Why is the media doing this with old depression treatments that have been around for ages? First it was the deep brain stimulation article, now this? rTMS technology has been around since 2008. The picture they are using is the same magnetic figure 8 coil that they used on the first devices and not even the newer technology using the Brainsway or deep TMS device.
This article is incredibly frustrating. This is NOT new technology. It is a different modality called theta burst which they didn't even mention the name of in the article. The benefit of using theta burst is that you can do TMS courses much faster. This is a major benefit but the technology is still the same. If you didn't have remission with the prolonged rTMS course theta burst is not a magic bullet. The benefit is that it's easier to do bilateral treatment and speed up the treatment quite a bit. Normally you have to come in every business day for a few months for 20 mins at a time.
It really sucks to have "lay people" in my life email me these articles like this is some new breakthrough. The articles often come out prior to FDA approval but these modalities have been around for 10+ years prior and I always knew about them with someone with treatment resistant depression. Remember, off label treatments are a thing, and theta burst was available well before this study came out.
I'm currently undergoing deep TMS treatment with the Brainsway device on my left hemisphere and they were able to boost the treatment by adding the theta burst with the figure 8 coil like in the picture to do my right hemisphere to improve chances of remission. It is a good trick and it boosts your chances of remission because it's faster and easier to do bilateral but as I said there is nothing magical about theta burst other than it's a very fast treatment. Those who didn't have remission on long courses of TMS before unilaterally probably aren't going to magically have remission on this. What we might end up seeing is some kind of threshhold that wasn't achievable in the past, say that some people could reach remission but it's not feasible to come into the office every day for 6 months.
Anyway TMS is great and should be used more but I just hate these dumb articles. Especially since it's touting this as some magical new technology. No way. And we're still a long way from TMS being prescribed in general cases - less side effects than meds but insurance wise you have to trial and fail several meds before it's covered. Even SSRIs which are given out like candy can have severe side effects like GI bleeding. TMS is very, very safe with few side effects. For me it was just discomfort during the treatment but not after.
Also just got to say this quote summed up how ridiculous the article was for me: "“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we're finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we'll supplement the conventional chemical imbalance and psychological conflict models with a new brain circuit model.” In other words, psychiatrists will use electricity instead of talk therapy and drugs to treat mental health disorders." No reason to make rTMS sound like some Frankenstein tech and no, rTMS will not be used "instead of talk therapy and drugs".
TBH a little disappointed at hacker news, next time link to the study! I would love to see articles on NEW treatments for depression. Spoiler alert..there really haven't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.
> TBH a little disappointed at hacker news, next time link to the study! I would love to see articles on NEW treatments for depression. Spoiler alert..there really haven't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.
No sorry, this is silly. For one thing, because speeding up a treatment from taking 6 weeks to 5 days is still pretty huge. And also because what inevitably happens is:
> New experimental treatment with potential discovered
HN: "yawn, most of these never pan out, let me know when they have completed studies"
> New treatment study shows amazing results
HN: "Okay, but nobody can get it yet, right? It's gonna be years"
> New treatment widely available
HN: *crickets*
or
HN: "So what? It's not a NEW treatment, we've known about this for YEARS now"
No matter what, you have people dismissing some new thing, because either it's too new to know for sure whether it works, or it's not new enough to be interesting. Your comment is a perfect example of that, as it's new enough to where most people probably have never heard of this treatment, but you're already dismissing it as too old and boring.
I think you missed the point of my comment and fair enough because I was ranting :)
TMS is a GREAT technology. More people should use it, and it should be considered first line treatment over meds. These machines should be in inpatient psych wards. TMS will inevitably help people. I'm not contesting any of that and this is a good thing.
HOWEVER - this is a small study and I'm willing to bet they didn't include people who had failed previous rounds of TMS (or maybe even people who had failed ECT) for a reason. Because it's still the same technology. I'm pretty sure that the remission rate for this will top off around 30%, perhaps a bit more, when more studies have been done and we're looking and real world treatment resistant patients, which is about what we see with TMS (and ketamine for that matter) already.
The point I'm trying to make is that treatment resistant depression is very common and debilitating. If someone is very treatment resistant, they will have tried TMS in the course of their treatment, as I did in 2012, when it was first released. I'm not sure how common this is but in my state Medicaid covers the cost of a course of TMS.
We need new treatment modalities, not because TMS or existing treatments are "boring or "old news", but because treatment resistant depression is a serious issue and we have very limited tools as of yet to help people who aren't responding to these end of the line treatments.
I'm also wary of how TMS is handled in clinics. It can be a bit cult like in some places (doctors overprescribing, overpromising, shrugging off side effects in populations that shouldn't be getting it like bipolar). The quote at the end of the article scares me too. I've noticed the more widespread and accepted a treatment becomes, the more stigmatized and impossible it is as a patient to get help. BUT WHAT PROZAC DIDN'T WORK FOR YOU?? BUT HUHH, CBT DIDN'T WORK FOR YOU?
15 years in, I still get doctors trying to get me back on an SSRI and try behavioralism on me. There are people who are very treatment resistant, and we need to understand this isn't a cure all. The more of a "fad" something becomes the more screwed you are in the medical system looking for help when it legitimately didn't work for you, even though we know even from this paper it's not a 100% remission rate. That's my perspective and lived experience that I'm trying to bring to this discussion.
TMS is great, and it's great it's being adopted more. But I'm wary of what that means for people who really need help and have failed TMS and other treatments and need and new modalities like me. I can hold both perspectives.
> If someone is very treatment resistant, they will have tried TMS in the course of their treatment,
[citation needed]
A dear relative of mine has depression that medication has only sort of worked for, and they'd never even heard of this treatment before I just linked them to it. I think you're drastically overestimating how aware people are of more recent treatments. Not everyone is hyperconnected to new medical developments.
Plus, making a fairly effective treatment work in five days vs six weeks is still a huge deal. And that helps answers your question of, "Why is the media doing this with old depression treatments that have been around for ages?" Because it's not actually that old, a lot of people don't know about it, AND it's a big step forward for the practicality of that treatment.
I wouldn't consider your relative necessarily treatment resistant. I'm talking about those of us who have been left behind. In my case, that's 15+ plus of over 30 medication trials (following the STAR-D algorithm as well), failed bilateral ECT, TMS, ketamine IV, trigeminal nerve stimulation, and more. I'm on disability for the depression.
I'm not trying to invalidate your relative's situation but there are also people who have been stuck in the system for years like me and we need NEW OPTIONS. As I said, both things can be true. TMS being made faster is good, but we can't stop there, and that's my perspective on the article with someone with my lived experience. Not everyone knows someone this treatment resistant so I'm offering my unique experience about it. Your relative's experience and anyone who has tried a few meds or even hasn't and wants to try TMS is valid and I'm happy this exists. What I'm saying is that for the smaller population like me who has already been left behind this isn't going to help that much.
