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What to Do When a Loved One Is Severely Depressed

312 points by johnny313 8y ago

weliketocode 8y ago
A friend of mine died last year in his 20s from related issues. It's unfortunate to see the events bringing it to light, but I'm glad to see the issue receiving greater public attention. In the US at least, suicides have been and continue to be much more prevalent than homicides.
- pm90 8y ago
  Its not just the US. Its widespread in India and spans different age groups as well: from destitute farmers to students from pretty wealthy families. And I'm sure in other countries as well... so yes I too am glad this is getting more attention.
questionsuch 8y ago
As much as I know all of these things, the attitude my loved one has has killed the love out of me. Constant negativity, agitation, it's just tiring. I just can't seem to not take it personal, and to have a mindset that it is the disease and not the person. I can't figure out how to start loving the person again.
- AnimalMuppet 8y ago
  Act in love, no matter how you feel. That takes emotional energy and strength. You have to find that somewhere other than out of that relationship.
  - snarfy 8y ago
    That's how you send yourself to therapy. How long do you put up the act for?
- howard941 8y ago
  What you just wrote had me wondering if my wife was posting to HN because I'm sure she too is also at the end of her rope dealing with my anxiety and depression. If your person is anything like me please resume the loving and know that in all likelihood you're not being intentionally wronged. We just aren't dealing with the black dog as well as we'd like or wish we could.
- serpix 8y ago
  Four years ago I was at this point. I talked with a number of psychologists and therapists about this. One of them said: "Have you wondered if your anxiety is really because of your relationship". And so began the steps to disengage and end the relationship. I don't regret it now. I could not and still cannot keep my empathy separate from the suffering of others. The alternative would have been to harden my emotions and become like a rock. My opinion is that depression does transfer and it is contagious. Just as laughter and joy is contagious. I choose my company wisely now and cannot bear to be around negativity anymore, it just catches and makes me numb to everything. I choose being sad and ecstatic even while they alternate to extreme highs and lows. I refuse to heal anyone anymore.
  - phkahler 8y ago
    Whatever anyone says about this, don't feel bad about it. We are not all the same - some can deal with it and some can not. Therapists actually have a high burn-out rate because listening to other peoples issues can get to them. It's great that you've established this boundary for yourself.
- ohtwenty 8y ago
  Have you considered going to a therapist yourself?
- DoreenMichele 8y ago
  If there are no children or other complications, I would not hesitate to leave. The relationship could be part of why the depression persists, and I don't mean that in a "it's your fault" kind of way. Some people just mix like oil and water. It is possible to leave in a nice way. My divorce followed telling him "I'm tired of hurting you. I'm tired of being hurt. I think we both really gave it our best. If we could do this dance, we would have figured it out by now. I want a divorce." He breathed a sigh of relief and agreed. We both cooperated in making it amicable and not a disaster for any involved party. Leaving doesn't have to be a case of abandonment or rejection. It can be a case of gently setting both parties free.
  - mhink 8y ago
    Thank you so much. I’m gonna need this way of explaining things very soon, it’s been eating me up inside.
kyleperik 8y ago
Great article, but what is this about? Is this really true? > But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background.
- Klathmon 8y ago
  Sadly yes. I honestly don't have any numbers to backup my feelings, but I know that a lot of people truly fear the police, and possibly for good reasons. A while ago we had to call the police on a loved one that we were fearing was suicidal. By the end of the whole night the only thing that happened was the loved one was stuck with a rather large hospital bill as they were admitted (then discharged the next day), and they were cited for having the registration of their car be several months past due BY the cops that were sent to their house. There are also countless stories online of people (often minorities) calling police or having the police called for them, but they end up getting injured or even killed in the process. There are also reports of cops entering the house of someone that was reported as suicidal with their guns drawn... Not to mention that with drug laws in the US, someone with contraband or illegal drugs in their house or on their person might be risking everything just interacting with police. I don't really want to get into the debate about how police should act, or a debate about guns or laws or racism or what is warranted or not or drug laws or whatever else right now, but I do want to point out that for some people, the police might be more of a "threat" than help. And even if statistically the police aren't that likely to hurt someone, the frequency that it's happening and the growing resentment on both "sides" can make it so that many people will want to attempt other solutions before involving police.
  - kyleperik 8y ago
    Honestly I wasn't trying to start any sort of debate either, I just didn't know that was really something people have to be aware of. That's very sad. I feel bad not knowing that's the way things are now.
    - Klathmon 8y ago
      It's absolutely not like that everywhere, or for everyone, but for many it's a real problem, and it's not one that has an easy solution. And I'm kind of upset that your comment is getting downvoted so much, as it's a very valid question. Growing up I was taught to trust the police, that if something was wrong to go to them and they will help, that they were safe and would protect me. But at this point in my life I'm honestly not sure if I would teach the same to my children. And that thought terrifies me because I honestly can't think of a scenario where these kinds of feelings end well for society in general.
caio1982 8y ago
"Remember, people do recover from depression" That IMHO seems to be as much of a taboo as having depression itself for a lot of people... it's hard to convince someone that depression is seriously real, and equally hard to convince people [affected by their loving one's] depression is not like terminal cancer.
- Liquix 8y ago
  So true. Our minds don't just influence how we see the world around us - they create the subjective realities which we all inhabit. If you keep telling yourself 'there is no way I can do X', it becomes reality. Empirical evidence has indeed proven that there are many cases of depression which are rooted in chemical imbalances or physical abnormalities and can't be cured by shifting one's thinking patterns. But that represents a portion, not a rule or even a majority of cases. It's frustrating and saddening to try and help someone when they deeply believe that they can't be helped.
- agumonkey 8y ago
  Depression fucks with your interpretation of reality, the distortion seems impossible to 1) not be true, 2) restored. It's indeed possible to get near normal, but it's very hard to convey to someone in such pains. Rationality also goes out of the window when emotion storms strike. Even though I knew that the previous day I was alright, if the next I go down, it's not always enough to help me go through the bad times. ps: also give pills a chance, they might not work, but it might lessen your load tremendously and avoid further damage.
  - astine 8y ago
    The depressed are hard to convince because they are depressed. The friends and family of the depressed are hard to convince because they are ignorant.
- weego 8y ago
  Recovery is just another step in the process. You don't forget what it's like to start to suffocate in the abyss. You don't forget what it's like to know that dying is easier than any other option available to you and that it's a blink of an eye away. It scars you
spdustin 8y ago
I feel like this should be left here: Everybody you meet has a secret smile, and a secret pain. If your secret pain feels like a weight you can no longer carry, please talk to someone. Anyone. Lay down your burdens, and give your shoulders a rest. If you're in the US, there's the National Suicide Prevention Hotline: 1-800-273-8255 LGBT folks in the US might also consider The Trevor Project Lifeline: 1-866-488-7386 I don't know about international numbers or other region- or culture-specific services; perhaps others can reply with the ones they're aware of.
- astockwell 8y ago
  UK: 116 123
- oceanghost 8y ago
  > Everybody you meet has a secret smile, and a secret pain. Star Trek V! Sybok: Let us explore it together. Each man hides a secret pain. It must be exposed and reckoned with. It must be dragged from the darkness and forced into the light. Share your pain. Share your pain with me, and gain strength from the sharing.
