8 ms·

We Need To Talk About Depression

92 points by ajiang 12y ago

kevingadd 12y ago
Not just depression. Other related health issues like Bipolar Disorder are terrifyingly common in SV and other tech communities; far too many of my past and present coworkers are clearly suffering from symptoms that typically indicate depression, mania, or other issues. Worse still, some people I know are aware and accepting of the fact that they have issues, but they refuse to treat them because they fear antidepressants or mood stabilizers will impact productivity. One person I know explicitly refrains from treating his bipolar disorder because he thinks manic episodes make him productive. :-/ No one treatment is appropriate for everyone, but far too many people are willing to throw away their health in order to chase after the startup dream, despite the fact that it can hurt everyone around them in addition to shortening their own life.
- anon48191 12y ago
  I refuse treatment because I am afraid of the reaction of the people around me (family, friends, coworkers, employer) upon hearing I am being treated for psychological problems.
  - DanBC 12y ago
    How would those people know? Why would they be unsupportive of you getting medical help for this medical problem? Would they be similarly unsympathetic if you got medical help for a different medical problem?
- Nanzikambe 12y ago
  > Worse still, some people I know are aware and accepting of the fact that they have issues, but they > refuse to treat them because they fear antidepressants or mood stabilizers will impact productivity. > One person I know explicitly refrains from treating his bipolar disorder because he thinks > manic episodes make him productive. :-/ The issue is a little more complicated than that, first amongst the many problems is the tendency to medicate unnecessarily - there're many different and interwoven reasons for this, amongst which are the financial incentives to prescribe, deficits in empirical understanding of the issues, and the extremely severe and detrimental effects of some of the medications. It's easy to blame a patient for unwillingness to participate, which can be the case, but doing so without an objective look at the reasons doesn't fundamentally address the problem. There are many other conditions both physical and mental, that are personally and societally difficult to discuss openly, yet they aren't plagued by similar levels of reluctance in patients. Why is that? I would add more so much more, as I hope you can understand, and as the article alludes to, these aren't issues easily discussed, especially not with relative strangers on the Internet and I'm not interested in hiding my opinions behind a throwaway. Suffice it to say that my own experiences have led to similar choices to the person you described, and whilst I've never experienced mania, I too believe myself to be better off for those choices. I can categorically say that the opinions shared by those closest to me, the effect on my creativity, productivity and my sense of "self", corroborate that. In my case, the choice wasn't to refuse all treatment or therapy, but only to refuse specific types of treatments which were drastically over-powered and negatively impacted me beyond any perceptible benefit. Subsequent consultations corroborated that decision, and criticised the treatment I was initially suggested as being so heavy handed, that it's analogous to treating a cut finger with amputation of the entire arm. One size does not fit all, and until approaches to treatment reflect that, we will keep repeating the same mistakes to the detriment of the afflicted. If you're lucky enough to have a supportive network of family and friends around you, I can only reiterate the article's salient point: "talk about it" and add the suggestion that you educate yourself to the best of your ability, to help making the best possible decision.
  - electronvolt 12y ago
    Just on the subject of not medicating, specifically for bipolar disorder: in the case of bipolar disorder, medication is considered the only completely responsible primary treatment, with anything else acting as a supplemental treatment. (Therapy simply won't prevent later episodes, lifestyle changes can only lower the chance, and are less reliable than medication.) Medication adherence is also a problem in bipolar patients because mania and hypomania are characterized by euphoria, delusions of grandeur, overconfidence, and a lot of other symptoms people find enjoyable in the moment. I'd echo the suggestion of educating yourself to the best of your ability. Most people from HN are pretty intelligent: learning about one disease and the treatments for it is not difficult to do at a basic level. Generally those who've spent years studying it (say, doctors) are going to know more and be able to better contextualize that information, but it helps to know what the evidence is for a particular treatment, if it's considered responsible, what side effects to expect, etc., as it helps you better evaluate the doctor and makes you aware of your options.
- Nanzikambe 12y ago
  I have no idea why the comment by "anon48191" is dead - it's extremely relevant and part of the point raised within the article.
  - Flow 12y ago
    If you really are depressed, everyone around you most likely already know it. They already know, the medication will not be the reason people know your mental health.
  - anon96342 12y ago
    Thank you Nanzikambe. This is anon48191, I apologize for using yet another anonymous user. As outlined in my, unfortunately dead, comment I have reasons to stay anonymous (check shadowdead if you're interested in my original comment). I would also like to quickly address the comment by Flow: It might very well be that people around me already know. However, there's a big issue between knowing and officially knowing. Further, I never talked about medication. I personally don't believe much in medication. The steps I was considering were talking to a psychiatrist and take it from there. However as soon as I do this, it is bound to become public, as in public within my circles. I will not question Flows intention in their comment, their knowledge or familiarity of the issue. However, and you'll have to take the word from an anonymous commenter on the internet for this, I am most definitely depressed, if not worse, and outright claiming my (however anecdotal) comment is wrong, seems a bit harsh.
    - Flow 12y ago