> Even SSRIs which are given out like candy can have severe side effects like GI bleeding.
SSRIs and SNRIs can cause akathisia. It happened to me, and it was by far the worst thing that happened to me ever in my life. I went through 6 months of nonstop hell with akathisia, and it was the worst 6 months of my life. Trust me, if you have severe akathisia, it is worse than death.
SSRIs are awful. I still have doctors trying to throw them at me after 15+ years of treatment resistant depression. It's honestly delusional. MAOIs actually have less drug/drug interactions and less systemic reactions if used responsibly. If another drug had the same dangers SSRIs had I don't think doctors would be overprescribing it as much but by definition people who are going in to get Prozac, we can easily tell them everything's in their head and blame anything that happens on their disorder.
SSRIs also INCREASE the risk of suicide and a trial with healthy people without history of behavioral health issues on Prozac ended in some of the patients dying this way. This has been a huge cover up and I'm not sure if these meds got the black box warning about this. It's easy to say "ohh these patients would have done that anyway, they're depressed" but that's not what the data shows...
I don't know about a cover, but the notice at least in France for venlafaxine (Effexor) are quite clear about the increase of suicidal ideation in the first week(s), during which neurotransmitters rebalance. I was briefed by my doc and it still was quite the experience, trying the whole day to keep myself from jumping in front of trains, cars, or from bridges, windows, cars... Like 'WTF is happening to me'.
I also had very strange differences in mood or tolerance between brands of generics, that I'd never had before with any med. I'd go from OK to crap in 2 weeks and my wife would link it to prescription renewal and pharmacist giving me whatever brand. I used to think it didn't matter...
Oh and venlafaxine is a bitch to taper out. Constant vertigo, nausea, ringing and tingling, migraines and the fun panic attacks...
If we can find better, please please please keep researching.
> If we can find better, please please please keep researching.
Agreed. The current push and research around ketamine/psilocybin is promising but can't come fast enough. Other than the ketamine spray which is still very hard to get and needs to be taken in office there have been no novel depression treatments for decades really.
This is very interesting. TMS has always been a no go for me on account of how much time it took and how expensive it was. 5 days is very dooable compared to 30 days, every day, for a month.
The most difficult thing about depression treatments is that most medications take 2-3 weeks to kick in and it's hard to get motivated to see the treatment through.
Chemically here's what worked for me:
1. Ketamine saved my life. It's the only thing I've encountered that provides instant relief. If you're in a particularly bad moment and buried by your thoughts, ask your psych to write you and Rx for Ketamine nose spray. It's much cheaper than intravenous Ketamine and highly effective by my experience. There's a pharma version of Ketamine on the market now (esketamine) but that require heavy doctor supervision and are also expensive. There are special pharmacies that synthesize the nose spray for you. The effect of those small, regulated doses of ketamine is like putting your brain in the sink and giving it a good wash. It helped me through some rough times. The best part about it is that it's non-addictive. Once I got through the deepest of my doldrums, I stopped filling the Rx.
2. Wellbutrin. It's the only pill that worked for me, with the fewest side effects. The only side effect is that my libido is now significantly higher (undesireable, for me).
Paramedics gave me Ketamine on the street after an accident last year. And then for 6 months after, it was like a veil had been lifted from my mind. I noticed I would laugh much more easily, I felt happiness every few days when random pleasant things happened like seeing the sun or having good coffee, I was in severe physical pain from the results of the accident and yet it was the least miserable time I've had in the past decade.
I only connected the dots a few months back when looking into what Ketamine does. It's a miracle drug, I'm hoping my doctor will prescribe it to me but it looks like in my country you need to have been prescribed other anti-depressants and for them to have failed.
I had ketamine for a colonoscopy and had the exact same experience. I woke up feeling like I had the best sleep of my life, and filled with an extreme contentness, just bliss, that lasted for 6 weeks.
I have bipolar II, and usually suffer from depression. Unfortunately ketamine is not legally available for me.
My doctor wants to get me on esketamine and insurance will cover it -- the issue we're having is my doctor is 2200 miles away and I have to take it under supervision (we're looking at who we might be able to partner with to try this). I'm hopeful I'll be able to try it in the new year.
I'm really glad Wellbutrin worked for you. When I tried it ~20 years ago (as a young teenager), it worked well for me for a few weeks and then absolutely did not work anymore. But that's the beauty/pain of SSRIs. There are a million of them and they impact each person differently.
COVID has been great for telehealth. Talking to a doctor is so much easier over Zoom. I hope you're able to get it as well. The effect is orthogonal to that of every other anti-depressant out there.
The hardest part about finding the right meds is the patience/iteration/experimentation you need to finally land on the right thing and, knock on wood, I've finally found that stability.
I also recommend that those experiencing SSRI-resistant depression try it. SSRIs didn't do much for me other than hit me like a rubber mallet to the brain.
Wellbutrin's subtle stimulation has been so effective for the type of depression where you want to stay in bed and have no motivation to do even the basic things, which is how I felt before.
If you're reading this and depressed, you're not alone. It will get better, and you too will eagerly look forward to your days ahead.
Second: what are the negative impacts of alternative treatments?
Not clear what the level of impact is in humans and what the real trade-off is between better mental clarity when young/middle-aged vs. higher risk of cancer in old age. In the end we all die of something.
NAC is widely consumed, if it was a significant carcinogen you would think the effect would have been detected.
The study is at the level of cells, so 'in mice' doesn't seem inappropriate. But yes, this is one study and I'm not a medical researcher. This is merely one study I happen to know about; I'd rather mention it than not. If thinking about consuming NAC, please do your own research.
Honestly, I can't speak more highly of N-acetylcysteine. It helped me reduce my caffeine consumption to near zero and helped me battle my attention deficit issues. I bought out the entire stock of my local grocery store after trying it for a few days. I'm afraid of sounding like one of those supplement nuts but it really worked for me.
The recommended dosage on the label was enough for me to see full benefits, 600mg. The effect is within an hour.
As other people in the thread said, it may not be without side effects. The FDA has not approved it as a dietary supplement. Please do your due diligence.
Personally I've linked caffeine with anxiety. The more I take the more anxious I feel, particularly if I take caffeine a few days in a row. So now I'm only occasionally having some, like on weekends or on family holidays.
I tend to drink caffeine with I need to recruit mental energy. I find I don't get compulsive cravings to drink coffee and I can drink a single cup of coffee and be fine for the entire day. If anyone knows why this is, I'm all ears, I'm honestly shocked.
Yep, me too. I started three weeks ago. It's truly unbelieveble. Here's how much satisfied I am with the results: I would gladly trade 10 years of my life to continue like this than live them as miserable as I was, plagued with rumination, anxiety and horrible attention control.
