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Ask HN: How to cope with depression

69 points| lotsofthrows | 11 years ago | reply

I'm struggling with depression, and don't know how to manage it.

Just to get my background out of the way :

I'm a programmer and have been severely under performing at work (to the point of almost being fired), and routinely question whether or not I deserve to be alive. As a result of my difficulties, I've begun seeing a therapist and psychiatrist. Both feel that I should be on anti depressants, and I am not opposed to this.

Short of medication, however, they haven't really offered any strategies I can implement. Perhaps that will come later, but for now I was hoping to hear about what may have worked for others. All the logical advice (exercise, go to sleep on time, live a healthy lifestyle) are things that I struggle to find the motivation for. Perhaps the medication will help in that department. However, I'm concerned they will dull my focus (which is a bit silly, considering I can't focus at all right now).

edit :

I am sincerely grateful for all the thoughts that have been shared. I've read every post in this thread. A few follow ups :

1. I understand the limitations of asking for advice about mental health online, and I want to reassure any/everyone concerned that I will not make any treatment decisions without the input of the specialists I'm seeing.

2. Related to the above, reading about the (mostly successful / positive) experience others have had with medication has been very reassuring. I did have some lingering skepticism about SSRI's (which may or may not have come through in my original post), and I am very glad to hear that medication has worked well for others. Maybe it's a bit silly to have an opinion partially validated by a peer group, but so it goes.

3. This is probably as emotional as I've been in weeks : reading through the responses here makes me feel like I'm not alone. Thank you, very, very much.

116 comments

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[+] Tech1|11 years ago|reply
I'm an Army veteran that was diagnosed with PTSD in 2010 after a particularly shit deployment to Afghanistan. I've also battled with depression my entire life. Name an anti-depressant or anti-anxiety pill and I've probably been on it at one point in my life. They definitely help you. Conversely a good therapist is also extremely helpful. They can help you find directions that are away from the meds. I've currently been off meds for about 1.5 years and it's been great, but it takes a lot of focus and quite literally years of therapy to get there.

TLDR: stay on the meds; do what the therapist says to do, no matter how dumb or inconsequential it may seem; exercise.

[+] tptacek|11 years ago|reply
Thank you for this comment (and your service).
[+] lotsofthrows|11 years ago|reply
thank you for sharing your experience. it sounds like you've struggled more than I have, and I admire your persistence in making it through.
[+] Lewisham|11 years ago|reply
Take the meds; if you aren't able to feel like you can do the other things, your depression might be too severe for those to help anyway. I didn't realize I was depressed for a number of years, until my wife forced me to go. I am now on medication and I feel much improved.

The wrong medicine will dull your focus (I had a very bad sedative reaction to Lexapro) but the right ones will make you feel more normal. My work is the same as it was before, except I am happier now.

[+] lotsofthrows|11 years ago|reply
> The wrong medicine will dull your focus (I had a very bad sedative reaction to Lexapro) but the right ones will make you feel more normal. My work is the same as it was before, except I am happier now.

I'm really glad to hear that. It's surprisingly reassuring.

Out of curiosity, how long did it take you to decide Lexapro wasn't right for you?

[+] tunesmith|11 years ago|reply
You don't have to see the medications as a permanent thing from the outset. You may have to take the meds to give yourself the focus/ability to start changing your other habits. After that point, you might be able to build up enough momentum that you'll be able to work on yourself in other ways and eventually not need the meds anymore. But depressed people often need that initial boost to help move them out of the cycle.

Also, not to argue against "depression" or meds or anything, but... sometimes, especially for people in the first decade of their working career, we might be trying to convince ourselves we "should" be enjoying our career circumstances even if we just don't. Those shoulds can certainly exacerbate depression. I'm just saying that your underperformance might also be an indication that you don't like your job, which is totally ok.

Finally, one of the simplest harmless things you can do to start, that you might be able to motivate yourself for, is drink a lot more water, and take a B vitamin every day.

But yeah, main thrust - take the meds, trusting that you may find it easier to motivate yourself to take other healthy steps in the future.

[+] lotsofthrows|11 years ago|reply
> we might be trying to convince ourselves we "should" be enjoying our career circumstances even if we just don't. Those shoulds can certainly exacerbate depression. I'm just saying that your underperformance might also be an indication that you don't like your job, which is totally ok.

This is fair. My work has probably exacerbated my difficulties. In the past, work (or programming in general) has functioned as an outlet - something to focus on. At the moment, it's probably making things worse for various reasons. I will need to change my job soon, but feel the need to fix myself before I make any new commitments.