      I've been fighting exhaustion/fatigue, and some degree of depression that seems to always come with exhaustion, for more than 10 years. It's been a journey to put it mildly, but now I know myself better than ever. From what I've read and learnt during these years, is that exercise seems to be the most effective treatment. This is the only thing I've not tried seriously yet. Medication has helped a bit. I can say they are no quick fix, you have to give them at least 3-4 months before you stabilize and can start to reason about how you feel and how to proceed. I hesitated before I tried them, and feel that it was quite dumb and a waste of time to not take them earlier. The last thing I'd like to mention, is Cognitive Behavioral Therapy, CBT. It worked really well for me. I managed to do several things I wanted to do for years, and the feeling was incredible to finally get out of the catch-22. Here in (Nordic Country), CBT is not a crazy sign. I know a lot of people that go and have CBT sessions for things like to reason about how to unstuck their life, solve issues at work. It's no more weird than having a personal trainer at the gym. From your wording it seems you really feel you need to do something. I don't think your mental health will get better without you changing or doing something about it. Perhaps you could take a few CBT sessions for your depression, but officially say it's because you want to accelerate your career? Soften your friend and coworkers by sending them links to articles about becoming more efficient at work via CBT? It's really unproductive and shameful that mental health issues are so stigmatic. Thank your for replying to me instead of just drive-by down-voting. I wish you luck finding a solution that fits you.
- michaelochurch 12y ago
  One person I know explicitly refrains from treating his bipolar disorder because he thinks manic episodes make him productive. Does he have hypomania or actual mania? True mania (not hypomania, which is sometimes benign) is a hot mess and I'd be surprised if he's employed 12 months down the road. It's pretty devastating, and I can't see why anyone would want it.
  - kevingadd 12y ago
    I haven't ever observed him in full blown mania myself, but I've seen him in profound hypomanic episodes before. The frequency with which I observed it makes me very concerned, at the least. You're correct that true mania is a whole lot worse than hypomania. My perspective is that you should at least be getting regular guidance and treatment from a qualified psych, even if you aren't on mood stabilizers, to make sure you don't end up in the grips of a manic episode.
- deleted 12y ago
  [deleted]
alx 12y ago
https://www.youtube.com/watch?v=QnfOOoTOrDE https://www.youtube.com/watch?v=QnfOOoTOrDE 28c3: Geeks and depression panel
thathonkey 12y ago
We do need to talk about mental health. As a culture. But, sorry, I am not going to read Techcrunch article about it. Even publications that dedicated to following mental health (and ostensibly authored by "experts" in the field) tend to do a dubious job of describing what is an extremely complicated problem to which THERE IS NO QUICK FIX. Read that again. Addressing mental healthy problems is very hard work and treatment plans vary by individuals (not even by disease) so even once you find a doctor you like - no easy task - and whether you go into psychotherapy or the psychiatric [aka prescribed] route or both - you have a long, hard road ahead of you which will require a lot of patience from you and those that you maintain relationships with whether they are work or personal. There are lots of mental health disorders of which depression is a common symptom. It's important to work with a doctor you feel comfortable with to figure out if you suffer from depression, or if the root cause is some other disorder (OCD, bi-polar, anxiety are common amongst SDE types) which routinely causes you to feel depressed for days or weeks (or god forbid, months) at a time. Even if you are comfortable going the medication route (and there are many reasons why this choice should not be made lightly, especially if it is via anti-depressants or another - they're all habit forming and bring their own set of side-effects and problems), it is a long an arduous process to find the right one/right dosage/etc. that will work for you (if there even is one). Each one takes weeks to see results typically. Anti-depressants help some people greatly. Others will struggle with them and find them counter-productive to their treatment. There is no one-size-fits-all treatment plan. Mental health is a subject that doesn't get attention in any facet of American culture. PS. There is no evidence to suggest that the software industry suffers disproportionately from mental health issues compared to any other.
- zrail 12y ago
  The article is basically saying the same thing, for what it's worth, and is written by someone who claims to have extensive experience with the same issues you're discussing. The main message is "If you're feeling these things, please talk to someone you trust. If someone talks to you about these issues, please don't dismiss them." I think it's a good message, even if presented at Techcrunch. The more we as a culture talk about mental health issues in a constructive way the better.
- wcummings 12y ago
joshontheweb 12y ago
This probably won't be popular here but I have suffered from depression since I can remember and the best remedy I have found so far is psychedelics. Not too often but in higher doses as Terence Mckenna recommends. Psilosybe Mushrooms in particular are good at helping me to shed my fears, love life, and create out of passion. Mileage may vary but I thought I'd put that out there. Any others who have similar experience?
- kevingadd 12y ago
  What other things have you tried? Did you try them rigorously (over a long period of time, comparing results with time periods where they weren't in use?) Did you try those things with the assistance or guidance of a professional? Lifestyle changes, self-care techniques, antidepressants, dietary supplements, etc. are all things a medical professional will recommend to you - and the antidepressants are often the last thing they'll suggest. Did you try all of those, find them unhelpful, and resort to psychedelics?
- marvin 12y ago
  I think this is very individual. Glad it worked out for you, but experimenting with self-medication with untested drugs could go both ways. A Google Scholar search for "psychedelic drug psychosis" makes clear that there is nowhere near consensus on whether this is an advisable option.
  - lilsunnybee 12y ago
    Definitely! Like alcoholism, there is a risk factor in the use of psychedelics for some people, with a strong genetic component. It's important to take your own mental health history, as well as family history into account when experimenting. Especially before taking any high doses of anything, experiment just with lower doses first, with relatively sober, experienced friends present should anything go wrong. If you have a personal or family history of psychotic episodes though, including delusional thinking, be extremely cautious, and either only take lower doses or abstain entirely for your own safety and well-being.
- lilsunnybee 12y ago
h1karu 12y ago