I had a very nasty depression. Extreme mood swings. From very low up to neutral and back. (I never had manic episodes) Up and down, up and down... It was maddening. And extreme rumination. I discoverd acetylcysteine by accident. I didn't know it could help with depression. I felt its effects within an hour. I immediately went on the internet and searched for "acetylcysteine and depression". That is how I found above article. The internet is full of articles about the efficacy of NAC in relation to psychiatry. I used it for about 6 months. 3 * 600 mg daily.
> She says it felt like a woodpecker tapped on her skull every 15 seconds
> Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain.
All this sounds counterintuitive to me. For someone on the brink of a crisis daily, something that sounds like torture (a tap on your skill every 15 secs during 10 hours) helped her to feel relaxed at the end of the day.
My depression-like symptoms are caused by boredom. It would be really interesting if this would somehow make me not bored sitting in a chair for 10 hours.
Just to give some context. It’s not directly my line of work, but my employer filled out a New Drug Application (NDA) with the FDA recently and we were told the whole thing exceeds 200’000 pages. Given the size and amount of data in there, one year seems reasonable for FDA review.
No but i “felt” the effects of it but its hard to describe. it was pretty mild though but enough to dispel the idea i had that those 20 minutes would be meditation time!
Of course anecdotal and the effect might have been from the noise or vibration
Then for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain.
I wonder what the cost will be. A friend of mine had regular TMS 30 minutes a day, five days a week for a month and the cost even with excellent insurance was well north of a thousand dollars. This is five times as much time in the machine.
33% of Americans are living paycheck to paycheck. 45% of Americans have no money in a savings account. 69% of Americans have less than a thousand dollars in savings.
These numbers are based on flawed methodology. BLS data has the median US household having $1000/mo in discretionary spending. Of those that save it rather than spend it, they're unlikely to do so in a classic savings account, but add it to their checking account or an investment portfolio. Many people, including very rich people, don't even have a savings account yet they'd be counted in your 45% as "having no money in a savings account" or "having less than a thousand dollars in savings" (which derives from how much is in a savings account).
> If it works as advertised I don't think people would blink an eye at paying 5 figures for it.
>> [snip]And most of the Western world has healthcare where this would be covered for all citizens.
Well, let's be honest with ourselves here- if it's covered for all citizens, they probably wouldn't bat an eye at it whether it costs five figures or one.
Which has absolutely no relation to the claim that people would have no problem paying five figures for it. Additionally, public availability is often poor. For example the UK has a large and thriving market of private TMS clinics, with multiple competing providers.
Sure they would, considering a very large number of people (most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense) don't even have 5 figures.
Yet people buy 5 figure cars all of the time for much dumber reasons than crippling depression.
> most people, if you believe those surveys that say most Americans would borrow money to pay for an unexpected $400 expense
This is idiotic. I would technically “borrow money” as well because I would likely put it on my credit card since that is by far the most convenient way to pay for things (and gives you the most protection as a consumer). I would just pay it off at the end of the month though.
No, what's idiotic is calling putting something on a card and paying it back at the end of the month "borrowing money." Your perspective is very classist.
Scroll to the bar chart. To pay for an unexpected $1k expense, 41% would pay from savings, 13% would reduce their spending on other things. I think we can agree that 41+13=54 which is "most" would thus pay without any form of borrowing. What's left that's not unknown: 16% would pay with a credit card, 14% would borrow from friends/family, and 7% would get a loan. The article adds all three sources up to hit 37% and create a headline: "Nearly 4 in 10 Americans would borrow".
> The maintenance therapy with ketamine (from twice a week to once in two weeks) appears to be a promising option, although the evidence to firmly recommend it is insufficient
> The approval of esketamine for TRD by the FDA was controversial due to limited and mixed evidence of efficacy and safety.
> In January 2020, esketamine was rejected by the National Health Service (NHS) of Great Britain.[41] The NHS questioned the benefits of the medication for depression and claimed that it was too expensive.
It's too early, and it's for treatment resistant depression.
So yeah, unless you're a doctor/neurologist and know the protocol for validating drugs, it's not really worth listening to the pseudo science advocated by drug users who also encourage taking psilocybin/LSD/MDMA as a silver bullet, and constantly talk about pharma conspiracies. "Listen to the professionals" is a better advice.
I don't know about Wikipedia's editors but decent meta-analyses were already showing solid results in 2014[0] and this meta-analysis of 24 RCTs this year also shows decent results. The NHS reasoning is that it's too expensive, not ineffective and even that seems odd to me as it's produced pretty cheaply to use for variety of purposes. I'd guess the expense is due to the patents of esketamine used to approve it for depression while being able to profit, but that seems to be the less effective type at any rate.
I was depressed from age 20 to age 45. 10 years of meds and therapy, then therapy therapy therapy. Then I moved back to S. Florida after about 30 years, and I nearly went out of my mind, persistent mania. I self-treated mania successfully with decent herb.
But the experience taught me something, and I investigated and learned more. Sunlight regulates mood. Too much sunlight causes mania (which neatly explains the Florida Man phenomenon). I have cured my 25 year long depression with Sunlight and, when needed, sleep-deprivation (basically, I'd skip a night every once in while if I wasn't getting enough sun in my eyes), and I haven't felt clinical depression in over 7 years, and even through a few family tragedies during this period, my mood has not slipped once in just over 7 years.
The things done to the depressed by "modern" medicine is sometimes medieval. Electro-Convulsive Therapy should be illegal. It is the same thing as the scientist with the frog, cuts off one leg, still jumps, cuts off the other leg, frog is deaf. ECT isn't a valid treatment for anything at all. ECT fries the neurological system, obliterating neuronal myelin (which may take 20 years to return, and risks psychosis when it does for the return of a now unfamiliar internal monolog, racing thoughts and hearing voices. In all cases where a patient receives ECT, all cases with no exceptions, the patient will subsequently develop a pain disorder and are no longer able to recognize sarcasm, pinpointing some of the brain-damage ECT causes. Someone close to me was forced into ECT treatments by a quack psychiatrist. It murdered her, her body was still alive, but the person she was... was gone. 20 years later, when her wonderful personality only just started to return, she could no longer sleep because of being unaccustomed to the returning rush of internal thoughts, throwing her into a persistent depression due to going weeks and months without a decent night's sleep, until she took her own life.
I'd like to offer some advice to the depressed: stay away from psychiatrists, their only form of treatment is some pill that makes you feel worse. If you need prescriptions, see a Psychiatric Mental Health - Practical Nurse (PMH-NP). Psychologists also help, and they are harmless. Never ever submit to ECT, it won't help you, it just makes you more manageable to other people. If you can get off prescriptions, try getting more sunlight in your eyes every day it is possible, and if you don't get enough, skip a night's sleep, but never more than two in a row. If you experience mania, be very careful. Lithium, for all it's side-effects, rapidly brings stability, but it's effects wear off once levels drop too low. I'm not going to recommend anyone smoke pot, but it worked well enough for me as a stabilizer.
