11 ms·

I promise I am not pursuing the tiresome argumentative tactic of demanding formal sources as a way to postpone defeat. But, seriously, do you have a source for

by majos 8y ago

I promise I am not pursuing the tiresome argumentative tactic of demanding formal sources as a way to postpone defeat. But, seriously, do you have a source for > The majority of depression cases are relatively self-induced and could be fixed with simple behaviour modifications. I am very wary of telling a depressed person that it's probably just a matter of making the right lifestyle tweaks.

newplagiarist 8y ago
I can't agree with this statement more, espousing the tired pull yourself up by your bootstrap motto for clinically depressed people is dangerous.
- rednerrus 8y ago
  If we can’t have an honest discussion about the underlying causes of the depression epidemic, we are never going to get to a place where we can fix it.
  - Etheryte 8y ago
    Passing your personal opinions as facts doesn't make for an honest discussion. The query to back up your claims with some sort of sources is very reasonable.
    - mtalantikite 8y ago
      I’m not sure it’s just an opinion, there is a plethora of research showing the effects of exercise on depression. There are certainly people that are clinically depressed that are also physically active (some friends of mine are in that group). OP states as much. But I agree with OP, if we’re not going to talk about the low hanging fruit of exercise, diet, and sleep, we’re not going to get anywhere with combating depression. Edit: here’s just one of many studies (there are literally hundreds of them) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
      - mercer 8y ago
        I completely agree that these are important things to discuss. I just wish OP had left out the 'majority of cases' statement, because it doesn't really add much to his (valuable) point and hits a nerve with many people.
      - DanBC 8y ago
        > there is a plethora of research showing the effects of exercise on depression. Yes, there is. It all shows that exercise is moderately better than nothing as a treatment for depression, unless you only include good quality trials in which case the effectiveness drops off. https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depr... > Exercise is moderately more effective than no therapy for reducing symptoms of depression. [...] > The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.
        mtalantikite 8y ago
        Totally, it seems to be somewhere around about as effective as other treatments for depression. Personally I choose exercise over medication, and haven’t had any significant depressive episodes since I started swimming, running, and practicing yoga four or five times per week. As a bonus my body feels great and my mind is more clear now too. I just wish I could have made younger me wake up to it (even though I knew what the answer was). There are certainly people that aren’t able bodied and can’t choose exercise, or are clinically depressed beyond what exercise would be effective for, but for many people a solution seems to be exercise.
    - rednerrus 8y ago
      Diet: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291... https://dadun.unav.edu/bitstream/10171/4928/1/SUN%2028.pdf https://dadun.unav.edu/bitstream/10171/4928/1/SUN%2028.pdf https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626 https://www.health.harvard.edu/blog/nutritional-psychiatry-y... Sleep: https://aasm.org/studies-find-new-links-between-sleep-duration-and-depression/ https://aasm.org/studies-find-new-links-between-sleep-durati... https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health https://www.health.harvard.edu/newsletter_article/sleep-and-... https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders https://adaa.org/understanding-anxiety/related-illnesses/sle... Stimulants: This one I may be wrong about. My general thinking is if it disturbs your sleep and poor sleep habits cause depression, you should stay away from the stims. Exercise: https://www.psychologytoday.com/us/blog/the-athletes-way/201310/25-studies-confirm-exercise-prevents-depression https://www.psychologytoday.com/us/blog/the-athletes-way/201... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.16111223?journalCode=ajp https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.20... Screen time: https://www.sciencedirect.com/science/article/pii/S2211335517301316 https://www.sciencedirect.com/science/article/pii/S221133551... https://psychcentral.com/news/2017/11/15/more-screen-time-tied-to-depression-suicide-behaviors-in-teens/128771.html https://psychcentral.com/news/2017/11/15/more-screen-time-ti... Alcohol: This one I may be flat out wrong on. Moderate alcohol consumption seems to have an anti-depressant effect. Heavy alcohol consumption is associated with depression and suicide. Most of what I said, especially about diet, exercise, and sleep are not controversial.
      - AstralStorm 8y ago