[+] beat|11 years ago|reply
As everyone else is saying, take the meds. But be sure to work thoroughly with your psychiatrist to monitor the effects of the medication, and stop anything that's going awry. Don't make the decision on your own to quit a med, either - make an appointment.

Don't self-medicate with alcohol, "drugs" (the non-prescription kind), promiscuity, video games, or other things that numb you. As the psych meds take hold, you'll be able to get up, but you'll be dragged back down as well.

Be very conscious of suicidal ideas as you heal. The real danger point for depression-driven suicide isn't when things are so black you can't even get out of bed. It gets dangerous when you start feeling energetic again. Then you have enough energy to hurt yourself. Have a support group or friends who understand, and check in all the time.

Consider getting a new job now. It might help you to have a fresh thing to care about, and getting fired from your existing job will only hurt you.

[+] lotsofthrows|11 years ago|reply
> Don't self-medicate with alcohol, "drugs" (the non-prescription kind), promiscuity, video games, or other things that numb you. As the psych meds take hold, you'll be able to get up, but you'll be dragged back down as well.

poignant. I either have at one point or actively self medicate with all of the above.

> Be very conscious of suicidal ideas as you heal. The real danger point for depression-driven suicide isn't when things are so black you can't even get out of bed. It gets dangerous when you start feeling energetic again. Then you have enough energy to hurt yourself. Have a support group or friends who understand, and check in all the time.

this is valuable, thanks. I tend to be very private about anything concerning my mental health, but this makes me consider sharing it with a friend I trust who I can check in with.

> Consider getting a new job now. It might help you to have a fresh thing to care about, and getting fired from your existing job will only hurt you.

this is something I've considered very strongly. I'm a bit hesitant because I worry I'll fail to produce in my new position (if i don't take the time to heal), but it's definitely worth considering.

[+] RantyDave|11 years ago|reply
Take the meds.

Expect this to be a journey - you have to try several and you may end up on a combination (I take four). If you're dozy at work as for some ritalin to help. I hope you have health insurance :( Also, if you go through 'high' periods you're not depressed, you have bipolar 2.

Take the meds. This shit literally saved my life.

[+] zoba|11 years ago|reply
To make that a little clearer:

'Bipolar' is a condition with depressive and manic states. Low lows, and high highs.

'Bipolar Type 2' is a condition with depressive and hypomanic states. Low lows, and just feeling particularly good. People who experience hypomania without depression often don't complain about it / see it as a problem.

[+] lotsofthrows|11 years ago|reply
> I hope you have health insurance :(

That's honestly one of the only reasons I haven't quit my job. I'm performing so poorly, and am so intensely ashamed of it, but don't want to go on COBRA while unemployed.

> Take the meds. This shit literally saved my life.

Thanks for sharing. It really has been reassuring to hear they've genuinely helped others.

[+] parkovski|11 years ago|reply
I was in a kind of similar situation recently - I never went to class, ended up dropping out of school, would sleep 10-12 hours a day at odd hours, drank way too much, didn't really have much motivation for anything.

For me the dominant factor was anxiety, and I didn't get help until I started having panic attacks. Like you I started seeing a psychiatrist and a therapist, and I was very lucky to not experience any adverse effects to the medications I was prescribed.

SSRIs are an interesting thing - because they are such a gradual change, a lot of people write them off as not working. For a while, I wasn't even sure if it was doing anything, but at some point I realized that I didn't get the awful dread/despair feelings from normal everyday life anymore. I started reaching out to old friends again, and making new ones. I sleep 8 hours now.

I didn't realize how bad things had gotten, and how much better they should have been. I used to be very against being dependent on drugs, but I eventually came to the realization that I'd rather live till 40 and love it than live till 80 and hate it - even though I don't think that's the tradeoff I'm making, it's the one I was willing to make. So I just did whatever I could.

Don't write off drugs, meditation, exercise, diet changes, etc - try it all, and find what works for you. I mostly wrote about drugs here, but different people are averse to different things, or don't believe in them, when the reality is we still don't really understand mental health very well, and your best bet is just to throw everything you can at it and see what sticks. But you gotta do it. It's way better when you do.

[+] icc97|11 years ago|reply
A psychiatrist is key - but finding the right one for you is also key. There's a book about it (edit: changed the link): http://books.google.com/books/about/How_to_Choose_a_Psychoth...

I used to have a 20 mile-a-day cycle commute and doing triathlons and I didn't find that it actually helped.

I have directly witnessed my mood improve from getting a good night's sleep. But I'll still regularly fall back into not sleeping if I'm coding - which isn't bad as long as I'm enjoying the coding.

