I had better jump in here right away, because the last thread about depression on Hacker News basically got swallowed up by an n=1 anecdote, and while anecdotes are wonderful (we all prefer to make decisions based on anecdotes we feel we can relate to rather than based on statistics), it takes a lot more than one anecdote to represent a complicated subject.
As my last keystrokes about depression here on Hacker News pointed out, there isn't just one disease known as depression. Depression is a symptom pattern (prolonged low mood contrary to the patient's current life experience) found often in the broad category of illnesses known as mood disorders. Behavior genetic studies of whole family lineages, genome-wide association studies, and drug intervention studies have all shown that there are a variety of biological or psychological causes for mood disorders, and not all mood disorders are the same as all other mood disorders. I know a LOT of people of various ages who have these problems, so I have been prompted for more than two decades to dig into the serious medical literature[1] on this topic. (I am not a doctor, but I've discussed mood disorders with plenty of doctors and patients.) I've seen people who tried to self-medicate with street drugs end up with psychotic symptoms and prolonged unemployment, and I've seen people with standard medical treatment supervised by physicians thrive and enjoy well off family life. The best current treatment for depression is medically supervised medication combined with professionally administered talk therapy.[2]
The human mood system can go awry both by mood being too elevated (hypomania or mania) and by it being too low (depression), with depression being the more common symptom pattern. But plenty of people have bipolar mood disorders, with various mood patterns over time, and bipolar mood disorders are tricky to treat, because some treatments that lift mood simply move patients from depression into mania. And depression doesn't always look like being inactive, down, and blue, but sometimes looks like being very irritable (this is the classic sign of depression in teenage boys--extreme irritability--and often in adults too). Physicians use patient mood-self-rating scales (which have been carefully validated over the years for monitoring treatment)[3] as a reality check on their clinical impression of how patients are doing.
As the blog post kindly submitted here points out, a patient's mood disorder influences the patient's whole family. The more other family members know about depression, the better. Encouraging words (NO, not just "cheer up") are important to help the patient reframe thought patterns and aid professional cognitive talk therapy. Care in sleep schedules and eating and exercise patterns is also important. People can become much more healthy than they ever imagined possible even after years of untreated mood disorders, but it is often a whole-family effort that brings about the best results.
Would you mind sharing a little on how to go about this exactly? To be clear, I'm not surprised that "cheer up" isn't the right way - but I don't know what is. I don't even know how to talk positively to, say, cancer patients, let alone sufferers of mood disorders.
I had cancer when I was younger, and the best place to start is to ask yourself: "Do I need to say anything at all?"
Unless you're a close friend (with whom the patient is completely at ease), then you're putting them in a position where they feel like they have to act strong, smile, and thank you for your concern. (For my situation, I got dozens of phone calls from people I hadn't heard from much in years. I had more than enough on my mind than to appease their desire to show their concern.)
Your concern is definitely appreciated, but you need to choose your moments.
As for what to say? I guess that differs culturally and your relationship. I'm Australian, and I was totally okay with a simple "ah, shit mate, that sucks" over a "if you need ANYTHING, call me* (*but don't actually call me)" - I know I can call for help, and dozens of people can help, but all I really wanted was to be treated like a normal human. For instance, I was bald from the chemo and got a multi-colour clown wig as a joke present, which made me smile so much. It was a sense of "everything is normal despite being in the midst of chaos." I could count on my friends to distract me from the horrible reality of the situation when I was stressed/sad/confused.
And that is your job. Be a sincere option for distraction and advice when you're called upon. Trust them to ask for help when they need it..and they're much more likely to ask for it if they know you won't be overbearing/over-worried/judgemental/etc.
I don't know how well this advice applies to depression, but I think it's a good framework for being a good friend through most hardship.
(Sidebar: I'm more than happy to be a sounding board for approaching any cancer related issues you've got. Email's in my profile. I've heard all kinds of things, so don't think any question or issue is too simple or stupid!)
Thanks very much, your response is helpful. Thanks for the offer, too. Thankfully, I'm not struggling with this personally now, but I'm sure there are people here who are.
You don't have to say much. For example, my wife will ask 'is there anything I can do?' when I'm having a particularly bad time, and while the answer is often just 'no,' her asking the question that way acknowledges the fact that I'm struggling without putting me under pressure to come up with an answer. For me the most important thing is knowing that someone is available without feeling that they're waiting on me.
Chronic depression is a bit like an old AM radio; you can mitigate the lousy signal with the tuning knob and moving the antenna around, but you can't fix it and call it done; the station that's clearly tuned in today might stay clear tomorrow or be mired in static. As a patient, one can learn to separate oneself from one's mood, so that feeling miserable doesn't have to be attributed to an objective exterior cause. But learning that takes time, and inability to distinguish between one's emotional and the quality of one's environment was a major problem for me when I was younger.
The most helpful thing you can do is be around to listen and allow the depressed person to vent without pushing them to identify an actionable solution, frustrating as that may be. Asking questions can also be helpful, to inform yourself about what the other person is experiencing. For example suppose you were talking to a blind person; you get the basic idea of being blind but you don't know what it's like, so it's quite reasonable to wonder, say, how the person chooses groceries or decides what clothes to put on in the morning. When depression is chronic one develops a variety of coping strategies (which work more or less well at different times), and articulating that sort of thing often helps me get out of a trough and recover my sense of agency.
