on the bike every day.
There was no affect the first week, no lifting of depression.
On the 8th day I had ~one hour where my mind seemed normal before the veil dropped again.
By the time I went back to the therapist I was myself for all but an hour a day.
If you cannot do such extreme exercise you MUST go on medication (you should almost definitely go on medication, it's nothing to be scared of, many people are on them only short term), regardless you should see a therapist and follow their advice, you must talk through how you got to your current situation and take practical, physical steps to alter your environment. If you try exercise you must make a time gated deal with your therapist then hold yourself strictly to it.
Medication need not be permanent, if you are inside of depression you must get a mental toe hold out through any means necessary so your operating mindset isn't coming from helplessness and emotional poverty.
In addition to medication I would also practice the entire list below:
Non Pharmacological Cognitive Enhancers – Current Perspectives https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573018/
The one caution I have with medication is that in almost all cases it must accompany working/talking through underlying issues with an engaged therapist, otherwise you're cutting your gains way short. Depression in individuals without clear disorders is like anger, your body and mind are telling you that practical things must change.
Depression is the problem of the ego.
Once you realize it is not real, neither is depression.
Medication obviously has a place in the treatment of mental health disorders, but if you, for example, are in a toxic relationship with a spouse, parent or child, have experienced death of a loved one, are suffering from drug or sex addiction, an eating disorder, suicidal ideation, or are in an emotionally or physically abusive home environment, then meds are just going to treat your symptoms and not help you change the circumstances of your life that are causing your condition.
> 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.
Details really matter here. You can have every good thing in the world, but it only takes one instance of trauma, grief or loss to harm your long-term mental health.
> I usually end up using all my effort just to be a functional member of my team at work.
A person's life is much more than just their work. If all of one's energy goes into work, it's likely that their personal life is suffering as a result and thus either causing or exacerbating the underlying condition.
> I wake up with a pit in my stomach that I carry around all day and no matter how hard I try I just can't shake it.
This can be a symptom of anxiety. You cannot make it go away by force of will. There are medications that reduce feelings of anxiety, but if the cause is that you're worried about losing your job, getting sick, being left by your partner, etc. then medications will not help resolve those problems, though they may make them more tolerable.
> I have tried therapy, I have tried all sorts of coping mechanisms but nothing solves the problem permanently.
This sounds like a cognitive distortion. Details really, really matter here. One of the challenges in scaling the therapeutic treatment of mental illness is that a great deal of the efficacy of therapy depends on a person's willingness to actively engage with the circumstances of their life that are causing their condition as well as the therapists ability to effectively communicate and guide a patient to a state of mental well-being. Learning to cope with a problem is different than solving a problem.
For example, if you have a toxic parent, you can try to cope with that toxicity, try to communicate how you're being harmed by the toxicity and hope your parent responds positively, or cut off all communication with that parent. Sometimes the painful decision is the right one for your mental health. Are you willing to take that step? Could you find a therapist to even make the suggestion?
Many therapists, I venture to guess, would not make that suggestion but believe it to be the right one (as it sometimes is). Making that kind of honest, practical and effective guidance widely available is hard because the "industry" is trained to refrain from expressing personal opinions and unfortunately oriented in a much more passive fashion; partly due to concerns over liability and partly because the personality types attracted to the field are generally not assertive and direct.
> 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?
DO NOT ask the internet to tell you which medications to take. If you are jaded by the field of psychiatry, then start with your primary care physician who can also prescribe those same medications, evaluate you for depression and anxiety, and ask them for a referral to a mental health professional that specializes in cognitive behavioral therapy (CBT). Different states have different titles and licenses for these professionals, but if you are in the state of California, some titles and licenses to look for are the following:
- Licensed Marriage and Family Therapist (LMFT) - Licensed Master Social Worker (LMSW) - Licensed Clinical Social Worker (LCSW) - Licensed Professional Clinical Counselor (LPCC)
https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy https://en.wikipedia.org/wiki/Cognitive_distortion https://en.wikipedia.org/wiki/Reality_therapy
I agree with other comments that you should have this conversation with at least one doctor. But understanding other people’s experiences can be important, and can also make the prospect of going further less terrifying.