Isn't the real story here the over-pathologization of normal human experience in order to turn a larger profit (for the drug industry and the mental health industry) ? With the way these disorders are currently defined I'm convinced that every human being on earth could be diagnosed at various points within their life. I'm not suggesting that these symptoms don't exist, but rather that they've been a perfectly normal part of human life since the dawn of man. It's perfectly natural for people to go through periods where they have less energy than other periods, overeat or under-eat, have difficulty concentrating or making decisions, feel anxious. This is normal stuff depending on the life circumstances especially if you're drinking any amount of coffee because that will lead to periods of highs and lows. It does not mean you "have depression" as if there was some flu virus that you became infected with it simply means you're a human being. I would argue that legitimate diagnosis should be reserved for people who are either suicidal or who's symptoms strongly suggest elements of self-harming or harming others.
- keithflower 12y ago
  No. Some conditions are overdiagnosed, and there is a too-cozy relationship between medicine and pharma that is disturbing to many of us. However, to make a diagnosis based on Diagnostic and Statistical Manual (DSM) criteria almost without exception (one exception is for bipolar II disorder) require that symptoms (and several symptoms are required usually for any given disorder) must cause significant impact on one's lives, eg, "...sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features." or "...symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." EDIT: (based on your own edit) - reserving diagnosis and treatment just to those at risk for self- or other-harm is going to harm many suffering people. I don't think you understand what depression really is. It's not caffeine withdrawal or the flu. Even when no suicidal ideation is present, it's a serious disease with real costs to the individual and to society, just as real as cancer. Beyond depression, I think you'd agree that even in the absence of harmful behavior or ideation, people who experience auditory hallucinations in the course of depression, or OCD sufferers who are unable to work because they must wash their hands hundreds of times a day, or who have PTSD triggered simply by backfiring engines, or who have dozens of other DSM diagnoses, all have legitimate illnesses that deserve much more than the terrible, stigmatizing suggestion that their illnesses somehow are not real.
lostapathy 12y ago
I would encourage everyone thinking about depression go watch this TEDx talk. He's not the most traditional speaker, but his story made a huge difference in how I understand depression. http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share http://www.ted.com/talks/andrew_solomon_depression_the_secre...
n72 12y ago
Does YC have an in-house shrink? I've always thought that if I ran an incubator, one of the first things I'd do is institute twice-weekly meetings with a shrink. I think such an arrangement would pay off amply in the long run. I know when I was my mid-20s, if I'd had a shrink to help me combat some issues which had the side effect of leading to severe procrastination, I'd have been considerably more productive. To me it just seems like a no-brainer from an investment point-of-view.
- josai 12y ago
  I've thought the same thing. I'm constantly amazed that companies don't consider the health of their employees, both physical and mental, worth investing in. It's my firm belief that it would pay back many times over. I like your shrink idea (though probably once a week is enough). If it was me, I'd also encourage daily 1-hour exercise (gym, soccer, walking, whatever). It really helps.
  - michaelochurch 12y ago
    I'm constantly amazed that companies don't consider the health of their employees, both physical and mental, worth investing in. It's my firm belief that it would pay back many times over. Oddly enough, the "old-style" corporations that have gone out of style, did. At many investment banks, you can still schedule a confidential appointment with an on-site doctor or therapist. The depression stigma isn't as strong at the banks as it is in technology companies and in startups. I'm basically unfundable (cyclothymia, aka "bipolar 3") by VCs, but my condition, because it's well-treated, would be a non-issue at most financial firms (even at high levels).
- laironald 12y ago
  I participated in a top incubator and totally agree with this comment. cofounder breakups are such a nasty affair and I've part of one. we tried to resolve the issue but by the time it got to that point, it was a bit too late. I sometimes wonder if we would have addressed our issues sooner through counseling if this would have impacted the outcome of that company. I do think it could have resolved some issues faster. The problem with this incubator was the MD was also an investor, so it was very difficult to talk to him about our issues. I'm happy to be involved in a new company at a senior level, but like a long lost love, you kind of never forget.
bayesianhorse 12y ago
Having gone through this, my recommendation is to avoid talking about depression while depressed...
- jamesbritt 12y ago
  Interesting. I, too, battled depression and I don't think talking about depression was a problem for me, even when depressed. The catch here is that talking with people who don't actually know much about depression (e.g. the "just cheer up" crowd) can be a problem.
  - bayesianhorse 12y ago
    I've found that depressions lead to a particular kind of reality distortion that is hard on most relationships. As is lack of interest, of course.
lilsunnybee 12y ago
If you're experiencing depression, consistently lowered mood, heightened anxiety, or other mental health symptoms, especially if you don't have a history of it, be sure to rule out physical causes and simple nutritional deficiencies as well with your doctor, in addition to pursuing psychiatric medications and / or therapy. Especially if frequent tiredness and exhaustion are strong components, you could be experiencing a change in endocrine function, particularly thyroid, a sleep disorder, or any number of other medical conditions. Sleep disorders especially are often underdiagnosed, and can go untreated for years in lieu of just treating psychiatric symptoms instead (I know this from personal experience). Conditions such as hypothyroidism are often similarly underdiagnosed. So if you're feeling extraordinarily tired all the time, and anemia and other nutritional and medical causes have been ruled out, get your thyroid levels checked and a sleep study done too, or at least bring it up with your doctor. But also don't hesitate to seek out treatment for mental health problems even if a known medical cause can't be found or has yet to be identified. It's all physiological causes really, but there's a lot we still don't know about the human brain and body, and treating symptoms, especially if they are having a significant negative impact on your quality