  - phkahler 8y ago
    Sometimes the pain is a secret even from the person harboring it. IMO this is the basis for some PDs.
    - oceanghost 8y ago
      I never really believed in Freudian stuff until my first wife. Her subconscious was a monster.
      - phkahler 8y ago
        That's part of the stigma. Some of the concepts and models sound goofy (crazy) to those who haven't experienced it. Freud though... I'm not impressed with him in the slightest.
rjurney 8y ago
It is unfortunate that stigma around mental illness causes most people to view psychiatric hospitals as places to avoid at all cost, as they have a stigma so terrible going to one is like dying multiple deaths. After that you're 'legally' crazy (whatever the fuck that means)! In fact, if you need one, if you are severely depressed or hallucinating, a hospital is exactly the place for you. You will most likely love it there. They can help. They can really help. Everyone gets better in the hospital. Everyone. Not "1/3 get better, 1/3 stay the same, 1/3 get worse." Everyone in that sheltered environment rapidly improves. It is a vacation for the mind. The question then becomes staying out of the hospital. Many people come back every few years, get to know the staff quite well, etc. Others develop a plan to address mounting depression early through ongoing treatment, partial hospitalization, etc.
- deleted 8y ago
  [deleted]
- tptacek 8y ago
  I wish this were the case, but "vacation for the mind" is not a good description for the hospitalizations I've been a party to (and have had to work to get people out of). Hospitalization is better than physical harm and is an appropriate response to an acute crisis, but our acute mental health care system in the US is very problematic. I think it's important to be clear that there are interventions that work that precede crisis hospitalizations, and that even if hospitalization is the right call, you can improve the experience by getting people connected with a good doctor first. The belief --- not irrational --- that there's no available intervention other than psychiatric lock up is a part of the problem for some people.
  - rjurney 8y ago
    Partial hospitalization would be way preferable, but that generally requires more engagement on the part of the depressed than "show up and say you're gonna kill yourself."
- rjpr 8y ago
  Personally I'd avoid them at all costs due to the loss of control. You can't just decide "I'm done" or "I don't like it here", you getting released is at the discretion of people that you don't even know.
mhkl 8y ago
What I did is watch the 8 hour docuseries at www.brokenbrain.com and learn from 50 doctors what the various causes are and how to treat these caused. It did help me a lot to understand depression but my depressed son does not want to watch the docuseries. Sigh.
- ajkjk 8y ago
  Why should he want to? When I was very depressed I would have hated nothing more than being made to watch 8 hours of something meaningless to me. What helps (I would think) with depression would be things like "fitting in", "feeling valid", "feeling purpose", "not feeling shame", ""not having social anxiety", "sleeping well", "being fit", "having a healthy community", "having fulfilling hobbies", "having a healthy friend group", "having healthy family relationships". not "knowing more about how depression works".
  - gowld 8y ago
    You listed a pile of goals, not tools. Understanding how depression works can be a tool.
    - ajkjk 8y ago
      I'm not saying that a depressed person wouldn't want to understand how depression works, just that they don't necessarily want to, and it's wrong to be annoyed that they don't.
      - ajkjk 8y ago
        Addendum: I also don't believe that doctors really talk what the 'various causes are'. I've been depressed, very much so, and I've read books that summarize scientific reading about depression like The Upward Spiral[0], and I feel like they miss the point, somehow. Like: we're great at finding treatments and things that work for individual people, but I sort-of think that the problem with depression is fundamentally everyone else, ie, 'society is sick', and we treat it as a personal problem because well of course doctors can't prescribe fixes to society, but they can for a person, so it's all stopgaps that don't address the "real problem". I think that often depressed people have an idea of this -- that it is the existence around them that is sick, somehow -- and so no amount of suggestions (which indeed might actually help) quite gets to the bottom of that because it is the world that is fundamentally wrong. (Or specifically it is the nature of how they currently fit into the world.) From a treatment standpoint yes of course they should do the things that will probably help them, and people around them should be empowered to get them to do the things that will help them. But for the person that is struggling that really doesn't feel like the answer, and I think that they're not wrong. (By 'society is sick' I mean that the person does not, for whatever reason, exist in the mentally healthy setting that their brain was 'designed' to exist in -- a healthy community, the right kinds of relationships, the emotional mentors and sources of wisdom that provide the right kinds of useful guidance, a body that works the way that it's supposed to, physically and mentally, etc; and a world around them that makes sense, that they can feasibly cope with, which is exactly the opposite of the nihilism induced by news of politics and global tragedies.) [0]: (https://smile.amazon.com/Upward-Spiral-Neuroscience-Reverse-Depression/dp/1626251207 https://smile.amazon.com/Upward-Spiral-Neuroscience-Reverse-...)
brownkonas 8y ago
Not sure if this is substantiated or refuted by any clinical research, but through experience I believe depression to be a side effect of the mind being absent any existential threats that would, as an animal, threaten your survival on a daily basis: searching for food, maintaining shelter, guarding yourself or each other from predators. As we become farther and farther away our primal origins, the mind needs to invent challenges, obstacles and worry.
- cpncrunch 8y ago
  I'm not sure if it's as simple as lack of existential threats, but I'd agree that it is important to have a purpose in life, and a daily routine, and research backs this up. It's also important to rule out any life stressors that could be causing the depression, such as an unrewarding/stressful job, or living somewhere that you don't want to be.
- mikec3010 8y ago
  That's one theory. Another is that our society has so many more intangible responsibilities, obligations, serious decisions, and opportunities for failure (oh and consequences, every single action through out the day brings consequences that our minds are overloaded and constantly anxious. And research has found that anxiety and depression are tightly linked.
- oldgeezr 8y ago
  It's an interesting way of looking things. Depression is as complex as the brain which produces it, however. This may be a part of it, but there are many pieces in that puzzle.
danschumann 8y ago
One thing that helped me was seeing depressed thoughts as transient entities, not belonging to me, but just passing through my mind once and a while. It's like a weird dream. If you have a weird dream, you don't think, "oh I'm weird", you think, "that was a weird dream". It's the same with depressed thoughts: if you see them as "oh that's a depressing thought", rather than, "I'm depressing", then it's easier for those thoughts to go away. (usually when your blood sugar goes up or something like that)
- tkxxx7 8y ago
  This is very important. One of the first steps of recovery is refusing to identify with depressive thoughts.
  - serpix 8y ago
    also the first steps to enlightenment. Applies to all thoughts and emotions.
- rhcom2 8y ago
  I look at it like my brain is lying to me. "Hey, you want to die" ... "No I don't brain, you're full of shit."
- emptybits 8y ago
  FWIW, this is a common paradigm taught by instructors of meditation. That is, thoughts in general are transient and not something to necessarily identify as "me" nor to assign undue importance. Notice thoughts come and go and return to the breath. I am not qualified to suggest that meditation is beneficial specifically for depression, but I think there is sufficient evidence to advise the practice in general.
- cecilpl2 8y ago
  This is a great tactic for ridding yourself of any unwanted thoughts. Learn to see them as "other" or a "mindvirus", not part of you. Learning to identify myself with the aspects of myself that I like has helped me in nearly every facet of my life.
viburnum 8y ago
Good stuff, but I've learned the hard way that most therapists have no idea what they're doing. If someone is not feeling better after 6-8 sessions, they need to get a new therapist. It's all too easy to get into a codependent relationship with a therapist that only enables the depression or anxiety to persist.