So I’ll share mine, though they’re limited. I’ve only been prescribed one antidepressant, trazodone, which is an SARI not an SSRI. It wasn’t prescribed directly to treat depression, though I was seeking relief from depression at the time. It was prescribed to help me sleep, which it did for a time.
This was during a really severe mental health crisis, and I was also plagued by severe anxiety. I probably would have continued to explore antidepressants, had I not found the root cause in my own case was undiagnosed/untreated ADHD.
My experience with trazodone was short, so please don’t take it as more than one small anecdatum. But it was:
1. Extraordinarily helpful when I needed it most. It did exactly what I needed it for.
2. Wasn’t particularly helpful as other contributing factors eased. I had other steps to take to work on improving my mental health further. But I was more capable of approaching them.
3. Did not have, for me, serious side effects. It just became less effective.
4. Wasn’t hard, for me, to stop taking safely. I don’t know if this would have been appreciably different if I’d taken it longer but I assume it would have.
This is, in my opinion, a success story! It’s probably not a representative one though. And this is where my anecdata gets more speculative, so please take this with a grain of salt: I know a lot of people who have psychiatric experiences which span a wide range. I know people who have experienced the “utter terror” of meds that didn’t work for them. I’ve heard and read similar experiences from people less close to me.
Of those people close to me who went off meds, they almost universally had worse experiences and outcomes. Almost everyone I know who’s had unpleasant experience with antidepressants stuck with it, and found something that works at least for a while until an adjustment was needed.
Reiterating, I am not a doctor. Just relaying my experience and what I can relay from people in my community. The biggest hurdle is the one you already leapt: facing this. The next biggest hurdle is that antidepressants take a long time to become effective if they will, and a long time to transition off if they’re not helpful. That’s a real hurdle! But with attentive care it should be about the same level of risk as declining treatment. Because attentive care is the more important factor there.
I don’t know what the answer for you should be. I do know that it’s more available to you because you’re asking the question in a well considered way.
I hope this helps.
Unfortunately true; I opened up a few times to different friends, and it never went well. But more people talking about it is the only way to change that, so thanks for posting!
I was in a similar situation as you; I remember once leaving work at noon claiming to feel sick, but actually it was because I couldn't think of anything except how I wanted to kill myself.
A couple years later, I'm still around, and here's what helped me:
* Bupropion, 150mg XL * Some basic understanding of CBT * Adderall
> The obvious solution to these problems are SSRIs and other anti-depressants. These drugs are very powerful but have really bad side-effects for most people that take them.
SSRI's definitely have an unsettlingly long list of side-effects, but keep in mind two things:
1. Not everyone experiences them; anecdotally, my sister started Prozac recently, and she's told me it's been great for her 2. If you do experience side effects you don't like, you can just... stop taking them. There's lot's of different SSRIs with different effects, and from what I've read it's common to cycle though a few before finding what works best.
Also, SSRIs are not the only option. As mentioned, I'm taking Bupropion, which has virtually no serious side effects. Look it up. And if you want to try it, you can just ask a doctor for it; tell them your concerns about SSRIs and just ask for Bupropion. No doctor is going to force you on SSRIs if you don't want them.
Side note: the XL version is the 24, slow release version. Works much better for me than the standard 4 hour tablets I started with.
On the topic of CBT, as others in this comment section have recommended, I read Feeling Good by David Burns, and it did help. It wasn't enough on its own, but a basic understanding of CBT goes a long way. The basic idea is training yourself to recognize bad thought patterns and taking action before they affect your mood. Honestly, it's stuff everyone could stand to learn.
Finally, I also figured out that I had ADHD. This was related to my depression because, frankly, it was depressing to struggle to accomplish the basic tasks other people seemed to have no trouble with. Especially noticeable as a programmer, where intensely focusing on a single thing for a long time is... basically the job description. Adderall has been a life changer for me.