of life, is just as important as trying to find a cause. And last but not least since we are talking about depression and depression-related conditions (such as bipolar, etc.), I just wanted to raise a little awareness for borderline (BPD) too. For those of you that have strong emotions, maybe a little impulsive, and/or a troubled childhood and suicidal tendencies, or have people in your life like that, you should find it really worthwhile to read up a bit on BPD: http://en.wikipedia.org/wiki/Borderline_personality_disorder http://en.wikipedia.org/wiki/Borderline_personality_disorder It's a diagnosis which has gotten a bad but undeserved stigma over the years, that needs better awareness and understanding. Whether you identify strongly with a BPD profile or not, if you struggle with strong emotions and/or suicidal tendencies in your life, a lot of Dialectical Behavioral Therapy (DBT) coping strategies and methods might be particularly helpful to you in dealing with those feelings: http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy Stay healthy and happy hackers, but don't be afraid to ask friends, family, and professionals for help when you need it either!
QuantumChaos 12y ago
Where is the evidence that depression is qualitatively different from being unhappy, or feeling downtrodden and apathetic? All I ever read on the topic is (1) scientific studies that associate certain diagnoses, with the effectiveness of certain treatments, and (2) the claim by people with these conditions, that they are qualitatively different. Is there any evidence against the following hypothesis: What we call mental illnesses are (with possible exception of Schizophrenia and Bipolar disorder), not qualitatively different from ordinary experience. But in order to provide treatment (e.g. various kinds of therapy) it is useful to assign labels to people. But this usefulness doesn't make mental illness as "real as cancer", in the sense that it is a discrete category that we can definitively assign people too. One reason people prefer a diagnosis is that they prefer a label (even if it does come with some social stigma) to the greater social stigma associated with the same symptoms absent a "mental illness". Assigning such a label allows people (both the individual with the mental illness, and people around them) to view their symptoms in a different and more compassionate light. Most importantly, it allows people to think rationally about the best course of action for the person. My claim is that if society could be more compassionate, without needing to first assign a label in order to remove "blame" for people's symptoms, we wouldn't need the category of mental illness as much. E.g. instead of saying "I thought I was just a loser, but then I found out I suffered from depression", a person might say "I thought I was a loser, but then I realized that what society calls a loser is a person with certain characteristics, thought patterns, and patterns of behavior, and I decided that instead of judging myself for having these things, I would find the best approach to changing them". There is one more corollary to this, which is that "professional" help, in the form of drugs or therapy, may not be the only or best approach for such people.
- perfmode 12y ago
  There is mountain of evidence: http://m.youtube.com/watch?v=NOAgplgTxfc http://m.youtube.com/watch?v=NOAgplgTxfc
  - QuantumChaos 12y ago
    would you be able to point to how specifically this video addresses my points? I would be much easier to have a discussion if you did this, since otherwise people who don't have time to watch a 1 hour video will have to take it on faith that this video really addresses the questions I asked. And assuming it did, it would probably be useful to have the points summarized here so we could discuss them.
LordHumungous 12y ago
It's not just limited to startups. The "everything is awesome!" cult of constant positivity is becoming standard throughout corporate America, particularly the tech sector. IMO it is a counter productive attitude. Does ignoring the negative possibilities of life really increase your chance of avoiding them? It seems to me that recognizing those possibilities head on is a healthier and saner way to go through life.
- deleted 12y ago
  [deleted]
- ForHackernews 12y ago
  Barbara Ehrenreich wrote a good book about this subject: http://www.amazon.com/Bright-Sided-Positive-Thinking-Undermining-America/dp/0312658850/ http://www.amazon.com/Bright-Sided-Positive-Thinking-Undermi...
read 12y ago
Being vulnerable is powerful. http://www.ted.com/talks/brene_brown_on_vulnerability http://www.ted.com/talks/brene_brown_on_vulnerability You are vulnerable, but you are not weak. It is a sign of weakness to avoid showing signs of weakness. - Nassim Taleb
- bronson 12y ago
  Came to post the same thing. ftfa: "Asking for help makes you vulnerable, but it does not mean you are weak." I still need to learn this.
Balgair 12y ago
"When you are up to your neck in shit, start singing"[0]. This is from a very popular commencement speech this year at UT. Im curious to HN's opinion of this attitude in the light of the OP. I think that the scenarios are different, as the SEALs training is specifically against something, but the founder's depression arises from the against yourself. Possibly some of the lessons in the struggle for a good life and doing a good job that the SEALs have can be used to the benefit of founders and other tech workers. I think the quote I had there is a great one. When you are really in the dumps, go out and sing as a reflex. Possibly a good way to overcome the depression that many feel is to develop a better sense of yourself, so as to recognize when to just reflexively start singing. [0]http://www.artofmanliness.com/2014/05/24/manvotional-want-to-change-the-world-start-by-making-your-bed/ http://www.artofmanliness.com/2014/05/24/manvotional-want-to...
deleted 12y ago
[deleted]
Mz 12y ago
We need to get a lot better about dealing with the biochemical piece of depression but mostly we need to get better at dealing with the social constructs that keep people stuck with "unsolvable" problems. That seems, more often than not, to be the real roots of depression.
Maria1987 12y ago
Excellent blog! Reminded me of Silicon valey series :))) For me, It is encouraging to see that people in the same insane positions of starting their own company are facing similar problems with me and I am Not the only crazy person around! Starting your own company and fighting the unknown lonely steps of success is undeniably hard,scary and depressing but with some weird manner also extremely rewarding! The high risk always comes with the high satisfaction. people like me and many others, need to hear it get encouragement and an indirect form of support so useful and valuable to keep you going! I found great pleasure watching silicon valey series for this exact reason; and listening to real people having similar issues is even better x