Just simply having a 20 minute walk every day can be better than running or cycling as it takes no effort and doesn't involve pressuring yourself to do it.

I found looking for interesting projects worthwhile. Code on things that you enjoy. If you hate some of the code you work on just try some ideas out for yourself how you'd improve it - it shouldn't be for anyone else - just for yourself as you enjoy it.

Yoga, meditation, Taoism, Buddhism, easy reading (about these topics), talking, beer(s) all help too.

Accentuate the positive (in any way you can).

[+] zoba|11 years ago|reply
I've dealt with a couple major depressive episodes in my life. In addition to the standard advice of 'Go see a therapist!' heres some things that help for me:

1) Committing to myself that I'm getting out of this state, and reminding myself that I'm working on fixing it. Then having the leniency on myself that depression is not a solved problem, and I will keep trying until I actually have accomplished my goal - however unclear my progress may be.

2) Consistently enforcing myself to complete small achievable goals. For me, this is stuff like: getting out of bed within 3 minutes of my alarm going off, having an ironed shirt, show up at the gym and do some sort of exercise daily.

If you have motivational trouble, start with even smaller goals eg 'I will put water in my cereal bowl after I put it in the sink so the milk doesnt dry and get gross.' Then work up to 'I will put the bowl in the dish washer after I am done with it.'

3) Creating arguments for why everything is actually all okay. Many of them don't convince me, eg 'You've got a steady income', but some of them do eg 'Well I've read several papers that forcing yourself to smile releases neurochemicals that make you happier' was pretty convincing.

4) http://examine.com/topics/Depression I'm not a medical professional, but the evidence gathered for supplements listed on this site is convincing. In addition to Fish Oil and Saffron, I've seen a lot of evidence for supplementing Vitamind D and found it to be very helpful.

5) Go see a therapist that you like and respect. It was important to me to find one who I thought was smart and practical - I didn't want a ooshy gooshy feelings therapist. I've had the most success with CBT.

6) Learn to refocus your thoughts. This is tough, but, the worst part of depression for me is often the sad thoughts that come with it. I find that days are better when I don't allow myself to indulge in thinking sad thoughts. So this means 1) catching myself when I've starting thinking something sad 2) Successfully putting my thought train on a non-negative track.

If you take the meds, just be aware of the side effects of being on the meds and also be aware of the side effects of coming off the meds. I've found no doctor that really sufficiently warns of these.

If you ever want to chat, my email address is in the link in my profile.

[+] turoczy|11 years ago|reply
I don't have any immediate answers, but I did want to quickly thank you for having the courage to reach out, rather than just suffering silently. This is something with which many of us struggle on a regular basis.
[+] lotsofthrows|11 years ago|reply
thank you. that's kind of you to say, and very reassuring. I honestly felt really apprehensive and guilty / self centered / narcissistic for posting here.

> This is something with which many of us struggle on a regular basis.

it certainly feels that way at times :(

[+] goshx|11 years ago|reply
Take the meds. Don't worry about focus at this point... meds are your way out of this situation. It is hard to see light at the end of the tunnel before you start taking them, but once you do, try to find hobbies that relax you and make you happy. Keep working with your therapist and psychiatrist to find the root cause... sometimes it is hard to find it when you simply can't talk about certain subjects because of the way you feel. Don't give up. You can overcome this and you will.
[+] Kronopath|11 years ago|reply
I want to start off with a bit of encouragement. You've admitted that you have a problem and you're taking steps to solve it. That's a great thing, because it's showing acknowledgement of the problem and a commitment to getting better. Too many people lack that, and so you should feel proud of yourself for that.

That said, a therapist can probably guide you better than the internet can. The trick is finding the right one. Most of the effectiveness of a therapist comes down to the "fit" between the two of you, so if you've gone to about three sessions or so and you're still not feeling it, it's encouraged and expected to try another one. Your current therapist may even refer you to another.

Above all, just keep fighting the good fight, and never be afraid to reach out for the things you need.

[+] lotsofthrows|11 years ago|reply
> Most of the effectiveness of a therapist comes down to the "fit" between the two of you, so if you've gone to about three sessions or so and you're still not feeling it, it's encouraged and expected to try another one. Your current therapist may even refer you to another.

thank you. this is very helpful. you're the second person to mention this, and it's the sort of advice about treatment I may not have come by otherwise.

as it turns out, this is something I've been curious about (how / when to change, the etiquette of switching therapists, etc).