        They aren't controversial but effect sizes on mood are small. You do not fix depression with small mood changes. A lot of this research is further confounded by the simple fact that depressed people exercise less as well as eat less healthy. Epidemiology does not show causation here, only interventional studies do with tiny effects. Example is the studies that show having friends makes one less depressed. Obviously people who are depressed regularly have fewer friends because they're avoided.
  - deleted 8y ago
    [deleted]
- agumonkey 8y ago
  I've been suffering from extreme depression in 2014[1]. I'd still say the 'bootstrap' thing has a bit of truth. It's because the symptom of cured depression is that little stem of inner desire. Almost no one can restore it. Now I wouldn't say it in a blaming tone. I'd just add 1) you're hurt, you need to rest 2) don't drown so keep as much things you can in check (rhythm, sunlight, diet, movement) even it's just one thing do it, then be proud and rest again 3) you can't see it now but things will improve, just slowly. Again take your time, but keep in mind : slow and steady, you'll be back I promise
paradroid 8y ago
He's not wrong, but he's not taking into consideration the fact that it's a feedback loop. It's the same perspective as chiding the homeless for not pulling themselves up by their bootstraps. They are in too much mental poverty to do it.
- DoreenMichele 8y ago
  If only "mental poverty" were the entire problem for homeless individuals, instead of actual poverty, classism, lack of affordable housing and, typically, a host of substantial personal problems.
  - memelord69 8y ago
    JUST GET A HOUSE LOOOOOOOOOOOOOOL
    - DoreenMichele 8y ago
      "Please don't use uppercase for emphasis." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html For every 100 families living in poverty on the West Coast, there are no more than 30 affordable homes https://www.geekwire.com/2018/every-100-families-living-poverty-west-coast-no-30-affordable-homes/ https://www.geekwire.com/2018/every-100-families-living-pove...
      - paradroid 8y ago
        He's using internet speak. Since it can't be communicated as such in any other way, it's likely an exception, although to someone who hasn't been read in it probably reads funny.
        DoreenMichele 8y ago
        The commenter in question has been here 15 days and has left 4 comments. Other than the gendered term "lord" that is part of the username, I see no indication of gender. I would be curious how you determined it. I am unaware of an exception in the official HN guidelines that allow for all caps for "internet speak." Perhaps you could advise me where you found that? Perhaps you could also clarify what on earth the comment even meant. I am failing to comprehend if it is mocking homeless individuals or mocking toxic attitudes towards them or doing something else entirely. Thank you.
rednerrus 8y ago
Part of the reason why I quantified it. There are legitimate cases of depression caused by non-self-inflicted chemical imbalances. I’m not advocating for people who are currently taking anti-depressants to drop their pills tomorrow. The studies (I’m on the train so I’m not trying to cite these sources, google it) show that lifestyle changes with antidepressants is much more effective than antidepressants alone. Even if you have a non-self-inflicted chemical imbalance, your shrink is likely to prescribe all of the things I listed. Source: my shrink, and every shrink worth their salt.
- WalterGR 8y ago
  Part of the reason why I quantified it. You qualified it. If you quantified it, you would have provided numbers backing up your argument.
  - rednerrus 8y ago
    Fewer than 30% of people with MDD episodes have treatment resistance depression. The majority of people with depression respond to treatment. The efficacy of diet, exercise, and sleep are on par with drugs.
    - AstralStorm 8y ago
      You mean low and not additive, right?
    - DanBC 8y ago
      > The efficacy of diet, exercise, and sleep are on par with drugs This is simply untrue.
- phnk 8y ago
  Apologies for bluntness, but you clearly have no idea of what you are talking about. The false dichotomy between "self-induced" and "non-self-inflicted [sic]" is something that your "shrink" would have dismissed in the first minutes of honest conversation, before turning to your list of lifestyle adjustments and pointing out that there is a wide range of responses to them. The kind of baseless speculation that you offer, followed by the obligatory confirmation-bias sequence, is precisely how some people end up treating psychiatric illness in highly neglectful and harmful ways.
majewsky 8y ago
> I am very wary of telling a depressed person that it's probably just a matter of making the right lifestyle tweaks. I don't see rednerrus advocating that. But if what they say is true, then psychotherapists need to know that, and plan their therapies accordingly.
- rednerrus 8y ago
  Any PDoc you see will start with these things for the majority of “depression” patients. Therapists are more cautious about any sort of prescribing, even if it’s lifestyle prescriptions.
baccheion 8y ago
Tests like NutrEval can verify/refute the presence of nutrient deficiencies, and combined with genetic testing and a comprehensive hormone panel (includes thyroid panel), provide clarity/perspective/insight.