92 points by ajiang 12y ago

Not just depression. Other related health issues like Bipolar Disorder are terrifyingly common in SV and other tech communities; far too many of my past and present coworkers are clearly suffering from symptoms that typically indicate depression, mania, or other issues. Worse still, some people I know are aware and accepting of the fact that they have issues, but they refuse to treat them because they fear antidepressants or mood stabilizers will impact productivity. One person I know explicitly refrains from treating his bipolar disorder because he thinks manic episodes make him productive. :-/ No one treatment is appropriate for everyone, but far too many people are willing to throw away their health in order to chase after the startup dream, despite the fact that it can hurt everyone around them in addition to shortening their own life.

anon48191 12y ago
I refuse treatment because I am afraid of the reaction of the people around me (family, friends, coworkers, employer) upon hearing I am being treated for psychological problems.
- DanBC 12y ago
  How would those people know? Why would they be unsupportive of you getting medical help for this medical problem? Would they be similarly unsympathetic if you got medical help for a different medical problem?
Nanzikambe 12y ago
> Worse still, some people I know are aware and accepting of the fact that they have issues, but they > refuse to treat them because they fear antidepressants or mood stabilizers will impact productivity. > One person I know explicitly refrains from treating his bipolar disorder because he thinks > manic episodes make him productive. :-/ The issue is a little more complicated than that, first amongst the many problems is the tendency to medicate unnecessarily - there're many different and interwoven reasons for this, amongst which are the financial incentives to prescribe, deficits in empirical understanding of the issues, and the extremely severe and detrimental effects of some of the medications. It's easy to blame a patient for unwillingness to participate, which can be the case, but doing so without an objective look at the reasons doesn't fundamentally address the problem. There are many other conditions both physical and mental, that are personally and societally difficult to discuss openly, yet they aren't plagued by similar levels of reluctance in patients. Why is that? I would add more so much more, as I hope you can understand, and as the article alludes to, these aren't issues easily discussed, especially not with relative strangers on the Internet and I'm not interested in hiding my opinions behind a throwaway. Suffice it to say that my own experiences have led to similar choices to the person you described, and whilst I've never experienced mania, I too believe myself to be better off for those choices. I can categorically say that the opinions shared by those closest to me, the effect on my creativity, productivity and my sense of "self", corroborate that. In my case, the choice wasn't to refuse all treatment or therapy, but only to refuse specific types of treatments which were drastically over-powered and negatively impacted me beyond any perceptible benefit. Subsequent consultations corroborated that decision, and criticised the treatment I was initially suggested as being so heavy handed, that it's analogous to treating a cut finger with amputation of the entire arm. One size does not fit all, and until approaches to treatment reflect that, we will keep repeating the same mistakes to the detriment of the afflicted. If you're lucky enough to have a supportive network of family and friends around you, I can only reiterate the article's salient point: "talk about it" and add the suggestion that you educate yourself to the best of your ability, to help making the best possible decision.
- electronvolt 12y ago
  Just on the subject of not medicating, specifically for bipolar disorder: in the case of bipolar disorder, medication is considered the only completely responsible primary treatment, with anything else acting as a supplemental treatment. (Therapy simply won't prevent later episodes, lifestyle changes can only lower the chance, and are less reliable than medication.) Medication adherence is also a problem in bipolar patients because mania and hypomania are characterized by euphoria, delusions of grandeur, overconfidence, and a lot of other symptoms people find enjoyable in the moment. I'd echo the suggestion of educating yourself to the best of your ability. Most people from HN are pretty intelligent: learning about one disease and the treatments for it is not difficult to do at a basic level. Generally those who've spent years studying it (say, doctors) are going to know more and be able to better contextualize that information, but it helps to know what the evidence is for a particular treatment, if it's considered responsible, what side effects to expect, etc., as it helps you better evaluate the doctor and makes you aware of your options.
Nanzikambe 12y ago
I have no idea why the comment by "anon48191" is dead - it's extremely relevant and part of the point raised within the article.
- Flow 12y ago
  If you really are depressed, everyone around you most likely already know it. They already know, the medication will not be the reason people know your mental health.
- anon96342 12y ago
  Thank you Nanzikambe. This is anon48191, I apologize for using yet another anonymous user. As outlined in my, unfortunately dead, comment I have reasons to stay anonymous (check shadowdead if you're interested in my original comment). I would also like to quickly address the comment by Flow: It might very well be that people around me already know. However, there's a big issue between knowing and officially knowing. Further, I never talked about medication. I personally don't believe much in medication. The steps I was considering were talking to a psychiatrist and take it from there. However as soon as I do this, it is bound to become public, as in public within my circles. I will not question Flows intention in their comment, their knowledge or familiarity of the issue. However, and you'll have to take the word from an anonymous commenter on the internet for this, I am most definitely depressed, if not worse, and outright claiming my (however anecdotal) comment is wrong, seems a bit harsh.
  - Flow 12y ago
    I've been fighting exhaustion/fatigue, and some degree of depression that seems to always come with exhaustion, for more than 10 years. It's been a journey to put it mildly, but now I know myself better than ever. From what I've read and learnt during these years, is that exercise seems to be the most effective treatment. This is the only thing I've not tried seriously yet. Medication has helped a bit. I can say they are no quick fix, you have to give them at least 3-4 months before you stabilize and can start to reason about how you feel and how to proceed. I hesitated before I tried them, and feel that it was quite dumb and a waste of time to not take them earlier. The last thing I'd like to mention, is Cognitive Behavioral Therapy, CBT. It worked really well for me. I managed to do several things I wanted to do for years, and the feeling was incredible to finally get out of the catch-22. Here in (Nordic Country), CBT is not a crazy sign. I know a lot of people that go and have CBT sessions for things like to reason about how to unstuck their life, solve issues at work. It's no more weird than having a personal trainer at the gym. From your wording it seems you really feel you need to do something. I don't think your mental health will get better without you changing or doing something about it. Perhaps you could take a few CBT sessions for your depression, but officially say it's because you want to accelerate your career? Soften your friend and coworkers by sending them links to articles about becoming more efficient at work via CBT? It's really unproductive and shameful that mental health issues are so stigmatic. Thank your for replying to me instead of just drive-by down-voting. I wish you luck finding a solution that fits you.
michaelochurch 12y ago
One person I know explicitly refrains from treating his bipolar disorder because he thinks manic episodes make him productive. Does he have hypomania or actual mania? True mania (not hypomania, which is sometimes benign) is a hot mess and I'd be surprised if he's employed 12 months down the road. It's pretty devastating, and I can't see why anyone would want it.
- kevingadd 12y ago
  I haven't ever observed him in full blown mania myself, but I've seen him in profound hypomanic episodes before. The frequency with which I observed it makes me very concerned, at the least. You're correct that true mania is a whole lot worse than hypomania. My perspective is that you should at least be getting regular guidance and treatment from a qualified psych, even if you aren't on mood stabilizers, to make sure you don't end up in the grips of a manic episode.
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alx 12y ago