But of all the antidepressants tried over 25 years, nothing worked remotely as well as religiously getting as much bright sun in my eyes as I could.
From reading the linked paper on the study that was conducted by the Stanford School of Medicine, what aspects of the study did you deem to be unscientific?
I find depression very interesting. Maybe because I am sometimes on the brink of depression myself. Maybe because I am interested in the other side of the spectrum: How to live a happy life.
One thing I often wonder: What happens when a depressed person forces themselves to do things that are associated with not being depressed? Workout, dopamine fasting, social interaction.
When I observe myself in depressed phases and people who suffer from worse forms of depression, usually they do not work out, do not spend empathic time with others and constantly dopamine binge (via eating or other forms of quick pleasure).
Would a change of behavior/lifestyle change the depression?
Depression is like a catchall term to represent symptoms that could have any number of causes, which is why treatment is very difficult and inconsistent from person to person.
A lot of the time the change in behavior is a coping mechanism rather than a cause for the depressive symptoms. They don't work out because they are so physically drained they can barely even muster up the energy to fulfill their responsibilities, or they become recluses because they believe their social connections aren't capable of supporting that level of vulnerability.
I suspect that it is more like the other way around, in that lifestyles incentivized in the developed world are rather poor at mitigating causes of depression, and by that I mean on a more fundamental, macro level instead of individual, which is why it has become so pervasive. For example, we have a fairly individualistic society, where many people have very shallow roots in their communities because of various causes of upheaval like immigration, education, employment. This makes it very difficult to get compassionate community support, which leaves mental healthcare workers to fulfill that position in a clinical manner.
>lifestyles incentivized in the developed world are rather poor at mitigating causes of depression
More like, intentionally designed to cause mild reactive depression. You even have social media corporations openly admit to running psyops on their users.
depressed people probably spend more money on random bs trying to make themselves happier, or soothe their psychological pain.
> One thing I often wonder: What happens when a depressed person forces themselves to do things that are associated with not being depressed? Workout, dopamine fasting, social interaction.
First, that's borderline impossible to the point that it's an impractical and irrelevant suggestion. Second, for many, including myself, not much results but more stress and misery. Depression isn't one disease and is just a syndrome (a set of symptoms) caused by many different unrelated conditions and for many people those causes are entirely biological- not behavioral- and need to be treated like any other physical ailment. For some people (but not all), medication, therapy or other treatment can cause an improvement great enough for them to do be able to do those things and for some of those people (but not all) doing those things does help.
For depressed people I wonder. How much is it the brain's "fault" or is it genuinely something (a lot of) thing(s) wrong in the person's life?
It's easy for example to overlook trauma, and just blame ourselves "why can't we just be happy" or our brain's chemistry, while ignoring all the terrible things that happened to us, because it's too painful to relieve them.
Aren't treatments like this like reducing a person's fever by force (which they got because of a bacteria infection) while not fixing the underlying issue that caused it in the first place?
TL;DR:
Instead of asking "What's wrong with you?" and making that part right by force, shouldn't we be asking "What happened to you?" and helping with that?
Mental health conditions (like clinical depression, especially personality disorders etc) more often than not tends to be due to multiple factors, dominated by genetics and environmental/traumatic experiences. - [0]
A lack of willpower does not make something "borderline impossible". Not to suggest that it's easy to get someone to do something that they don't want to do, but let's not remove personal agency here.
I wonder to what extent this mindset of viewing depression as purely biological is responsible for keeping people in depression by removing their sense of agency over it, as well as fostering dependence on drugs that at best result in temporary relief with a constant need for ever-increasing dosages as desensitization arises, and at worst can actually dramatically worsen one's mental condition (happened to a friend of mine recently who started experiencing depression since COVID lockdowns, was prescribed medication by a therapist, which seemed to be working at first until he started experiencing bipolar psychosis, and has now been switched to another medication and had to have the police called on him after multiple episodes of insanity, and is now on the verge of being sent to a mental hospital)
> Someone mentions lack of willpower and personal agency.
It's honestly incredible how people STILL try to argue that depressed people should "just get over with it", just stop being sad and stop being lazy. My god.
Excuse me, but you have fundamentally failed at understanding what depression even is and apparently conflate it with some rebel teenager phase during puberty by telling people to just get a grip on themselves.
Strawman fallacy. I never said that it was easy or "just get over it". To quote my original post: "Not to suggest that it's easy to get someone to do something that they don't want to do, but let's not remove personal agency here." My comment was simply disputing the other comment's assertion that forcing oneself to do something outside of their comfort zone like going to the gym when depressed is "borderline impossible to the point that it's an impractical and irrelevant suggestion". It is my belief that this victim mentality and remove of one's sense of personal agency in the matter is at best useless, at worst incredibly damaging.
Even the original commenter stated that for some, depression is purely biological, whereas for others, it may involve behavioral components. It's kind of ridiculous that anytime someone mentions personal agency in a depression thread, one gets heavily downvoted with hoards of commenters jumping in to say "depression is purely biological and only treatable through medication and therapy!" Ok, perhaps this is true for many depressed people, but what is the breakdown of depressed people who's depression is purely biological like this vs. those who's depression is also behavioral (I would guess the former being a small minority)? Why are we not allowed to acknowledge the latter? How does speaking to self-agency make anyone worse off?
Depression is complex. Let's not reduce it to something as simple as being a biological disease curable only via medication and therapy. In the past I would've said something along the same lines as my previous posts but excused myself out of the conversation earlier since I don't really have a horse in this race. But now that I have a close friend who's experiencing psychosis and basically lost his mind (eg. running around naked, talking to voices in his head) due to some psychiatrist prescribing him with the "wrong" depression medication, the issue has become personal to me. Apparently even the "experts" don't seem to know how to treat depression, so let's not speak so condescendingly and matter-of-factly as if anyone knows what they're talking about here.
You seem to be conflating also biological with purely biological. The parent was arguing against reducing depression to biology only, not claiming that biology plays no part in it. The link you provide does not prove that "medical and scientific mindset" views depression as purely biological - it just shows various ways depression affects/is affected by biology, which is not mutually exclusive with other things playing part in depression. I believe the current scientific consensus is that it is not even possible to clearly separate biological from psychological or behavioral in a complex system where psychological states affect biology and vice versa.
Your invitation to "educate yourself" seems condescending and unnecessary.