[+] hipsterrific|11 years ago|reply
Been suffering with depression for most of my life. Exercise does help (for me, it's walking or hiking). I took medication for a year and I hated it. I meditate a lot (I'm a Christian) and I spend a lot of time introspecting my issues. Much of my depression comes from having a crappy childhood so I often have to address them in creative ways.

There have been times work has made me depressed so I take some time off. I also have done a good job of not associating things with my identity, so work is work and if I lose my job, then it's my job I lost. I tend to segment things in my mind so that when I underperform at work, I feel bad but not to the point that I want to kill myself over it. Learning to value yourself can be difficult but it's not impossible.

[+] Kneedler|11 years ago|reply
30 minutes of Exercise + 10 minutes Meditation every morning did wonders for me. Finding the motivation to get started will be a constant struggle, but once you establish the habit for a few weeks it gets much easier. Start small if you have to, but do it every day -- building the habit is the key. If this doesn't work, or you can't muster the motivation to do it, then the meds are probably worth a try.
[+] shampine|11 years ago|reply
I dropped exercise for the past year, worst mistake I've made. Everything changed, my productivity, my happiness, my stress increased, etc. Now I'm forcefully pushing it back upon myself and as a result I feel better, I'm getting things done at an amplified level at work and at home. Once you get in that rhythm of having it you don't realize how important it really is.
[+] 112864|11 years ago|reply
Before going to work? what time does it make you wake up then? Well I'm not a morning person
[+] sameboatbro|11 years ago|reply
I was in, or am in, a very similar spot. I've struggled with depression to the point where I got almost nothing done with work. I had the same fear you did about dulled focus, but you're right: it is silly to worry about that if you aren't productive already.

A few months ago I went on Prozac. I still struggle with focus and getting work done and there are some other negative side effects, but crucially I am able to think more clearly about the situation. I'm now working on strategies myself to get myself to a better place long term.

I'd advise taking the medication -- it's unlikely to put you in a worse spot, and very likely to put you in a better spot. From that better spot you will see more avenues you can pursue.

[+] humanrobot|11 years ago|reply
1. Try the meds. View them as a crutch on your road to recovery, not a cure all. You have to retrain your mind to see the positives in life. The drugs may help, they might not, but at the end of the day you are the one that determines if you are happy. 2. Try mindfulness meditation. TL;DR is go to quiet spot, close your eyes, breath in and out, and focus on just breathing deeply. Longer link at the bottom. Lots of good books out there too. 3. Everyone dies eventually, so there is no need to rush there. Push yourself to enjoy life, even if it if hard.

Good luck

[+] silent-h|11 years ago|reply
Take the meds. That's what helped me to stabilize. Expect that you need to try multiple anti depressants before you find one that helps you. Therapy comes after that. For me what you call logical advice didn't work until the medication kicked in.
[+] ctocoder|11 years ago|reply
Take the meds. The meds get you to a level of normalcy. The underlying issues causing depression can then be dealt with. But once you are diagnosed with severe depression its rare for your dr to take you off of the meds. Speaking from personal experience I have been on 20 mg of Lexapro for 10 years. When I am off for 4 months my depression comes roaring back so I stay on it and don't experiment with my brain anymore.
[+] drzaiusapelord|11 years ago|reply
I've posted this elsewhere before. I hope it helps.

The truth is there are no real fixes in our lives. Everything gets worn down. This is pretty much a central concept in many philosophies and religions through the ages. Fighting burn out, re-energizing, being unsatisfied for while, being satisfied for a while, etc is just going to happen to you. Work with it. But don't be short sighted to think "Oh its my career, if I was instead $some_other_job_youll_hate, things would be perfect."

Personally, I follow a lifestyle of relatively low materialism and focus on engaging experiences instead of chasing products or salaries. This mostly translates into traveling instead of buying. There's no way to win this game, you can only occasionally step off it. I also find side creative side projects help as they take my mind off work and remove work from the "fulfillment" side of my life. Who cares about bullshit at work when I have a robot to build at home or when Im trying to finish the game I'm writing or the basement remodeling I'm planning.

I also have a lot of success with meditation, being slightly more compassionate and tolerant (even of things I know are wrong), and living a slower paced/low drama life. I try to think about the right things, not the default things. I try to not let the world get to me. I'm not often good at it, but at least I'm cognizant of trying. DFW talks a bit about this here if you're interested:

https://www.youtube.com/watch?v=8CrOL-ydFMI

I found bringing these attitudes into my work life helped a lot. Its hard to explain, but I think when you get your ducks in a row in a general they naturally get in a row at work as well.