- astura 8y ago
  I had a therapist that once suggested taking herbs for an non-treatable medical issue and another time antibiotics for a cold. I can't believe I actually paid money to see her.
  - lazyasciiart 8y ago
    I had a therapist once who suggested that my anxiety was the product of excessively high expectations, and I would feel better if I stopped expecting colleagues to do things like tell the truth. I quit therapy, and also quit that job. I felt much better after doing both!
    - chris_wot 8y ago
      So you essentially stopped having high expectations of your therapist and consequently stopped paying her :-)
      - lazyasciiart 8y ago
        Yes, and I suppose if I'd had the option of stopping the company from paying my colleagues I would have been fine with stopping my expectations of them as well :)
  - fjsolwmv 8y ago
    Why are you discussing a cold or antibiotics with a therapist anyway? They can't prescribe drugs.
    - 8y ago
resource0x 8y ago
One great man's account of dealing with depression (the term hadn't been invented yet at the time of writing, but you will recognize the symptoms) https://www.goodreads.com/book/show/26244.A_Confession https://www.goodreads.com/book/show/26244.A_Confession Download: http://manybooks.net/titles/tolstoylother08a_confession.html http://manybooks.net/titles/tolstoylother08a_confession.html
metamet 8y ago
Someone close to me once shared this as the best representation of how depression feels to them. It was really helpful in helping me understand in a way that I hadn't been able to before. * http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-... * http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html http://hyperboleandahalf.blogspot.com/2013/05/depression-par...
mikec3010 8y ago
This is the quintessential video for understanding clinical depression. A Stanford lecture given by Dr Sapolsky: https://youtu.be/NOAgplgTxfc https://youtu.be/NOAgplgTxfc I highly recommend watching it to better understand the disease.
- camel_Snake 8y ago
  Someone else (maybe it was you) shared this recently on hn and I watched it and don't regret a single minute. Insanely informative and the style of presentation where one covers the history of our understanding of a topic is possibly my favorite.
- su30mki117 8y ago
  That's a great video, but I think it's from 2011. I recently came across another video from 2016 which is a bit more technical and sheds some light on the results of recent research. People interested should definitely give it a watch - https://www.youtube.com/watch?v=BZbunmaU-60 https://www.youtube.com/watch?v=BZbunmaU-60
mendelsd 8y ago
Ensure they are getting adequate folate, noting that normal blood levels may not indicate functional sufficiency [1][2]: "Folate deficiencies may lead to an increased risk of depression and poorer antidepressant treatment outcomes..." "...deficiencies may be caused by improper absorption and utilization, often due to genetic polymorphisms." "Supplementation with the active form of folate, (methylfolate), which is more readily absorbed, may be effective in the prevention and treatment of both depression and dementia." "...(methylfolate) indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels..." [1] https://www.ncbi.nlm.nih.gov/pubmed/19909688 https://www.ncbi.nlm.nih.gov/pubmed/19909688 [2] https://www.ncbi.nlm.nih.gov/pubmed/17900207 https://www.ncbi.nlm.nih.gov/pubmed/17900207
- ridgeguy 8y ago
  Yes. There is a subset of patients with depression who have either of two different genetic polymorphisms for methyeneltetrahydrofolate reductase. This may be causally linked to their depression. [1] Supplementing diet with a modified form of folate appears to diminish depression in patients with these particular polymorphisms. My understanding is that this is still a matter of controversy. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/
  - mendelsd 8y ago
    A few interesting things to note on this topic: 1) Prevalence of MTHFR gene variants you refer to is very high, e.g. 10%/50% for homo/heterozygous C677T SNP [1] (with frequencies varying substantially between ethnic groups). 2) Effects tend to be stronger with two copies of a variant (homozygous), but a single copy (heterozygous) may still be a concern, e.g. for C677T: "Individuals with the 677TT genotype, have approximately 30% the MTHFR enzyme activity of those with the 677CC genotype, whereas heterozygotes 677CT have around 65% of enzymatic activity" [2] 3) It seems odd to me that pharmacological dosages of folate are getting prescribed (I mean, it's a nutrient so why take it in doses that exceed the nutritional range?): "The most active form of folate has recently been approved in the United States as a prescription medical food for depressed patients with folate deficiency. Doses are usually 7.5 to 15 mg/d". [3] "Another concern is that folate doses > 800 μg/d can result in high levels of unmetabolized serum folic acid, reducing the amount of brain l-methylfolate and leading to decreased monoamines, an outcome that potentially increases the risk of or exacerbates depression." [3] Folate RDA is 400-800 μg/d depending on pregnancy status [4] [1] https://www.ncbi.nlm.nih.gov/pubmed/28847029 https://www.ncbi.nlm.nih.gov/pubmed/28847029 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6 [3] https://www.ncbi.nlm.nih.gov/pubmed/19909688 https://www.ncbi.nlm.nih.gov/pubmed/19909688 [4] https://www.mayoclinic.org/drugs-supplements-folate/art-20364625 https://www.mayoclinic.org/drugs-supplements-folate/art-2036...
dkrich 8y ago
I was thinking about this this morning and couldn't help but notice the apparent correlation between high profile people who have committed suicide recently and their profiles. All from arts/creative fields (Avicii, Kate Spade, Bourdain, Robin Williams, Heath Ledger, I'm sure there are more). Is there any scientific research that has explored the possibility that the wiring in the brain that makes people creative has a propensity for depression? Of course the sample size is small and could be selection bias, but would like to hear from people who are knowledgeable on the topic.
- Smudge 8y ago
  Doesn't really answer your questions, but I'd point out that it's possible that we only hear about these suicides precisely _because_ they are from professions that tend to produce high-profile celebrities. I'd counter your apparent correlation with the fact that apparently suicide among doctors is extremely high: https://www.washingtonpost.com/national/health-science/what-ive-learned-from-my-tally-of-757-doctor-suicides/2018/01/12/b0ea9126-eb50-11e7-9f92-10a2203f6c8d_story.html https://www.washingtonpost.com/national/health-science/what-...
  - danso 8y ago
    Is's a common convention in newspaper obituaries and articles to not mention cause of death as suicide, except in newsworthy situations. Covering suicides in general were somewhat taboo unless they involved someone noteworthy: https://www.poynter.org/news/reporting-suicide https://www.poynter.org/news/reporting-suicide
  - dempseye 8y ago
    That doesn't counter it, though. It could be true that "the wiring in the brain that makes people creative" increases the risk of depression while also being true that there are other things that increase it too. Your comment also implies that whatever that wiring is, doctors don't have it, and I don't know if that is an assumption we should make.
  - DanBC 8y ago
    The suicide rate in doctors is not higher than the general population. Suicide is common. There are lots of doctors. Some doctors die by suicide.
slx26 8y ago
this is a very sensible article. kudos to nytimes and the writer. we also need this kind of advice on tv, schools, etc. a better general understanding of depression by society as a whole is not only one of the best tools we have to deal with it, but also a great way to start building a better society
rectang 8y ago
I'm uncomfortable with the idea that someone who is in agony must be kept alive at all costs.
- backpropaganda 8y ago
  I used to think like this, but not any more. The agony is temporary. The not being alive is permanent. It's an irrational suboptimal decision that they would regret 2 years later. It makes sense to help them. It's like helping your friend quit smoking. They will be agonized for a few months, but eventually will get out of the addiction and be thankful.
  - rectang 8y ago
    I agree that in general that is the right approach. However, some people suffer with chronic depression for their entire lives. What makes me uncomfortable is that no exceptions are ever allowed. Every sufferer must continue to stay alive indefinitely no matter how much pain they are in. I understand why this idea will forever be taboo, but it still bothers me.
- phil248 8y ago
  Depression can be effectively treated. It is not the same as terminal illnesses that are often covered by right to die laws.
- mmt 8y ago
  This seems a bizarrely simplistic (or incomplete) statement. It needs at least an adjective in front of "agony". I don't expect you're suggesting euthanizing someone with acute appendicitis or a severe cluster headache.