https://www.youtube.com/watch?v=QnfOOoTOrDE https://www.youtube.com/watch?v=QnfOOoTOrDE 28c3: Geeks and depression panel

thathonkey 12y ago

We do need to talk about mental health. As a culture. But, sorry, I am not going to read Techcrunch article about it. Even publications that dedicated to following mental health (and ostensibly authored by "experts" in the field) tend to do a dubious job of describing what is an extremely complicated problem to which THERE IS NO QUICK FIX. Read that again. Addressing mental healthy problems is very hard work and treatment plans vary by individuals (not even by disease) so even once you find a doctor you like - no easy task - and whether you go into psychotherapy or the psychiatric [aka prescribed] route or both - you have a long, hard road ahead of you which will require a lot of patience from you and those that you maintain relationships with whether they are work or personal. There are lots of mental health disorders of which depression is a common symptom. It's important to work with a doctor you feel comfortable with to figure out if you suffer from depression, or if the root cause is some other disorder (OCD, bi-polar, anxiety are common amongst SDE types) which routinely causes you to feel depressed for days or weeks (or god forbid, months) at a time. Even if you are comfortable going the medication route (and there are many reasons why this choice should not be made lightly, especially if it is via anti-depressants or another - they're all habit forming and bring their own set of side-effects and problems), it is a long an arduous process to find the right one/right dosage/etc. that will work for you (if there even is one). Each one takes weeks to see results typically. Anti-depressants help some people greatly. Others will struggle with them and find them counter-productive to their treatment. There is no one-size-fits-all treatment plan. Mental health is a subject that doesn't get attention in any facet of American culture. PS. There is no evidence to suggest that the software industry suffers disproportionately from mental health issues compared to any other.

zrail 12y ago
The article is basically saying the same thing, for what it's worth, and is written by someone who claims to have extensive experience with the same issues you're discussing. The main message is "If you're feeling these things, please talk to someone you trust. If someone talks to you about these issues, please don't dismiss them." I think it's a good message, even if presented at Techcrunch. The more we as a culture talk about mental health issues in a constructive way the better.
wcummings 12y ago

joshontheweb 12y ago

This probably won't be popular here but I have suffered from depression since I can remember and the best remedy I have found so far is psychedelics. Not too often but in higher doses as Terence Mckenna recommends. Psilosybe Mushrooms in particular are good at helping me to shed my fears, love life, and create out of passion. Mileage may vary but I thought I'd put that out there. Any others who have similar experience?

kevingadd 12y ago
What other things have you tried? Did you try them rigorously (over a long period of time, comparing results with time periods where they weren't in use?) Did you try those things with the assistance or guidance of a professional? Lifestyle changes, self-care techniques, antidepressants, dietary supplements, etc. are all things a medical professional will recommend to you - and the antidepressants are often the last thing they'll suggest. Did you try all of those, find them unhelpful, and resort to psychedelics?
marvin 12y ago
I think this is very individual. Glad it worked out for you, but experimenting with self-medication with untested drugs could go both ways. A Google Scholar search for "psychedelic drug psychosis" makes clear that there is nowhere near consensus on whether this is an advisable option.
- lilsunnybee 12y ago
  Definitely! Like alcoholism, there is a risk factor in the use of psychedelics for some people, with a strong genetic component. It's important to take your own mental health history, as well as family history into account when experimenting. Especially before taking any high doses of anything, experiment just with lower doses first, with relatively sober, experienced friends present should anything go wrong. If you have a personal or family history of psychotic episodes though, including delusional thinking, be extremely cautious, and either only take lower doses or abstain entirely for your own safety and well-being.
lilsunnybee 12y ago

h1karu 12y ago

Isn't the real story here the over-pathologization of normal human experience in order to turn a larger profit (for the drug industry and the mental health industry) ? With the way these disorders are currently defined I'm convinced that every human being on earth could be diagnosed at various points within their life. I'm not suggesting that these symptoms don't exist, but rather that they've been a perfectly normal part of human life since the dawn of man. It's perfectly natural for people to go through periods where they have less energy than other periods, overeat or under-eat, have difficulty concentrating or making decisions, feel anxious. This is normal stuff depending on the life circumstances especially if you're drinking any amount of coffee because that will lead to periods of highs and lows. It does not mean you "have depression" as if there was some flu virus that you became infected with it simply means you're a human being. I would argue that legitimate diagnosis should be reserved for people who are either suicidal or who's symptoms strongly suggest elements of self-harming or harming others.