> 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?
I totally get the mindset of not wanting to take drugs. It feels like a crutch; something you shouldn't need to do. But eventually I realized that taking drugs daily wasn't any different than wearing glasses daily. I need the glasses to correct a biological defect with my eyes. I need the drugs to correct a biological defect with my brain. Humans are fragile, and a lot us aren't built to spec. The great thing about living in the modern world is that we can actually fix these problems.
> 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 ideal (well, the ideal is that they never pop up again, but from my experience that hasn't happened yet). It's not easy, it's a process, but it's something to think about and work towards.
I also have learned over the years what things elevate my mood, and break the spiral. I'm an introvert (in a general sense), but thrive with friends and family (in small groups). I took up sports and athletics as an adult and found being outside and the kinds of activities being fit enabled to be helpful to me. Team sports gave me some camaraderie that I was missing, too.
Like I said, though, it's not perfect, I have not "beaten" depression. I was doing great in my old town, old job, and pre-COVID. I was doing fine here before COVID, and then just got slammed by the isolation and stress of it all. Many of my coping mechanisms weren't available. But I still had enough awareness of myself, how I was feeling, the sense of the downward spiral, and the openness with my wife about my feelings, that we cut it short in 2020 (compared to some of my prior episodes) and I went straight to therapy. Learned new skills, found new ways to cope despite the isolation, etc. I still had "every reason to be happy" at that point during COVID. I still had my health, no one in my family had caught COVID (at least not immediate family, several "x's in-laws' in-laws' nephew died last week" kind of things though), still had my job (no risk of being laid off, the work still needed to be done and was still making money). But depression the disorder does not care about the reasons, it's a thing we have to deal with (healthy coping mechanisms, therapy, and medication being the better ways).
Learning to accept that idea, that it's not my fault that I'm depressed, that it's not a moral failing that I'm depressed, that it's just a fact of life that I (with some frequency and to varying degrees) become depressed, has itself been immensely helpful in getting the help that I need, recognizing (because I stopped being in denial, for one reason) when I am in a depressive episode, and getting through them and out of them more effectively.
TLDR Its thought LSD sort of mimics SSRI's and locks into the serotonin receptor, but which receptor I dont know as I havent read the article and there will be a few different one's if other receptors are to go by, like histamine.
SSRI's can affect your sleep which will affect your memories and possibly your work. If you program then not being able to remember where code is could be a problem but it might not be. Escitalopram is like doing Ecstasy (MDMA) if you drink copious amounts of black tea and sugar when on them, ie you will have little E rushes throughout the day which could send your life off the rails. Melatonin besides being the sleep hormone is an anti oxidant and helps release stem cells and SSRI's can affect this hormone.
The older MAOI's maybe better, but OD on those and you will literally lights out and have no recollection of passing out. Popular with those looking to end it which is why SSRI's came to be. Problem with some of the SSRI's is they can also affect other parts of the brain which could heighten aggression and other less than desirable effects. You will reports of some SSRI's even on here https://www.erowid.org/pharms/fluoxetine/fluoxetine.shtml
I'd also look into the metals that make up various SOD's. Super Oxide Dismutase's they reduces Free Radicals and these can contribute enormously to stress, and other less than desirable effects in the body. Start with copper.
An inorganic Carbonate would probably be the only form of a metal I'd touch not chloride & sulfate, the others I would get chelated ie a metal bound to something like Glycine, which causes vasodilation and reduces inflammation , and happens to be the one chemical that has significantly increased the life span of rats more than anything else. It powers up the mitochondria.
I'd take a serious look at your diet though, your environment and even your sleep habits. Identify what it is that gets you down and see if you can resolve them. Easier said than down when considering how stubborn or criminal people can be which may be contributing your depression, but I'd start with diet and environment, and I'm not qualified in anything except my own opinion!