  - rectang 8y ago
    For the purposes of constructive discussion I don't mind qualifying "agony" with "enduring", so to limit scope to those with chronic, untreatable depression. But the original statement is an honest representation of my thoughts. ETA: At the same time, it's important to recognize that suicides inflict dramatically more pain on those left behind than other causes of death.
chris_wot 8y ago
I am an Australian. You must NOT take your loved one to an ED if they mention they have had suicidal thoughts. You simply cannot trust that they will be treated with respect and dignity. Two and a bit years ago I was having suicidal thoughts. I had an episode and left the house in distress, but eventually arrived back home where my wife comforted me and my suicidal thoughts went away, and yet I was ripped from my bed and taken to hospital where I was thrown into a seclusion room for five and a half hours. There is no clinical documentation, I’m not in the seclusion register, there was no explanation given, I wasn’t assessed until hours later someone turned up, said I was fine and not only did I leave the room - I left the hospital! The authorities do not care, they leave you powerless, stripped of your dignity and autonomy and in some cases your life can be at risk. The following review was done last year by the NSW Chief Psychiatrist and it is absolutely damning: http://www.health.nsw.gov.au/patients/mentalhealth/Documents/report-seclusion-restraint-observation.pdf http://www.health.nsw.gov.au/patients/mentalhealth/Documents... I have been trying to get justice and answers for two and a half years. I went to the body who is meant to investigate these matters after the health service denied I was even in seclusion, they did nothing. The Hospital has now acknowledged I was in seclusion. They have literally just now started to find out about my lack of clinical records it’s, but they don’t think they’ll ever find out who threw me in that room. I now have severe PTSD, completely distrust the medical profession and will never speak of suicide to any medical professional ever again, and I strongly believe that anyone who does so takes a grave risk of being abused or mistreated by uncaring “professionals” who act more like jailers than carers. Certainly an ED is the very last place you want to go to - they simply do not care about depressed or suicidal people and you will almost certainly be thrown into a psych ward. Your rights will be servely curtailed, your decision making ignored and removed and it can be very hard to get out of such places.
jMyles 8y ago
I started reading with a lot of interest, but this line caused me to close the window: > In some cases, calling 911 may be the best option. It seems so tone-deaf. More accurate is: > In cases where life is at stake, consider calling 911, but if you do, know that police will likely respond first and may not be trained to deal with a mental health crisis. In some cases, people have been brutalized or even killed after seeking help from poorly trained law enforcement.
- kortex 8y ago
  We need a civilian-life equivalent of Rangers from the burner community. > Rangers act as non-confrontational community mediators, providers of reliable information, facilitators of public safety, and navigators of the edge of chaos. And/or, train police in these techniques. More empathy and patience, less judgement.
- phailhaus 8y ago
  If only you had continued reading one more sentence! > But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background. In cases where you’re concerned that calling police could put a person in danger, try to come up with an alternate plan in advance.
  - jMyles 8y ago
    Indeed you're right. I can't believe I missed that sentence, and I agree that it does a lot to address my concerns.
depressed_394 8y ago
I really don't want to be asked if I'm having suicidal thoughts. Ever. By anyone. If I say yes, someone might try to "help" me by having me confined to a psychiatric hospital. Or worse. Having to lie about it is unpleasant. I have suicidal thoughts regularly, but I am not going to act on them. From most objective standards, my life is generally good. I've never had problems getting dates - at least once I got the courage to try, though long term relationships are hard. I have a job I like and find fulfilling. I'm well on my way to having "fuck you money". Still depressed. Since childhood (25+ years) I've been taking antidepressants. Have changed them a few times, though not for many years. They allow me to be mostly functional most of the time. Switching now might put me in a hole I can't get myself out of. Talk therapy has never really helped me. I don't really have any hope left of ever not being depressed. I've thought about trying psychedelics or ketimine therapy, but can't really find the motivation to do anything. Fuck depression.
xivzgrev 8y ago
I have struggled with depression for over half of my life. This sentence really struck me: "If you want to say something positive, focus on highlighting what he means to you". I teared up because it is so true. Give it a try if someone you love has depression.
braindongle 8y ago
As a person who has experience with severe depression, studying evidence-based psychiatry, and conducting psychiatric services research, I wholeheartedly endorse the advice in this piece.
0xcde4c3db 8y ago
> A severely depressed friend needs professional assistance from a psychologist, psychiatrist, social worker or another medical professional. This is an example of a troubling pattern often seen when talking about "depression". Depressed mood can be a symptom of numerous medical conditions. That means you need to write down all observed symptoms and see a doctor to diagnose or rule out those conditions. It's a bad idea to jump straight to psychology or psychiatry just because your most distressing symptoms are psychological. It's an especially bad idea to get committed to a psychiatric hospital with an undiagnosed chronic condition that psychiatrists don't specialize in treating.
whitepoplar 8y ago
A couple things that helped me when I was severely depressed and suicidal: 1) I can kill myself, at any time, if I want to. I'm in control and nobody can take that away. Paradoxically, understanding that made me feel better, because if I know I can do it at any time, why do it now? May as well wait a little while. 2) Make a checklist of essential tasks and get into a habit of doing those things no matter what. Some examples: shower, brush teeth, floss, use mouthwash, clip nails, walk 10k steps, do dishes, make bed etc. Check them off. It doesn't matter what's on the list, but it is important to check off 100% of the items each day. Put every small task you can think of on this list and you'll feel good when you check each of them off. 3) Take a good multivitamin + vitamin D 4) Eat healthier. Fresh steamed spinach and wild salmon always made me feel a little better for whatever reason. 5) Get out of the house! Walk! This is really important. 6) Go to the gym. Aim for at least a couple minutes of sprints per day (I like the rowing machine for this). Sprints are holy time in that suicidal thoughts will completely disappear, if only for those few minutes. 7) Walk through a dangerous part of town. Nothing gets rid of depressive thoughts faster than rising blood pressure and a fast heartbeat. 8) Get rid of as much decision-making as possible in your life. Turn decisions into mechanical rules. e.g. don't think "do i want to brush my teeth today?" You need to brush your teeth in order to cross it off your list. 9) Sleep will naturally improve on its own, over time, if you exercise, move around, and eat healthier, so don't worry if you currently have trouble sleeping. 10) This book is pretty good, but only read after you've eaten healthy, gone outside, and exercised: https://www.amazon.com/Guide-Good-Life-Ancient-Stoic/dp/0195374614 https://www.amazon.com/Guide-Good-Life-Ancient-Stoic/dp/0195... What didn't work for me was: thinking about all the people i'd hurt, calling a hotline, any decision-making that wasn't mechanical and required reasoning, insight, or motivation. If you're suicidal right now, start by putting some shoes on, going outside, and sprinting until you can't breathe anymore. Do this 3 times.
beegeezuz 8y ago
Depression is like a powerful spell, no matter what you do you know you can't beat it until it's done doing its thing. Best thing you can possibly do is give them direction. Tell them what to do, keep them occupied all the time! I get serious depression once or twice a year and even though I know what's going on I have no control over it and I'm always afraid I might do something radical which I might regret later. Unfortunately I live alone, but I wish I had someone to take control of me during those phases of depression. Someone to keep telling me what to do and keep a tab on me making sure I do all those things until I get well again. Don't be sympathetic, be a guide.