keithflower 12y ago
No. Some conditions are overdiagnosed, and there is a too-cozy relationship between medicine and pharma that is disturbing to many of us. However, to make a diagnosis based on Diagnostic and Statistical Manual (DSM) criteria almost without exception (one exception is for bipolar II disorder) require that symptoms (and several symptoms are required usually for any given disorder) must cause significant impact on one's lives, eg, "...sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features." or "...symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning." EDIT: (based on your own edit) - reserving diagnosis and treatment just to those at risk for self- or other-harm is going to harm many suffering people. I don't think you understand what depression really is. It's not caffeine withdrawal or the flu. Even when no suicidal ideation is present, it's a serious disease with real costs to the individual and to society, just as real as cancer. Beyond depression, I think you'd agree that even in the absence of harmful behavior or ideation, people who experience auditory hallucinations in the course of depression, or OCD sufferers who are unable to work because they must wash their hands hundreds of times a day, or who have PTSD triggered simply by backfiring engines, or who have dozens of other DSM diagnoses, all have legitimate illnesses that deserve much more than the terrible, stigmatizing suggestion that their illnesses somehow are not real.

lostapathy 12y ago

I would encourage everyone thinking about depression go watch this TEDx talk. He's not the most traditional speaker, but his story made a huge difference in how I understand depression. http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share http://www.ted.com/talks/andrew_solomon_depression_the_secre...

n72 12y ago

Does YC have an in-house shrink? I've always thought that if I ran an incubator, one of the first things I'd do is institute twice-weekly meetings with a shrink. I think such an arrangement would pay off amply in the long run. I know when I was my mid-20s, if I'd had a shrink to help me combat some issues which had the side effect of leading to severe procrastination, I'd have been considerably more productive. To me it just seems like a no-brainer from an investment point-of-view.

josai 12y ago
I've thought the same thing. I'm constantly amazed that companies don't consider the health of their employees, both physical and mental, worth investing in. It's my firm belief that it would pay back many times over. I like your shrink idea (though probably once a week is enough). If it was me, I'd also encourage daily 1-hour exercise (gym, soccer, walking, whatever). It really helps.
- michaelochurch 12y ago
  I'm constantly amazed that companies don't consider the health of their employees, both physical and mental, worth investing in. It's my firm belief that it would pay back many times over. Oddly enough, the "old-style" corporations that have gone out of style, did. At many investment banks, you can still schedule a confidential appointment with an on-site doctor or therapist. The depression stigma isn't as strong at the banks as it is in technology companies and in startups. I'm basically unfundable (cyclothymia, aka "bipolar 3") by VCs, but my condition, because it's well-treated, would be a non-issue at most financial firms (even at high levels).
laironald 12y ago
I participated in a top incubator and totally agree with this comment. cofounder breakups are such a nasty affair and I've part of one. we tried to resolve the issue but by the time it got to that point, it was a bit too late. I sometimes wonder if we would have addressed our issues sooner through counseling if this would have impacted the outcome of that company. I do think it could have resolved some issues faster. The problem with this incubator was the MD was also an investor, so it was very difficult to talk to him about our issues. I'm happy to be involved in a new company at a senior level, but like a long lost love, you kind of never forget.

bayesianhorse 12y ago

Having gone through this, my recommendation is to avoid talking about depression while depressed...

jamesbritt 12y ago
Interesting. I, too, battled depression and I don't think talking about depression was a problem for me, even when depressed. The catch here is that talking with people who don't actually know much about depression (e.g. the "just cheer up" crowd) can be a problem.
- bayesianhorse 12y ago
  I've found that depressions lead to a particular kind of reality distortion that is hard on most relationships. As is lack of interest, of course.

lilsunnybee 12y ago

If you're experiencing depression, consistently lowered mood, heightened anxiety, or other mental health symptoms, especially if you don't have a history of it, be sure to rule out physical causes and simple nutritional deficiencies as well with your doctor, in addition to pursuing psychiatric medications and / or therapy. Especially if frequent tiredness and exhaustion are strong components, you could be experiencing a change in endocrine function, particularly thyroid, a sleep disorder, or any number of other medical conditions. Sleep disorders especially are often underdiagnosed, and can go untreated for years in lieu of just treating psychiatric symptoms instead (I know this from personal experience). Conditions such as hypothyroidism are often similarly underdiagnosed. So if you're feeling extraordinarily tired all the time, and anemia and other nutritional and medical causes have been ruled out, get your thyroid levels checked and a sleep study done too, or at least bring it up with your doctor. But also don't hesitate to seek out treatment for mental health problems even if a known medical cause can't be found or has yet to be identified. It's all physiological causes really, but there's a lot we still don't know about the human brain and body, and treating symptoms, especially if they are having a significant negative impact on your quality of life, is just as important as trying to find a cause. And last but not least since we are talking about depression and depression-related conditions (such as bipolar, etc.), I just wanted to raise a little awareness for borderline (BPD) too. For those of you that have strong emotions, maybe a little impulsive, and/or a troubled childhood and suicidal tendencies, or have people in your life like that, you should find it really worthwhile to read up a bit on BPD: http://en.wikipedia.org/wiki/Borderline_personality_disorder http://en.wikipedia.org/wiki/Borderline_personality_disorder It's a diagnosis which has gotten a bad but undeserved stigma over the years, that needs better awareness and understanding. Whether you identify strongly with a BPD profile or not, if you struggle with strong emotions and/or suicidal tendencies in your life, a lot of Dialectical Behavioral Therapy (DBT) coping strategies and methods might be particularly helpful to you in dealing with those feelings: http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy Stay healthy and happy hackers, but don't be afraid to ask friends, family, and professionals for help when you need it either!