Honestly the random question of “what would happen if you just forced depressed people to pretend they’re not depressed” when my understanding is that is about the same as wondering what would happen if you had chronically ill folk try yoga. That is to say, a generic wellness strategy that shows condescending attitudes towards the severity of someone else’s disease. Someone with depression very likely attempted to exercise, eat right, etc and found that it is either impossible to perform when suffering from untreated/treatment-resistant depression or that their depression involves the inability to respond appropriately to exercise and a good diet.
Depression changes substantially the way you think, apart from leaving you with no energy. You do not realize how much or in what ways unless you have passed through it, really.
“Doing” things is literally impossible (well, torture is possible but unsustainable).
What you have seen is probably depressed people not managing well. Do not call it dopamine-bingeing because there is absolutely no intent there.
Depression is very very debilitating and it really messes up with your mind in unfatomable ways.
There are 2 "types" of depression: situational and physical.
- Situational: you force yourself to do things, you feel better and break out of the cycle
- Physical: you force yourself to do things, you don't feel anything but suffering. You don't get endorphins from exercise, you don't get serotonin from going to events and hanging out and achieving things. Depression is usually anhedonia which is a loss of feeling - whatever happens you're completely emotionless
Depression creates a feedback loop: not doing things makes you depressed, depression makes you not do things. So sometimes you are just lazy and need to start doing stuff. But sometimes it's a physical depression which caused you to stop doing things, and just doing things again won't make you not depressed. That's why I generally suggest starting and trying things, to see if they have any effect, but don't push it otherwise.
No, that's what you're saying - I'm not sure where your rephrasing comes from, as it doesn't correspond to anything I've written above.
I'm explicitly saying "it" [that is, forcing yourself to do things, like get in the sun, exercize, sleep less, better diet, etc.] does change something psysiologically, and does help, even in cases of non-situational depression.
The grandparent comment claimed that this helps only in cases of situational depression.
And often, even if you want to, you can't. Like, no matter how much you want to, you can't force yourself to get out of bed or go for a run or socialise of whatever.
It's not a case of "doing what you normally do" either. What you normally do got you to this point. It's about recognising the situation and pushing through it, as though you were a robot, and taking a walk around the block, let's say.
Winston Churchill used to paint while he's depressed. Its not a case of "they are hopeless" - they need to move and do something. And in the process, recognising what the triggers are and how to overcome it.
Part of the problem here is the vagueness of the term. Sometimes, diagnosing someone with "depression" is like diagnosing them with a headache - accurate, but not particularly clinically useful.
Lifestyle changes will help some depression, it will not help others. Generalizing from your own experiences is useful, but be very careful with how you present this to others.
Telling a chronically depressed person they just need to take a walk and eat some fruit is not just insulting, it's fodder for self-invalidating thoughts which can increase self-destructiveness.
And it’s hard to accept that your life style is “bad”. You can’t be you, basically, as if you were born untreatably ill. For me personally, these abnormal states turn on the rage against the nature, which in turn motivates to do workout in intricate ways sometimes, but it may not be the case for other people or for other activites. E.g. no way I’m going to look for a social interaction when depressed and/or anxious, that will only strengthen the negative effects.
It all ends up with a constant questioning why the life (in a sense of nature etc) is so fucked up and cannot exist in different forms than “normal”. You become an almost broken engine which it feels like requires a maintenance 24/7 and now this is your life. Yes, you can do that, but it is itself demotivating.
I fully agree with the triggers part though, and that can only be done through doing something.
Depression in many ways is consistent with "sickness behaviour". It is often a signal to get away from a stressor, just like sickness behaviour you have during flu is a signal that it's time to lay down and rest.
P.S. inb4, yes, there are other kinds of depression, like endogenous depression and such that are different in that regard (and treated differently too). none of the exceptions invalidate the most common scenario.
I understand this quesiton, but it is an ignorant and insulting one.
Though I do not suggest it was intended that way.
It is unfortunate that the term "depression" is used frequently
for things that are not really depression.
I highly recommend this lecture by Stanford's Sapolsky On Depression
to understand the difference. He will do so far more articulatly
than I ever could.
As a person intimately familiar with depression as it has been with me for decades and it is still deeply inside of me the answer to your question is “No”.
Depression is hell. It sits inside you. You cannot run from it, you cannot hide from it.
Whatever you do it is still inside you and it does not let up and it tortures you continuously.
It does -not- improve by going for a walk.
It does not go away with social interaction.
It does not go away by not eating.
It turns the entire world bleak.
I have to time my interaction with other people carefully, so I won’t start screaming before I am alone again.
Asking a depressed person to “go for a walk”, “exercise” and things will be better is absurd.
It Is like asking person in a wheel chair to get up and go for a run,
It is also the standard reaction from people once they hear “you are depressed”.
They have no idea whatsoever what they are talking about, and I wish people would just stop it. Don’t you think if it was that f…ing simple I would have done it a long time ago.
I feel a deep need to scream at a person who suggests it, but you can’t do that in this society.
If I could put a finger on them and let them experience what is inside me for a moment they would be the one running away screaming.
However, in my experience, when you truly are clinically depressed, (1) you can't really force yourself to do anything good, and (2) even if you do something positive, you'll just get tired from trying to look like a functioning human being and may even feel worse.
In general, doing positive things do help, but only after you started medication and/or psychotherapy.
Is dopamine fasting really a thing? Sounds very dubious to me, dopamine gets a bad rap but it's actually a very essential chemical in the brain for all kinds of things. Maybe what is meant by the term is more 'digital detox' which I can see working for all kinds of reasons unrelated to dopamine.
No its not a thing. It's a modern variant of the holistic detoxification fad. There might be good things in taking breaks from your everyday stimuli, but the connection to dopamine is wholly imagined and pseudoscienctific.
* If I don't eat sugar for a week, the next time I eat it, it tastes way better
* If I don't watch TV for a week, the next time I watch a good movie, it's way more enjoyable
* If I'm physically active for a week, the lazy day after that week of physical activity is more enjoyable
In my experience, a lot of things in life seem more enjoyable when moderated. The list can certainly be expanded.
No clue if this is official dopamine fasting, but that's what it makes me think of. And to be honest, I don't care what the science says on this*... my own personal experience is important enough for me to change the way I behave.
* unless it says it'll somehow lead to some horrible outcome down the road... then I'd consider it
About the third point, interesting that it's exactly the opposite.
If I get used to being physically active, the next day that I am NOT physically active I feel terrible.
On the other hand, if I have been lazy for a period, then one day I do a very brief exercise, even a 10-min moderate run, makes me feel excellent. However when I start doing those runs everyday, I don't feel that same good feeling.
> If I get used to being physically active, the next day that I am NOT physically active I feel terrible.
How hard are you pushing it? Increase the difficulty/duration, and you may find a different outcome. I'm not talking pro-athlete level, but competitive high school athlete level (2-3 hours / day, 5-6 days / week, with some good lung heaving moments each day).