312 points by johnny313 8y ago

A friend of mine died last year in his 20s from related issues. It's unfortunate to see the events bringing it to light, but I'm glad to see the issue receiving greater public attention. In the US at least, suicides have been and continue to be much more prevalent than homicides.

pm90 8y ago
Its not just the US. Its widespread in India and spans different age groups as well: from destitute farmers to students from pretty wealthy families. And I'm sure in other countries as well... so yes I too am glad this is getting more attention.

questionsuch 8y ago

As much as I know all of these things, the attitude my loved one has has killed the love out of me. Constant negativity, agitation, it's just tiring. I just can't seem to not take it personal, and to have a mindset that it is the disease and not the person. I can't figure out how to start loving the person again.

AnimalMuppet 8y ago
Act in love, no matter how you feel. That takes emotional energy and strength. You have to find that somewhere other than out of that relationship.
- snarfy 8y ago
  That's how you send yourself to therapy. How long do you put up the act for?
howard941 8y ago
What you just wrote had me wondering if my wife was posting to HN because I'm sure she too is also at the end of her rope dealing with my anxiety and depression. If your person is anything like me please resume the loving and know that in all likelihood you're not being intentionally wronged. We just aren't dealing with the black dog as well as we'd like or wish we could.
serpix 8y ago
Four years ago I was at this point. I talked with a number of psychologists and therapists about this. One of them said: "Have you wondered if your anxiety is really because of your relationship". And so began the steps to disengage and end the relationship. I don't regret it now. I could not and still cannot keep my empathy separate from the suffering of others. The alternative would have been to harden my emotions and become like a rock. My opinion is that depression does transfer and it is contagious. Just as laughter and joy is contagious. I choose my company wisely now and cannot bear to be around negativity anymore, it just catches and makes me numb to everything. I choose being sad and ecstatic even while they alternate to extreme highs and lows. I refuse to heal anyone anymore.
- phkahler 8y ago
  Whatever anyone says about this, don't feel bad about it. We are not all the same - some can deal with it and some can not. Therapists actually have a high burn-out rate because listening to other peoples issues can get to them. It's great that you've established this boundary for yourself.
ohtwenty 8y ago
Have you considered going to a therapist yourself?
DoreenMichele 8y ago
If there are no children or other complications, I would not hesitate to leave. The relationship could be part of why the depression persists, and I don't mean that in a "it's your fault" kind of way. Some people just mix like oil and water. It is possible to leave in a nice way. My divorce followed telling him "I'm tired of hurting you. I'm tired of being hurt. I think we both really gave it our best. If we could do this dance, we would have figured it out by now. I want a divorce." He breathed a sigh of relief and agreed. We both cooperated in making it amicable and not a disaster for any involved party. Leaving doesn't have to be a case of abandonment or rejection. It can be a case of gently setting both parties free.
- mhink 8y ago
  Thank you so much. I’m gonna need this way of explaining things very soon, it’s been eating me up inside.

kyleperik 8y ago

Great article, but what is this about? Is this really true? > But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background.

Klathmon 8y ago
Sadly yes. I honestly don't have any numbers to backup my feelings, but I know that a lot of people truly fear the police, and possibly for good reasons. A while ago we had to call the police on a loved one that we were fearing was suicidal. By the end of the whole night the only thing that happened was the loved one was stuck with a rather large hospital bill as they were admitted (then discharged the next day), and they were cited for having the registration of their car be several months past due BY the cops that were sent to their house. There are also countless stories online of people (often minorities) calling police or having the police called for them, but they end up getting injured or even killed in the process. There are also reports of cops entering the house of someone that was reported as suicidal with their guns drawn... Not to mention that with drug laws in the US, someone with contraband or illegal drugs in their house or on their person might be risking everything just interacting with police. I don't really want to get into the debate about how police should act, or a debate about guns or laws or racism or what is warranted or not or drug laws or whatever else right now, but I do want to point out that for some people, the police might be more of a "threat" than help. And even if statistically the police aren't that likely to hurt someone, the frequency that it's happening and the growing resentment on both "sides" can make it so that many people will want to attempt other solutions before involving police.
- kyleperik 8y ago
  Honestly I wasn't trying to start any sort of debate either, I just didn't know that was really something people have to be aware of. That's very sad. I feel bad not knowing that's the way things are now.
  - Klathmon 8y ago
    It's absolutely not like that everywhere, or for everyone, but for many it's a real problem, and it's not one that has an easy solution. And I'm kind of upset that your comment is getting downvoted so much, as it's a very valid question. Growing up I was taught to trust the police, that if something was wrong to go to them and they will help, that they were safe and would protect me. But at this point in my life I'm honestly not sure if I would teach the same to my children. And that thought terrifies me because I honestly can't think of a scenario where these kinds of feelings end well for society in general.

caio1982 8y ago

"Remember, people do recover from depression" That IMHO seems to be as much of a taboo as having depression itself for a lot of people... it's hard to convince someone that depression is seriously real, and equally hard to convince people [affected by their loving one's] depression is not like terminal cancer.

Liquix 8y ago
So true. Our minds don't just influence how we see the world around us - they create the subjective realities which we all inhabit. If you keep telling yourself 'there is no way I can do X', it becomes reality. Empirical evidence has indeed proven that there are many cases of depression which are rooted in chemical imbalances or physical abnormalities and can't be cured by shifting one's thinking patterns. But that represents a portion, not a rule or even a majority of cases. It's frustrating and saddening to try and help someone when they deeply believe that they can't be helped.
agumonkey 8y ago
Depression fucks with your interpretation of reality, the distortion seems impossible to 1) not be true, 2) restored. It's indeed possible to get near normal, but it's very hard to convey to someone in such pains. Rationality also goes out of the window when emotion storms strike. Even though I knew that the previous day I was alright, if the next I go down, it's not always enough to help me go through the bad times. ps: also give pills a chance, they might not work, but it might lessen your load tremendously and avoid further damage.
- astine 8y ago
  The depressed are hard to convince because they are depressed. The friends and family of the depressed are hard to convince because they are ignorant.
weego 8y ago
Recovery is just another step in the process. You don't forget what it's like to start to suffocate in the abyss. You don't forget what it's like to know that dying is easier than any other option available to you and that it's a blink of an eye away. It scars you

spdustin 8y ago

I feel like this should be left here: Everybody you meet has a secret smile, and a secret pain. If your secret pain feels like a weight you can no longer carry, please talk to someone. Anyone. Lay down your burdens, and give your shoulders a rest. If you're in the US, there's the National Suicide Prevention Hotline: 1-800-273-8255 LGBT folks in the US might also consider The Trevor Project Lifeline: 1-866-488-7386 I don't know about international numbers or other region- or culture-specific services; perhaps others can reply with the ones they're aware of.

astockwell 8y ago
UK: 116 123
oceanghost 8y ago
> Everybody you meet has a secret smile, and a secret pain. Star Trek V! Sybok: Let us explore it together. Each man hides a secret pain. It must be exposed and reckoned with. It must be dragged from the darkness and forced into the light. Share your pain. Share your pain with me, and gain strength from the sharing.
- phkahler 8y ago
  Sometimes the pain is a secret even from the person harboring it. IMO this is the basis for some PDs.
  - oceanghost 8y ago
    I never really believed in Freudian stuff until my first wife. Her subconscious was a monster.
    - phkahler 8y ago
      That's part of the stigma. Some of the concepts and models sound goofy (crazy) to those who haven't experienced it. Freud though... I'm not impressed with him in the slightest.