QuantumChaos 12y ago

Where is the evidence that depression is qualitatively different from being unhappy, or feeling downtrodden and apathetic? All I ever read on the topic is (1) scientific studies that associate certain diagnoses, with the effectiveness of certain treatments, and (2) the claim by people with these conditions, that they are qualitatively different. Is there any evidence against the following hypothesis: What we call mental illnesses are (with possible exception of Schizophrenia and Bipolar disorder), not qualitatively different from ordinary experience. But in order to provide treatment (e.g. various kinds of therapy) it is useful to assign labels to people. But this usefulness doesn't make mental illness as "real as cancer", in the sense that it is a discrete category that we can definitively assign people too. One reason people prefer a diagnosis is that they prefer a label (even if it does come with some social stigma) to the greater social stigma associated with the same symptoms absent a "mental illness". Assigning such a label allows people (both the individual with the mental illness, and people around them) to view their symptoms in a different and more compassionate light. Most importantly, it allows people to think rationally about the best course of action for the person. My claim is that if society could be more compassionate, without needing to first assign a label in order to remove "blame" for people's symptoms, we wouldn't need the category of mental illness as much. E.g. instead of saying "I thought I was just a loser, but then I found out I suffered from depression", a person might say "I thought I was a loser, but then I realized that what society calls a loser is a person with certain characteristics, thought patterns, and patterns of behavior, and I decided that instead of judging myself for having these things, I would find the best approach to changing them". There is one more corollary to this, which is that "professional" help, in the form of drugs or therapy, may not be the only or best approach for such people.

perfmode 12y ago
There is mountain of evidence: http://m.youtube.com/watch?v=NOAgplgTxfc http://m.youtube.com/watch?v=NOAgplgTxfc
- QuantumChaos 12y ago
  would you be able to point to how specifically this video addresses my points? I would be much easier to have a discussion if you did this, since otherwise people who don't have time to watch a 1 hour video will have to take it on faith that this video really addresses the questions I asked. And assuming it did, it would probably be useful to have the points summarized here so we could discuss them.

LordHumungous 12y ago

It's not just limited to startups. The "everything is awesome!" cult of constant positivity is becoming standard throughout corporate America, particularly the tech sector. IMO it is a counter productive attitude. Does ignoring the negative possibilities of life really increase your chance of avoiding them? It seems to me that recognizing those possibilities head on is a healthier and saner way to go through life.

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ForHackernews 12y ago
Barbara Ehrenreich wrote a good book about this subject: http://www.amazon.com/Bright-Sided-Positive-Thinking-Undermining-America/dp/0312658850/ http://www.amazon.com/Bright-Sided-Positive-Thinking-Undermi...

read 12y ago

Being vulnerable is powerful. http://www.ted.com/talks/brene_brown_on_vulnerability http://www.ted.com/talks/brene_brown_on_vulnerability You are vulnerable, but you are not weak. It is a sign of weakness to avoid showing signs of weakness. - Nassim Taleb

bronson 12y ago
Came to post the same thing. ftfa: "Asking for help makes you vulnerable, but it does not mean you are weak." I still need to learn this.

Balgair 12y ago

"When you are up to your neck in shit, start singing"[0]. This is from a very popular commencement speech this year at UT. Im curious to HN's opinion of this attitude in the light of the OP. I think that the scenarios are different, as the SEALs training is specifically against something, but the founder's depression arises from the against yourself. Possibly some of the lessons in the struggle for a good life and doing a good job that the SEALs have can be used to the benefit of founders and other tech workers. I think the quote I had there is a great one. When you are really in the dumps, go out and sing as a reflex. Possibly a good way to overcome the depression that many feel is to develop a better sense of yourself, so as to recognize when to just reflexively start singing. [0]http://www.artofmanliness.com/2014/05/24/manvotional-want-to-change-the-world-start-by-making-your-bed/ http://www.artofmanliness.com/2014/05/24/manvotional-want-to...

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Mz 12y ago

We need to get a lot better about dealing with the biochemical piece of depression but mostly we need to get better at dealing with the social constructs that keep people stuck with "unsolvable" problems. That seems, more often than not, to be the real roots of depression.

Maria1987 12y ago

Excellent blog! Reminded me of Silicon valey series :))) For me, It is encouraging to see that people in the same insane positions of starting their own company are facing similar problems with me and I am Not the only crazy person around! Starting your own company and fighting the unknown lonely steps of success is undeniably hard,scary and depressing but with some weird manner also extremely rewarding! The high risk always comes with the high satisfaction. people like me and many others, need to hear it get encouragement and an indirect form of support so useful and valuable to keep you going! I found great pleasure watching silicon valey series for this exact reason; and listening to real people having similar issues is even better x