> On the other hand, if I have been lazy for a period, then one day I do a very brief exercise, even a 10-min moderate run, makes me feel excellent. However when I start doing those runs everyday, I don't feel that same good feeling.
I don't think this is the opposite. One is moderation of laziness, the other of physical activity. "If I'm lazy for a week, the day of exercise after that lazy week is more enjoyable".
Hardness varies but it's always proportional. Doesn't matter if it's a 10-min extra walk or 3000-calorie burned full day of snowboarding. If I'm relatively performing more physical activity, I feel better, proportional to the amount of extra activity.
growing up in Taiwan there's a branch of Buddhism that does this ultra hardcore 10 days bootcamp where you can't speak nor supposed to look at others and you just go about your day with everyone else, bit of chanting and a lot of meditation. Imagine life after that! I guess you're be buzzing for a day or two at least... and yes some do get addicted to that.
What I mean with dopamine fasting is not giving in to the urge of a quick dopamine kick for a certain amount of time.
Say you feel the urge to play another round of a video game. You tell yourself "No, make a break". Now your brain replies "Ok, then let's eat some chocolate". You reply "No, let's not eat chocolate either". Now your brain replies "What? You said take a break from the GAME! Why not chocolate? Ok, then lets drink a coffee". Now you reply "We take a break from dopamine! No game, chocolate, coffee, beer etc! You understand?". Your brain "Damn. Ok. Grumble. Grumble.".
I believe you misunderstand how dopamine works.[1] What you're talking about is called self-discipline in English and has value but doesn't need pseudoscience to support it.
This response is like so many others on this topic.
"Dopamine fasting" is not a literal or scientific term, its not pseudoscientific either. It merely describes the process (perhaps incorrectly) of imposing some challenge to impulsive behaviours which is a perfectly acceptable way to help break these habitual behaviors, neurologically speaking that is perfectly sound, and consistent with scientific insight into this area.
People often misunderstand and apply the overly simplistic "dopamine bad" mentality and think it's somehow about volume of dopamine which is laughably incorrrect for such a complex and nuanced process.
But critics can't see the woods for the trees with this one.
My brain disagrees that it feels good to be dopamine deprived in some areas already and then taking away most of the rest too. I'd say if you manage to pull that off for a few days, let alone weeks as I've seen suggested for dopamine fasting, you didn't have a problem with it in the first place.
It's a very similar idea. But you could imagine that your brain would be mentally fatigued if you want from chocolate, to video games, to jerking off, to having a cigarette. Etc.
I know a personal trainer with depression. <shrug> No silver bullets. I'm inclined to see these things as symptoms, although (if I may borrow more PT lingo) maladaptive behaviour from unrecovered injuries is also a thing. Pretty much every physio will tell you that a pain in muscle X is caused by a deficiency in supporting muscle Y. It's just that we have zero insight into the mutual support structure (if any!) inside the brain.
Careful management of your social group and obligations can turn you from a depressed person who does nothing into a depressed person who does things. Sometimes that's good enough. But antidepressants can definitely do more.
That’s the premise of behavioral therapy, which is very commonly used to treat depression. When the article describes patients having exhausted all other options before turning to rTMS, it means that no, behavior change could not do the the trick.
You assume they only tried with one therapist. Most people I know with treatment-resistant mental illnesses, including myself, try many over years if not decades. This person probably had to go through a whole series before even being allowed to move on to something like the study here.
Bingo. Rather than assuming that someone just didn't have a good doctor and then gave up trying, I would actually guess that most people with treatment-resistant depression who are actively seeking treatments (such as ketamine or rTMS) have gone through many, many doctors and many, many treatments.
For many people with major depression, this isn't something you can just think your way out of or face your way out of. There are biochemical factors at play. Just like someone with diabetes can't exercise their way into a working pancreas, someone with major chronic, major depression can't just behavioral therapy their way into treatment.
Can behavioral therapy help? Absolutely. Is it going to be enough for people with hard to treat cases? Absolutely not.
Would a change of behavior/lifestyle change the depression?
Yes. Clearly I disagree with others here.
The problem is that it's a vicious circle so it's difficult to change your behavior/lifestyle. But if you can, maybe with external help, it surely helps except maybe in very hard cases.
By the way, I'm not sure the term clinical is being used correctly in other comments. Could someone with relevant knowledge confirm?
The worst obstacle to break the circle are negative thoughts, that hide where the exits from the labyrinth are.
Not me, but someone I know very well. Yes, lifestyle helps, but doesn't fix depression. Example: running is great! If you get up, go for a 5km run, do a bunch of stretches and maybe pick up the dumbbells for 10 minutes, then have a shower and then eat a healthy breakfast, you physically feel amazing! If you have depression or anxiety, it's still there, but instead of also feeling tired and crap, you at least have a baseline 'feelgood' with it. If you do this regularly enough that you're in good shape, then you don't have depression and hate your body. You're also less likely to sustain random injuries when you're physically active. But depression and anxiety is still there.
This person has been managing depression without drugs or counseling for decades. There are ups and there are downs. From the outside, it's not always possible to tell the difference until they drop the bombshell "I'm extremely depressed lately" (as in, not just today or yesterday, but continually for a week or more).
I think of it like this: inside my head is a brain, and that brain experiences the world a particular way. Let's call it a colour filter. Well, everyone has a different filter, based on genetics and formative years. For some people, their normal state is 'content', unless something pushes their mood above or below. For other people the normal state is "shitty: slightly worried about nothing in particular, a bit sick of everything, I just want to go to sleep", and they have to constantly struggle to push above that state into one that is more bearable.
My understanding is "yes" and that's coming from someone who has come from depression and a few other mental ailments.
Quite often I get told that my experience and what I have witnessed from my friends and family going through similar change of life situations, is that it's all anecdote.
We must simply wait until enough scientific studies that test "primal methods" such as dopamine management, exercise, etc, come out to support this theory.
Until then, trust the science and buy whatever new pill or method that will solve it.
As for me and my friends however, we have our cure, and we try to motivate others around us with mediocre success. (Who are you to question the ways of science? Dr says to take pills and I can keep eating my junk food..)
I would add that depression is not a one-diagnosis-fits-all illness. You cannot treat every depression with CBT & exercise, some people are depressed as a comorbidity to a different issue. That issue can e.g. be neurological and hard to fix.
Sometimes I’ve been lucky and just stumbled upon a solution to something. That works for me. And which turns out to not work for most other people. (Whatever the problem might be.)
I would be careful about gloating about your success to those “pill-popping” “junk food eaters”… Even though it might feel great to get validation about your willpower or whatever.
> Dr says to take pills and I can keep eating my junk food
Dr says to take pills and I can maybe get shit together long enough to change my eating habit and regularly go see a therapist*
I understand that getting prescribed random medication has a bad reputation for good reasons, but it's still not a good idea to misrepresent those bad outliers as the average situation.