rjurney 8y ago

It is unfortunate that stigma around mental illness causes most people to view psychiatric hospitals as places to avoid at all cost, as they have a stigma so terrible going to one is like dying multiple deaths. After that you're 'legally' crazy (whatever the fuck that means)! In fact, if you need one, if you are severely depressed or hallucinating, a hospital is exactly the place for you. You will most likely love it there. They can help. They can really help. Everyone gets better in the hospital. Everyone. Not "1/3 get better, 1/3 stay the same, 1/3 get worse." Everyone in that sheltered environment rapidly improves. It is a vacation for the mind. The question then becomes staying out of the hospital. Many people come back every few years, get to know the staff quite well, etc. Others develop a plan to address mounting depression early through ongoing treatment, partial hospitalization, etc.

deleted 8y ago
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tptacek 8y ago
I wish this were the case, but "vacation for the mind" is not a good description for the hospitalizations I've been a party to (and have had to work to get people out of). Hospitalization is better than physical harm and is an appropriate response to an acute crisis, but our acute mental health care system in the US is very problematic. I think it's important to be clear that there are interventions that work that precede crisis hospitalizations, and that even if hospitalization is the right call, you can improve the experience by getting people connected with a good doctor first. The belief --- not irrational --- that there's no available intervention other than psychiatric lock up is a part of the problem for some people.
- rjurney 8y ago
  Partial hospitalization would be way preferable, but that generally requires more engagement on the part of the depressed than "show up and say you're gonna kill yourself."
rjpr 8y ago
Personally I'd avoid them at all costs due to the loss of control. You can't just decide "I'm done" or "I don't like it here", you getting released is at the discretion of people that you don't even know.

mhkl 8y ago

What I did is watch the 8 hour docuseries at www.brokenbrain.com and learn from 50 doctors what the various causes are and how to treat these caused. It did help me a lot to understand depression but my depressed son does not want to watch the docuseries. Sigh.

ajkjk 8y ago
Why should he want to? When I was very depressed I would have hated nothing more than being made to watch 8 hours of something meaningless to me. What helps (I would think) with depression would be things like "fitting in", "feeling valid", "feeling purpose", "not feeling shame", ""not having social anxiety", "sleeping well", "being fit", "having a healthy community", "having fulfilling hobbies", "having a healthy friend group", "having healthy family relationships". not "knowing more about how depression works".
- gowld 8y ago
  You listed a pile of goals, not tools. Understanding how depression works can be a tool.
  - ajkjk 8y ago
    I'm not saying that a depressed person wouldn't want to understand how depression works, just that they don't necessarily want to, and it's wrong to be annoyed that they don't.
    - ajkjk 8y ago
      Addendum: I also don't believe that doctors really talk what the 'various causes are'. I've been depressed, very much so, and I've read books that summarize scientific reading about depression like The Upward Spiral[0], and I feel like they miss the point, somehow. Like: we're great at finding treatments and things that work for individual people, but I sort-of think that the problem with depression is fundamentally everyone else, ie, 'society is sick', and we treat it as a personal problem because well of course doctors can't prescribe fixes to society, but they can for a person, so it's all stopgaps that don't address the "real problem". I think that often depressed people have an idea of this -- that it is the existence around them that is sick, somehow -- and so no amount of suggestions (which indeed might actually help) quite gets to the bottom of that because it is the world that is fundamentally wrong. (Or specifically it is the nature of how they currently fit into the world.) From a treatment standpoint yes of course they should do the things that will probably help them, and people around them should be empowered to get them to do the things that will help them. But for the person that is struggling that really doesn't feel like the answer, and I think that they're not wrong. (By 'society is sick' I mean that the person does not, for whatever reason, exist in the mentally healthy setting that their brain was 'designed' to exist in -- a healthy community, the right kinds of relationships, the emotional mentors and sources of wisdom that provide the right kinds of useful guidance, a body that works the way that it's supposed to, physically and mentally, etc; and a world around them that makes sense, that they can feasibly cope with, which is exactly the opposite of the nihilism induced by news of politics and global tragedies.) [0]: (https://smile.amazon.com/Upward-Spiral-Neuroscience-Reverse-Depression/dp/1626251207 https://smile.amazon.com/Upward-Spiral-Neuroscience-Reverse-...)

brownkonas 8y ago

Not sure if this is substantiated or refuted by any clinical research, but through experience I believe depression to be a side effect of the mind being absent any existential threats that would, as an animal, threaten your survival on a daily basis: searching for food, maintaining shelter, guarding yourself or each other from predators. As we become farther and farther away our primal origins, the mind needs to invent challenges, obstacles and worry.

cpncrunch 8y ago
I'm not sure if it's as simple as lack of existential threats, but I'd agree that it is important to have a purpose in life, and a daily routine, and research backs this up. It's also important to rule out any life stressors that could be causing the depression, such as an unrewarding/stressful job, or living somewhere that you don't want to be.
mikec3010 8y ago
That's one theory. Another is that our society has so many more intangible responsibilities, obligations, serious decisions, and opportunities for failure (oh and consequences, every single action through out the day brings consequences that our minds are overloaded and constantly anxious. And research has found that anxiety and depression are tightly linked.
oldgeezr 8y ago
It's an interesting way of looking things. Depression is as complex as the brain which produces it, however. This may be a part of it, but there are many pieces in that puzzle.

danschumann 8y ago

One thing that helped me was seeing depressed thoughts as transient entities, not belonging to me, but just passing through my mind once and a while. It's like a weird dream. If you have a weird dream, you don't think, "oh I'm weird", you think, "that was a weird dream". It's the same with depressed thoughts: if you see them as "oh that's a depressing thought", rather than, "I'm depressing", then it's easier for those thoughts to go away. (usually when your blood sugar goes up or something like that)

tkxxx7 8y ago
This is very important. One of the first steps of recovery is refusing to identify with depressive thoughts.
- serpix 8y ago
  also the first steps to enlightenment. Applies to all thoughts and emotions.
rhcom2 8y ago
I look at it like my brain is lying to me. "Hey, you want to die" ... "No I don't brain, you're full of shit."
emptybits 8y ago
FWIW, this is a common paradigm taught by instructors of meditation. That is, thoughts in general are transient and not something to necessarily identify as "me" nor to assign undue importance. Notice thoughts come and go and return to the breath. I am not qualified to suggest that meditation is beneficial specifically for depression, but I think there is sufficient evidence to advise the practice in general.
cecilpl2 8y ago
This is a great tactic for ridding yourself of any unwanted thoughts. Learn to see them as "other" or a "mindvirus", not part of you. Learning to identify myself with the aspects of myself that I like has helped me in nearly every facet of my life.

viburnum 8y ago

Good stuff, but I've learned the hard way that most therapists have no idea what they're doing. If someone is not feeling better after 6-8 sessions, they need to get a new therapist. It's all too easy to get into a codependent relationship with a therapist that only enables the depression or anxiety to persist.