by majos 8y ago

newplagiarist 8y ago

I can't agree with this statement more, espousing the tired pull yourself up by your bootstrap motto for clinically depressed people is dangerous.

rednerrus 8y ago
If we can’t have an honest discussion about the underlying causes of the depression epidemic, we are never going to get to a place where we can fix it.
- Etheryte 8y ago
  Passing your personal opinions as facts doesn't make for an honest discussion. The query to back up your claims with some sort of sources is very reasonable.
  - mtalantikite 8y ago
    I’m not sure it’s just an opinion, there is a plethora of research showing the effects of exercise on depression. There are certainly people that are clinically depressed that are also physically active (some friends of mine are in that group). OP states as much. But I agree with OP, if we’re not going to talk about the low hanging fruit of exercise, diet, and sleep, we’re not going to get anywhere with combating depression. Edit: here’s just one of many studies (there are literally hundreds of them) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
    - mercer 8y ago
      I completely agree that these are important things to discuss. I just wish OP had left out the 'majority of cases' statement, because it doesn't really add much to his (valuable) point and hits a nerve with many people.
    - DanBC 8y ago
      > there is a plethora of research showing the effects of exercise on depression. Yes, there is. It all shows that exercise is moderately better than nothing as a treatment for depression, unless you only include good quality trials in which case the effectiveness drops off. https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depr... > Exercise is moderately more effective than no therapy for reducing symptoms of depression. [...] > The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.
      - mtalantikite 8y ago
        Totally, it seems to be somewhere around about as effective as other treatments for depression. Personally I choose exercise over medication, and haven’t had any significant depressive episodes since I started swimming, running, and practicing yoga four or five times per week. As a bonus my body feels great and my mind is more clear now too. I just wish I could have made younger me wake up to it (even though I knew what the answer was). There are certainly people that aren’t able bodied and can’t choose exercise, or are clinically depressed beyond what exercise would be effective for, but for many people a solution seems to be exercise.
  - rednerrus 8y ago
    Diet: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291... https://dadun.unav.edu/bitstream/10171/4928/1/SUN%2028.pdf https://dadun.unav.edu/bitstream/10171/4928/1/SUN%2028.pdf https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626 https://www.health.harvard.edu/blog/nutritional-psychiatry-y... Sleep: https://aasm.org/studies-find-new-links-between-sleep-duration-and-depression/ https://aasm.org/studies-find-new-links-between-sleep-durati... https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health https://www.health.harvard.edu/newsletter_article/sleep-and-... https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders https://adaa.org/understanding-anxiety/related-illnesses/sle... Stimulants: This one I may be wrong about. My general thinking is if it disturbs your sleep and poor sleep habits cause depression, you should stay away from the stims. Exercise: https://www.psychologytoday.com/us/blog/the-athletes-way/201310/25-studies-confirm-exercise-prevents-depression https://www.psychologytoday.com/us/blog/the-athletes-way/201... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.16111223?journalCode=ajp https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.20... Screen time: https://www.sciencedirect.com/science/article/pii/S2211335517301316 https://www.sciencedirect.com/science/article/pii/S221133551... https://psychcentral.com/news/2017/11/15/more-screen-time-tied-to-depression-suicide-behaviors-in-teens/128771.html https://psychcentral.com/news/2017/11/15/more-screen-time-ti... Alcohol: This one I may be flat out wrong on. Moderate alcohol consumption seems to have an anti-depressant effect. Heavy alcohol consumption is associated with depression and suicide. Most of what I said, especially about diet, exercise, and sleep are not controversial.
    - AstralStorm 8y ago
      They aren't controversial but effect sizes on mood are small. You do not fix depression with small mood changes. A lot of this research is further confounded by the simple fact that depressed people exercise less as well as eat less healthy. Epidemiology does not show causation here, only interventional studies do with tiny effects. Example is the studies that show having friends makes one less depressed. Obviously people who are depressed regularly have fewer friends because they're avoided.
- deleted 8y ago
  [deleted]
agumonkey 8y ago
I've been suffering from extreme depression in 2014[1]. I'd still say the 'bootstrap' thing has a bit of truth. It's because the symptom of cured depression is that little stem of inner desire. Almost no one can restore it. Now I wouldn't say it in a blaming tone. I'd just add 1) you're hurt, you need to rest 2) don't drown so keep as much things you can in check (rhythm, sunlight, diet, movement) even it's just one thing do it, then be proud and rest again 3) you can't see it now but things will improve, just slowly. Again take your time, but keep in mind : slow and steady, you'll be back I promise