> What happens when a depressed person forces themselves to do things that are associated with not being depressed? Workout, dopamine fasting, social interaction.
[Note: I am not a doctor, but I lived with people with depression]
Apparently, in the case of true clinical depression (i.e. not just "feeling down"), not much. The typical reaction is "yeah, whatever", and they do it for as long as you want them to do it because they don't feel like resisting.
A change of behavior/lifestyle can certainly help, in the same way that lifestyle changes can help with many other diseases, but forcing depressive people to do what non-depressive people do looks just as effective as forcing people with broken legs to walk.
It also looks like there is more than one form of depressions. But the way I see it, depressive people are not sad, they are emotionless. Nothing brings them joy, but nothing saddens them either. I didn't even notice any "binge" behavior, they are just as likely to gain or lose weight, because who cares about eating. Depression is not grieving.
At one point I was working out 4 days a week, was absolutely ripped, and salsa dancing multiple nights a week; but I was still depressed.
It really depends on what kind of depression you have, often it’s a consequence of something else (in my case, probably an anxiety disorder and a genuine difficulty forming lasting social bonds).
Dopamine fasting is not a real thing. As with all addictions it's about consciously modulating your response to a stimuli. That's not to say restricting ones urges would not be sometimes beneficial, but calling it dopamine fasting sounds like putting a layer of snake oil on top of a perfectly good solution to many ills.
For me depressive periods manifest as borderline obsessive computer gaming. It's not the binging that triggers the depression. I continue functioning as an employee and family member but need something to lift the feeling of anxiety and sadness. It's very much like a pain killer. I don't suggest compulsive gaming for anyone as a remedy but for me it makes things tolerable. I've been also so depressed that I got therapy and antidepressants, and warmly recommend the approach - but you need to find a therapist you feel suitable.
> What happens when a depressed person forces themselves to do things that are associated with not being depressed?
Well, the problem is that depression causes a lack of motivation, and the lack of action or inability to do even normal chores continues to fuel the depression. (Depending on its severity it sometimes even impairs people from doing basic tasks like taking care of personal hygiene - there are cases where indiviuals don't brush their teeth or even bathe for weeks; e.g. https://web.archive.org/web/20120305002714/http://damnihateb... ). So to us "normal" individuals these people may look lazy or those that lack discipline, but it's actualy the disease impairing them.
As you guessed though, taking actions is indeed one of the behavioural techniques of Behaviour Therapy or Cognitive Therapy to tackle depression. It does work, and depressed individuals do cite an improvement in their mood when they do some task (especially stuff they have been procrastinating).
But if you consider the cognitive model of depression (i.e. the common thinking patterns of depressed individual), one other aspect of depression is that they don't feel satisfaction or a feeling of accomplishment in doing such tasks. And thus, any mood improvment is only temporary. Which again makes them feel helpless and they regress. Thus, cognitive therapy focuses on not only encouraging behavioural actions, but also working on correcting thought patterns that devalue such actions.
("Perfectionism" is one example of such thought pattern - if something is not "perfect", the individual often devalues the whole work done. Using the same examples you cited, even if you get this kind of individual to do a workout, as soon as s/he misses a workout, they will immediately start to blame themslelves for not being able to "maintain" discipline to the point of becoming dysfunctional..
Only temporarily. When I force myself to do something differently, the novelty might pull the weight off for a bit. It always comes back though. Exercise helps a little, when I can force myself to do it (which is hard; habits are slow to be gained, but can be broken quickly). What makes the most difference, is fasting (generally day fasts) and forcibly resetting my sleep schedule when it becomes nocturnal. The feeling of hunger is something real that I can hold on to, something to feel, even if it doesn't feel good. Waking early in the morning and sleeping at night seems to be helpful, but less so now that daylight only covers about 8 hours that I'm usually not outside for.
> Would a change of behavior/lifestyle change the depression?
Behavior is the result of the chemistry in your brain. You go out and socialize because it makes you feel good. Now what if you go out, socialize, and it makes you feel pain? Note, the pain itself does not have a physical cause, but that does not mean it is not real.
That's what difficult depression cases are like. Depression, like everything else, is a spectrum. The fact that one person can say "ah fuck it, I'll go out" and actually feels good does not mean that forcing a depressed person to go out is the cure for depression.
As someone who has struggled with depression: When I'm having a depressive episode, I'm using the same amount of willpower every day to try and force myself to get up, clean the apartment, meet people, go jogging, etc. - it's just that when the episode is bad, the amount of willpower isn't enough, and when it gets better, I can gradually do those things again. Obviously, those things, when I'm able to do them, help - but it's also a feedback loop and I first need to get better for me to be able to start the behavioral changes.
> When I observe myself in depressed phases and people who suffer from worse forms of depression, usually they do not work out, do not spend empathic time with others and constantly dopamine binge (via eating or other forms of quick pleasure).
Cause / effect. Are they depressed because they don't work or hang out, or do they not work / hang out because they're depressed? And there's bound to be other options as well.
I mean nothing personal, but your comment has energy of "thanks I'm cured"
>What happens when a depressed person forces themselves to do things that are associated with not being depressed?
I’ve been in both sides of this question and, at least in my experience, its like wondering what happens when a tank of gas ignites itself. The activation energy just isn’t there. The thoughts are, but the spark isn’t.
I used to think this was just an analogy in my mind, but we’re an electrochemical beast and what does our brain actually *do* beyond selective catalysis.
I recently talked with my partner about this, and annecdotaly, one friend had bad enough depressive episodes, they got an antidepressants prescription. Later they complained that it really helped with the downs of the depression, but in general it felt stifling and kind of muffled the highs in life previously accessible.
But, fortunately, the medication helped enough that they started and stuck to an exercise regime and then managed to phase out the medication.
I think with mental health in general, everything comes with a great deal of your-mileage-may-vary.
In the past several years I have done 12km charity runs & daily gym workouts, pushing myself mentally the whole time. When younger I was doing surf lifesaving, weightlifting, played soccer for nearly 15 years. I'm the social organiser for my group, regularly putting on BBQ's and arranging to meet up.
All of this takes a supreme level of effort, it never felt natural to me. Never got a "jogger's high". I was just depressed while my feet are moving. After spending time with friends I am emotionally drained and need to recharge. When I have a serious bout of depression, it's difficult to leave the bedroom / house for days or weeks at a time (at its worst). My entire body feels like I've been tumbled down a hill in a barrel.
In this time I've had a half dozen suicide attempts, two of them requiring medical attention. I still think of myself as a worthless waste of space. Every day when I wake up part of my routine is to shake off the suicidal ideation just to get started for the day.
CBT has helped to deal with the logical / behavioural impacts of this. I don't get as mad or frustrated at myself and am better equipped to recognise triggers and pull myself back from the edge.