astura 8y ago
I had a therapist that once suggested taking herbs for an non-treatable medical issue and another time antibiotics for a cold. I can't believe I actually paid money to see her.
- lazyasciiart 8y ago
  I had a therapist once who suggested that my anxiety was the product of excessively high expectations, and I would feel better if I stopped expecting colleagues to do things like tell the truth. I quit therapy, and also quit that job. I felt much better after doing both!
  - chris_wot 8y ago
    So you essentially stopped having high expectations of your therapist and consequently stopped paying her :-)
    - lazyasciiart 8y ago
      Yes, and I suppose if I'd had the option of stopping the company from paying my colleagues I would have been fine with stopping my expectations of them as well :)
- fjsolwmv 8y ago
  Why are you discussing a cold or antibiotics with a therapist anyway? They can't prescribe drugs.
  - 8y ago

resource0x 8y ago

One great man's account of dealing with depression (the term hadn't been invented yet at the time of writing, but you will recognize the symptoms) https://www.goodreads.com/book/show/26244.A_Confession https://www.goodreads.com/book/show/26244.A_Confession Download: http://manybooks.net/titles/tolstoylother08a_confession.html http://manybooks.net/titles/tolstoylother08a_confession.html

metamet 8y ago

Someone close to me once shared this as the best representation of how depression feels to them. It was really helpful in helping me understand in a way that I hadn't been able to before. * http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-... * http://hyperboleandahalf.blogspot.com/2013/05/depression-part-two.html http://hyperboleandahalf.blogspot.com/2013/05/depression-par...

mikec3010 8y ago

This is the quintessential video for understanding clinical depression. A Stanford lecture given by Dr Sapolsky: https://youtu.be/NOAgplgTxfc https://youtu.be/NOAgplgTxfc I highly recommend watching it to better understand the disease.

camel_Snake 8y ago
Someone else (maybe it was you) shared this recently on hn and I watched it and don't regret a single minute. Insanely informative and the style of presentation where one covers the history of our understanding of a topic is possibly my favorite.
su30mki117 8y ago
That's a great video, but I think it's from 2011. I recently came across another video from 2016 which is a bit more technical and sheds some light on the results of recent research. People interested should definitely give it a watch - https://www.youtube.com/watch?v=BZbunmaU-60 https://www.youtube.com/watch?v=BZbunmaU-60

mendelsd 8y ago

Ensure they are getting adequate folate, noting that normal blood levels may not indicate functional sufficiency [1][2]: "Folate deficiencies may lead to an increased risk of depression and poorer antidepressant treatment outcomes..." "...deficiencies may be caused by improper absorption and utilization, often due to genetic polymorphisms." "Supplementation with the active form of folate, (methylfolate), which is more readily absorbed, may be effective in the prevention and treatment of both depression and dementia." "...(methylfolate) indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels..." [1] https://www.ncbi.nlm.nih.gov/pubmed/19909688 https://www.ncbi.nlm.nih.gov/pubmed/19909688 [2] https://www.ncbi.nlm.nih.gov/pubmed/17900207 https://www.ncbi.nlm.nih.gov/pubmed/17900207

ridgeguy 8y ago
Yes. There is a subset of patients with depression who have either of two different genetic polymorphisms for methyeneltetrahydrofolate reductase. This may be causally linked to their depression. [1] Supplementing diet with a modified form of folate appears to diminish depression in patients with these particular polymorphisms. My understanding is that this is still a matter of controversy. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810582/
- mendelsd 8y ago
  A few interesting things to note on this topic: 1) Prevalence of MTHFR gene variants you refer to is very high, e.g. 10%/50% for homo/heterozygous C677T SNP [1] (with frequencies varying substantially between ethnic groups). 2) Effects tend to be stronger with two copies of a variant (homozygous), but a single copy (heterozygous) may still be a concern, e.g. for C677T: "Individuals with the 677TT genotype, have approximately 30% the MTHFR enzyme activity of those with the 677CC genotype, whereas heterozygotes 677CT have around 65% of enzymatic activity" [2] 3) It seems odd to me that pharmacological dosages of folate are getting prescribed (I mean, it's a nutrient so why take it in doses that exceed the nutritional range?): "The most active form of folate has recently been approved in the United States as a prescription medical food for depressed patients with folate deficiency. Doses are usually 7.5 to 15 mg/d". [3] "Another concern is that folate doses > 800 μg/d can result in high levels of unmetabolized serum folic acid, reducing the amount of brain l-methylfolate and leading to decreased monoamines, an outcome that potentially increases the risk of or exacerbates depression." [3] Folate RDA is 400-800 μg/d depending on pregnancy status [4] [1] https://www.ncbi.nlm.nih.gov/pubmed/28847029 https://www.ncbi.nlm.nih.gov/pubmed/28847029 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078648/#R6 [3] https://www.ncbi.nlm.nih.gov/pubmed/19909688 https://www.ncbi.nlm.nih.gov/pubmed/19909688 [4] https://www.mayoclinic.org/drugs-supplements-folate/art-20364625 https://www.mayoclinic.org/drugs-supplements-folate/art-2036...

dkrich 8y ago

I was thinking about this this morning and couldn't help but notice the apparent correlation between high profile people who have committed suicide recently and their profiles. All from arts/creative fields (Avicii, Kate Spade, Bourdain, Robin Williams, Heath Ledger, I'm sure there are more). Is there any scientific research that has explored the possibility that the wiring in the brain that makes people creative has a propensity for depression? Of course the sample size is small and could be selection bias, but would like to hear from people who are knowledgeable on the topic.

Smudge 8y ago
Doesn't really answer your questions, but I'd point out that it's possible that we only hear about these suicides precisely _because_ they are from professions that tend to produce high-profile celebrities. I'd counter your apparent correlation with the fact that apparently suicide among doctors is extremely high: https://www.washingtonpost.com/national/health-science/what-ive-learned-from-my-tally-of-757-doctor-suicides/2018/01/12/b0ea9126-eb50-11e7-9f92-10a2203f6c8d_story.html https://www.washingtonpost.com/national/health-science/what-...
- danso 8y ago
  Is's a common convention in newspaper obituaries and articles to not mention cause of death as suicide, except in newsworthy situations. Covering suicides in general were somewhat taboo unless they involved someone noteworthy: https://www.poynter.org/news/reporting-suicide https://www.poynter.org/news/reporting-suicide
- dempseye 8y ago
  That doesn't counter it, though. It could be true that "the wiring in the brain that makes people creative" increases the risk of depression while also being true that there are other things that increase it too. Your comment also implies that whatever that wiring is, doctors don't have it, and I don't know if that is an assumption we should make.
- DanBC 8y ago
  The suicide rate in doctors is not higher than the general population. Suicide is common. There are lots of doctors. Some doctors die by suicide.

slx26 8y ago

this is a very sensible article. kudos to nytimes and the writer. we also need this kind of advice on tv, schools, etc. a better general understanding of depression by society as a whole is not only one of the best tools we have to deal with it, but also a great way to start building a better society

rectang 8y ago

I'm uncomfortable with the idea that someone who is in agony must be kept alive at all costs.

backpropaganda 8y ago
I used to think like this, but not any more. The agony is temporary. The not being alive is permanent. It's an irrational suboptimal decision that they would regret 2 years later. It makes sense to help them. It's like helping your friend quit smoking. They will be agonized for a few months, but eventually will get out of the addiction and be thankful.
- rectang 8y ago
  I agree that in general that is the right approach. However, some people suffer with chronic depression for their entire lives. What makes me uncomfortable is that no exceptions are ever allowed. Every sufferer must continue to stay alive indefinitely no matter how much pain they are in. I understand why this idea will forever be taboo, but it still bothers me.
phil248 8y ago
Depression can be effectively treated. It is not the same as terminal illnesses that are often covered by right to die laws.
mmt 8y ago
This seems a bizarrely simplistic (or incomplete) statement. It needs at least an adjective in front of "agony". I don't expect you're suggesting euthanizing someone with acute appendicitis or a severe cluster headache.
- rectang 8y ago
  For the purposes of constructive discussion I don't mind qualifying "agony" with "enduring", so to limit scope to those with chronic, untreatable depression. But the original statement is an honest representation of my thoughts. ETA: At the same time, it's important to recognize that suicides inflict dramatically more pain on those left behind than other causes of death.