paradroid 8y ago

He's not wrong, but he's not taking into consideration the fact that it's a feedback loop. It's the same perspective as chiding the homeless for not pulling themselves up by their bootstraps. They are in too much mental poverty to do it.

DoreenMichele 8y ago
If only "mental poverty" were the entire problem for homeless individuals, instead of actual poverty, classism, lack of affordable housing and, typically, a host of substantial personal problems.
- memelord69 8y ago
  JUST GET A HOUSE LOOOOOOOOOOOOOOL
  - DoreenMichele 8y ago
    "Please don't use uppercase for emphasis." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html For every 100 families living in poverty on the West Coast, there are no more than 30 affordable homes https://www.geekwire.com/2018/every-100-families-living-poverty-west-coast-no-30-affordable-homes/ https://www.geekwire.com/2018/every-100-families-living-pove...
    - paradroid 8y ago
      He's using internet speak. Since it can't be communicated as such in any other way, it's likely an exception, although to someone who hasn't been read in it probably reads funny.
      - DoreenMichele 8y ago
        The commenter in question has been here 15 days and has left 4 comments. Other than the gendered term "lord" that is part of the username, I see no indication of gender. I would be curious how you determined it. I am unaware of an exception in the official HN guidelines that allow for all caps for "internet speak." Perhaps you could advise me where you found that? Perhaps you could also clarify what on earth the comment even meant. I am failing to comprehend if it is mocking homeless individuals or mocking toxic attitudes towards them or doing something else entirely. Thank you.

rednerrus 8y ago

Part of the reason why I quantified it. There are legitimate cases of depression caused by non-self-inflicted chemical imbalances. I’m not advocating for people who are currently taking anti-depressants to drop their pills tomorrow. The studies (I’m on the train so I’m not trying to cite these sources, google it) show that lifestyle changes with antidepressants is much more effective than antidepressants alone. Even if you have a non-self-inflicted chemical imbalance, your shrink is likely to prescribe all of the things I listed. Source: my shrink, and every shrink worth their salt.

WalterGR 8y ago
Part of the reason why I quantified it. You qualified it. If you quantified it, you would have provided numbers backing up your argument.
- rednerrus 8y ago
  Fewer than 30% of people with MDD episodes have treatment resistance depression. The majority of people with depression respond to treatment. The efficacy of diet, exercise, and sleep are on par with drugs.
  - AstralStorm 8y ago
    You mean low and not additive, right?
  - DanBC 8y ago
    > The efficacy of diet, exercise, and sleep are on par with drugs This is simply untrue.
phnk 8y ago
Apologies for bluntness, but you clearly have no idea of what you are talking about. The false dichotomy between "self-induced" and "non-self-inflicted [sic]" is something that your "shrink" would have dismissed in the first minutes of honest conversation, before turning to your list of lifestyle adjustments and pointing out that there is a wide range of responses to them. The kind of baseless speculation that you offer, followed by the obligatory confirmation-bias sequence, is precisely how some people end up treating psychiatric illness in highly neglectful and harmful ways.

majewsky 8y ago

> I am very wary of telling a depressed person that it's probably just a matter of making the right lifestyle tweaks. I don't see rednerrus advocating that. But if what they say is true, then psychotherapists need to know that, and plan their therapies accordingly.

rednerrus 8y ago
Any PDoc you see will start with these things for the majority of “depression” patients. Therapists are more cautious about any sort of prescribing, even if it’s lifestyle prescriptions.

baccheion 8y ago

Tests like NutrEval can verify/refute the presence of nutrient deficiencies, and combined with genetic testing and a comprehensive hormone panel (includes thyroid panel), provide clarity/perspective/insight.