I think if I had been able to get help when I was a child (I first started self-harming at age 7), perhaps being happy and motivated would feel more natural.
But no, even forcing a lifestyle change and doing all the things you said have no lasting effect. I doubt it will ever feel natural for me to wake up, go for a run, meet a friend before work for coffee, enjoy meetings with clients, etc.
Definitely still do those activities, otherwise things snowball. But the problem is a literal chemical / hormone imbalance in my brain that affects everything from when, how often and how long I sleep, and how much lethargy I have throughout the day.
A lot of people struggling with depression have had a lifetime of advice similar to what you suggested. Well-meaning family think it's as simple as just getting moving, and they think the symptoms are the problem, and we have a lifetime of being told to stop being lazy, stop feeling sorry for ourselves, etc, which is the main "stigma" of depression and the reason why these types of well-meaning posts usually result in less than positive responses from long-term chronic depression sufferers.
Edit to add - everyone's root causes are not the same, so while I have decent stretches where I can push myself to exercise and face the day, other people can't and there are times where I can't summon the energy and it's difficult to move. Also inb4 try changing your diet, have you tried meditation, read this <insert famous author>, etc. Living like this sucks and I've read and tried many things to ease the pain. Improvements are slow, incremental, hard-won, and often temporary / good until the next downer hits.
>Would a change of behavior/lifestyle change the depression?
It can, sure. But as many other commenters have pointed out, depression isn't just one thing. And for many individuals who suffer from major depression, it isn't situational at all, so doing all those things (assuming you can do them), doesn't really change anything at all. Because of what has happened in the world over the last 21 months, it's harder and harder to separate a chronic, deep depression from the situational depression that many people have found themselves in. I've suffered from depression my entire life (I self-diagnosed at age nine but had symptoms going back to at least age six), and even I'm unsure if the depression I'm experiencing now is more situational or more biochemical, just because everything in the world has been such a mess.
I can tell you that for people with deep depression, there is only so much fronting and working-out and socializing a person can do before the energy required to do those things and put on a front, of "acting" OK becomes too much. And that can often explode in a fit of rage/sadness/sorrow, because believe it or not, most depressed people don't want to be depressed and don't want anyone else to know they are depressed.
I can also tell you that there are people who are so depressed they literally cannot get out of bed to take a shower, let along go for a run. They cannot move, not out of laziness, but because the act of physically moving is too mentally and physically taxing and painful. They literally cannot do any of the things that give them any sort of dopamine binge. They don't eat. I was an incredibly active high school athlete (cheerleading and gymnastics) before I fell into my first "can't-get-out-of-bed"/"can't function" period of depression as a 16 year old. I was lucky I had my parents (especially my mom), because she was tireless at finding me the right psychiatrist (six in an 18 month period) and keeping notes of the side-effects of the different medications I kept trying (over 15 before we found a combo that worked at the time and probably that many have been tried since as I've gotten older and my body and biochemistry and hormones have changed), not to mention handling the insurance, taking me to doctor appointments, making sure I could eat. I had to handle more of it myself when I had another major depressive episode in college -- my mom still helped but I didn't live with her anymore and was no longer a minor, whose health she could take an active role in without signing forms that we didn't want to sign. And I had to handle it completely on my own when it happened in my early 30s, and I still had to work and had to expel every ounce of energy I had into getting a job done until I could get the right medication to help me out of it just enough to continue existing.
Trust me, if it was as easy as just forcing yourself into doing things that don't make you depressed, you'd have a whole lot less suicidal people. And you wouldn't have as much excitement around rTMS and Ketamine and other therapies that are starting to show real promise.
As someone who had a clinical depression after a psychotic episode, which lasted a couple of years, I would say — it's complicated.
I've actually maintained a pretty healthy schedule, with regular swimming, intense hatha-yoga (more like gymnastics), spend a fair amount of time with people. At some point I've also became a workaholic.
How I felt — pretty horrible, all those nice things (unhealthy attitude to work is not nice, of course) barely helped to maintain a thin veneer of my social persona. Basically, most of the people who interacted with me would not know that I'm depressed. I think there are a lot of people like that, just outer shells.
I did not get medical help either in the form of therapy or drugs.
In the hindsight, I think that depression could have been helped at least a bit by going to the good therapist. I had some issues with rage a couple years later, and going to psychoanalyst really helped me a lot.
Oh, you know what also helped a lot? It may sound stupid, but at some point I've started going to piano lessons and it really was beneficial somehow.
This article is incredibly frustrating. This is NOT new technology. It is a different modality called theta burst which they didn't even mention the name of in the article. The benefit of using theta burst is that you can do TMS courses much faster. This is a major benefit but the technology is still the same. If you didn't have remission with the prolonged rTMS course theta burst is not a magic bullet. The benefit is that it's easier to do bilateral treatment and speed up the treatment quite a bit. Normally you have to come in every business day for a few months for 20 mins at a time.
It really sucks to have "lay people" in my life email me these articles like this is some new breakthrough. The articles often come out prior to FDA approval but these modalities have been around for 10+ years prior and I always knew about them with someone with treatment resistant depression. Remember, off label treatments are a thing, and theta burst was available well before this study came out.
I'm currently undergoing deep TMS treatment with the Brainsway device on my left hemisphere and they were able to boost the treatment by adding the theta burst with the figure 8 coil like in the picture to do my right hemisphere to improve chances of remission. It is a good trick and it boosts your chances of remission because it's faster and easier to do bilateral but as I said there is nothing magical about theta burst other than it's a very fast treatment. Those who didn't have remission on long courses of TMS before unilaterally probably aren't going to magically have remission on this. What we might end up seeing is some kind of threshhold that wasn't achievable in the past, say that some people could reach remission but it's not feasible to come into the office every day for 6 months.
Anyway TMS is great and should be used more but I just hate these dumb articles. Especially since it's touting this as some magical new technology. No way. And we're still a long way from TMS being prescribed in general cases - less side effects than meds but insurance wise you have to trial and fail several meds before it's covered. Even SSRIs which are given out like candy can have severe side effects like GI bleeding. TMS is very, very safe with few side effects. For me it was just discomfort during the treatment but not after.
Also just got to say this quote summed up how ridiculous the article was for me: "“This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we're finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we'll supplement the conventional chemical imbalance and psychological conflict models with a new brain circuit model.” In other words, psychiatrists will use electricity instead of talk therapy and drugs to treat mental health disorders." No reason to make rTMS sound like some Frankenstein tech and no, rTMS will not be used "instead of talk therapy and drugs".
TBH a little disappointed at hacker news, next time link to the study! I would love to see articles on NEW treatments for depression. Spoiler alert..there really haven't been any for a long time now. Just me too drugs and this is a bit of a me too tech as well.