chris_wot 8y ago

I am an Australian. You must NOT take your loved one to an ED if they mention they have had suicidal thoughts. You simply cannot trust that they will be treated with respect and dignity. Two and a bit years ago I was having suicidal thoughts. I had an episode and left the house in distress, but eventually arrived back home where my wife comforted me and my suicidal thoughts went away, and yet I was ripped from my bed and taken to hospital where I was thrown into a seclusion room for five and a half hours. There is no clinical documentation, I’m not in the seclusion register, there was no explanation given, I wasn’t assessed until hours later someone turned up, said I was fine and not only did I leave the room - I left the hospital! The authorities do not care, they leave you powerless, stripped of your dignity and autonomy and in some cases your life can be at risk. The following review was done last year by the NSW Chief Psychiatrist and it is absolutely damning: http://www.health.nsw.gov.au/patients/mentalhealth/Documents/report-seclusion-restraint-observation.pdf http://www.health.nsw.gov.au/patients/mentalhealth/Documents... I have been trying to get justice and answers for two and a half years. I went to the body who is meant to investigate these matters after the health service denied I was even in seclusion, they did nothing. The Hospital has now acknowledged I was in seclusion. They have literally just now started to find out about my lack of clinical records it’s, but they don’t think they’ll ever find out who threw me in that room. I now have severe PTSD, completely distrust the medical profession and will never speak of suicide to any medical professional ever again, and I strongly believe that anyone who does so takes a grave risk of being abused or mistreated by uncaring “professionals” who act more like jailers than carers. Certainly an ED is the very last place you want to go to - they simply do not care about depressed or suicidal people and you will almost certainly be thrown into a psych ward. Your rights will be servely curtailed, your decision making ignored and removed and it can be very hard to get out of such places.

jMyles 8y ago

I started reading with a lot of interest, but this line caused me to close the window: > In some cases, calling 911 may be the best option. It seems so tone-deaf. More accurate is: > In cases where life is at stake, consider calling 911, but if you do, know that police will likely respond first and may not be trained to deal with a mental health crisis. In some cases, people have been brutalized or even killed after seeking help from poorly trained law enforcement.

kortex 8y ago
We need a civilian-life equivalent of Rangers from the burner community. > Rangers act as non-confrontational community mediators, providers of reliable information, facilitators of public safety, and navigators of the edge of chaos. And/or, train police in these techniques. More empathy and patience, less judgement.
phailhaus 8y ago
If only you had continued reading one more sentence! > But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background. In cases where you’re concerned that calling police could put a person in danger, try to come up with an alternate plan in advance.
- jMyles 8y ago
  Indeed you're right. I can't believe I missed that sentence, and I agree that it does a lot to address my concerns.

depressed_394 8y ago

I really don't want to be asked if I'm having suicidal thoughts. Ever. By anyone. If I say yes, someone might try to "help" me by having me confined to a psychiatric hospital. Or worse. Having to lie about it is unpleasant. I have suicidal thoughts regularly, but I am not going to act on them. From most objective standards, my life is generally good. I've never had problems getting dates - at least once I got the courage to try, though long term relationships are hard. I have a job I like and find fulfilling. I'm well on my way to having "fuck you money". Still depressed. Since childhood (25+ years) I've been taking antidepressants. Have changed them a few times, though not for many years. They allow me to be mostly functional most of the time. Switching now might put me in a hole I can't get myself out of. Talk therapy has never really helped me. I don't really have any hope left of ever not being depressed. I've thought about trying psychedelics or ketimine therapy, but can't really find the motivation to do anything. Fuck depression.

xivzgrev 8y ago

I have struggled with depression for over half of my life. This sentence really struck me: "If you want to say something positive, focus on highlighting what he means to you". I teared up because it is so true. Give it a try if someone you love has depression.

braindongle 8y ago

As a person who has experience with severe depression, studying evidence-based psychiatry, and conducting psychiatric services research, I wholeheartedly endorse the advice in this piece.

0xcde4c3db 8y ago

> A severely depressed friend needs professional assistance from a psychologist, psychiatrist, social worker or another medical professional. This is an example of a troubling pattern often seen when talking about "depression". Depressed mood can be a symptom of numerous medical conditions. That means you need to write down all observed symptoms and see a doctor to diagnose or rule out those conditions. It's a bad idea to jump straight to psychology or psychiatry just because your most distressing symptoms are psychological. It's an especially bad idea to get committed to a psychiatric hospital with an undiagnosed chronic condition that psychiatrists don't specialize in treating.

whitepoplar 8y ago

A couple things that helped me when I was severely depressed and suicidal: 1) I can kill myself, at any time, if I want to. I'm in control and nobody can take that away. Paradoxically, understanding that made me feel better, because if I know I can do it at any time, why do it now? May as well wait a little while. 2) Make a checklist of essential tasks and get into a habit of doing those things no matter what. Some examples: shower, brush teeth, floss, use mouthwash, clip nails, walk 10k steps, do dishes, make bed etc. Check them off. It doesn't matter what's on the list, but it is important to check off 100% of the items each day. Put every small task you can think of on this list and you'll feel good when you check each of them off. 3) Take a good multivitamin + vitamin D 4) Eat healthier. Fresh steamed spinach and wild salmon always made me feel a little better for whatever reason. 5) Get out of the house! Walk! This is really important. 6) Go to the gym. Aim for at least a couple minutes of sprints per day (I like the rowing machine for this). Sprints are holy time in that suicidal thoughts will completely disappear, if only for those few minutes. 7) Walk through a dangerous part of town. Nothing gets rid of depressive thoughts faster than rising blood pressure and a fast heartbeat. 8) Get rid of as much decision-making as possible in your life. Turn decisions into mechanical rules. e.g. don't think "do i want to brush my teeth today?" You need to brush your teeth in order to cross it off your list. 9) Sleep will naturally improve on its own, over time, if you exercise, move around, and eat healthier, so don't worry if you currently have trouble sleeping. 10) This book is pretty good, but only read after you've eaten healthy, gone outside, and exercised: https://www.amazon.com/Guide-Good-Life-Ancient-Stoic/dp/0195374614 https://www.amazon.com/Guide-Good-Life-Ancient-Stoic/dp/0195... What didn't work for me was: thinking about all the people i'd hurt, calling a hotline, any decision-making that wasn't mechanical and required reasoning, insight, or motivation. If you're suicidal right now, start by putting some shoes on, going outside, and sprinting until you can't breathe anymore. Do this 3 times.

beegeezuz 8y ago

Depression is like a powerful spell, no matter what you do you know you can't beat it until it's done doing its thing. Best thing you can possibly do is give them direction. Tell them what to do, keep them occupied all the time! I get serious depression once or twice a year and even though I know what's going on I have no control over it and I'm always afraid I might do something radical which I might regret later. Unfortunately I live alone, but I wish I had someone to take control of me during those phases of depression. Someone to keep telling me what to do and keep a tab on me making sure I do all those things until I get well again. Don't be sympathetic, be a guide.