One other thing that's very common for people with depression is muscle pain, because the inner tension is often mirrored by a physical tension. It's hard to describe, but the physical tension can even act as a focus for the bad feeling. A backrub or a neck rub can go a long way, if the depressed person is feeling up to it. Other times one may not want to be touched and is better off just going to bed or somesuch.
Thanks so much, this is very helpful. I'll remember that asking questions is usually okay; I'm often afraid that patients prefer not to think or talk about it, or that I'm the 30th person asking about it and they're tired of it, etc.
The problem of depression is, simplifying, an inability to experience happiness. Telling a depressed person to cheer up is like telling someone with a broken leg to stop having a broken leg, or telling someone with lung cancer to just stop having lung cancer. Not only is it not helpful, it's insulting because it reveals a huge misunderstanding of the issue.
My current impression is that while efficacy is demonstrated for many drugs, how they work is poorly understood or not at all. Do you know of good reviews that cover what we know about why some drugs work and others don't? Preferably in more detail than 'free seratonin serum levels were increased.'
You are correct that how any of the drugs work is currently poorly understood. Presumably, there are individual biochemical differences in either drug receptor sites on nerve cells or in metabolism of the drug after ingestion that make some kind of treatment difference, but there are not convenient medical tests yet to predict which kind of patient will respond to which drug. When I advise friends about pondering different medical treatments for most disease, my pickling in the research on human behavior genetics in the weekly journal club I attend suggests that you look to what works for your close relatives. If a particular medicine seems to be helpful with few side effects for a first-degree relative (parent, sibling, or child), give it a try. If a particular drug has been useless for someone closely related to you, for whatever condition you are concerned about, start your search with some other drug. And so on. Eventually we MAY get to a deeper genetic understanding of individual differences in response to prescribed medicines, but we are a long way from that so far.
Not every mental illness is a chemical imbalance, it might be neurological in nature, or it could be stress based, or maybe you just need a psychotherapist and learn some coping skills?
It seems to discuss the basics of neuroscience and how the brain and mind work. It also discusses medicine and how to fix things. It might be a good read for you.
I do believe you've neglected to mention Cognitive Behavioral Therapy and mindfulness meditation.
You did mention cognitive talk therapy with a professional, but my reading of David Burns' books (and my subsequent personal experience) leads me to believe that it can be effective when done by someone by themselves (and in combination with medicine and or talk therapy).
Indeed. The popular book by Burns (http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808...) in an earlier '80s edition before the behavioral angle was added made a significant and permanent improvement in my life, all done by myself, although with medicine and talk therapy added to the mix (my depression is not standard "unipolar affective disorder" and medicine is key to improving it, but not a complete solution).
CBT has an excellent evidence base and if you had read the references already posted to this thread you would have known that.
Mindfulness also has good evidence, but tends to be used with more severe forms of depression or other diagnoses such as borderline personality disorder.
The comment "sounds like voodoo to me" is unconstructive. I don't care what something sounds like to you. If you had said why it sounds like voodoo, why you have a problem with any of the research that supports it or the Cochrane reviews or the NICE guidance then there's something to talk about.
I looked at the Wikipedia articles and they referenced studies where the conclusion ranged from "needs further study" and "slight effect". It seems like it might be more placebo effect (granted this is still a real effect) but it means that you can probably use any sort of similar "therapy" in its place.
No double blind studies. "The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in."
"This study concluded that CBT is no better than non-specific control interventions", which I already guessed at in my previous comment.
"Taken together, trials using psychotherapy do not meet the qualifications of high quality evidence."
What do you find implausible about the thesis that if you think bad things about yourself, you can make yourself feel bad?
(Granted, I don't know about the "behavioral" addition to cognitive therapy, but the latter is on a sound footing in every way, from theory to practice, and I can personally attest to it being effective.)
'“Depression is not an emotional disorder at all! Every bad feeling you have is the result of your negative thinking.” In this paper, I intend to give this conclusion some good natured trouble.'
As my last keystrokes about depression here on Hacker News pointed out, there isn't just one disease known as depression. Depression is a symptom pattern (prolonged low mood contrary to the patient's current life experience) found often in the broad category of illnesses known as mood disorders. Behavior genetic studies of whole family lineages, genome-wide association studies, and drug intervention studies have all shown that there are a variety of biological or psychological causes for mood disorders, and not all mood disorders are the same as all other mood disorders. I know a LOT of people of various ages who have these problems, so I have been prompted for more than two decades to dig into the serious medical literature[1] on this topic. (I am not a doctor, but I've discussed mood disorders with plenty of doctors and patients.) I've seen people who tried to self-medicate with street drugs end up with psychotic symptoms and prolonged unemployment, and I've seen people with standard medical treatment supervised by physicians thrive and enjoy well off family life. The best current treatment for depression is medically supervised medication combined with professionally administered talk therapy.[2]
The human mood system can go awry both by mood being too elevated (hypomania or mania) and by it being too low (depression), with depression being the more common symptom pattern. But plenty of people have bipolar mood disorders, with various mood patterns over time, and bipolar mood disorders are tricky to treat, because some treatments that lift mood simply move patients from depression into mania. And depression doesn't always look like being inactive, down, and blue, but sometimes looks like being very irritable (this is the classic sign of depression in teenage boys--extreme irritability--and often in adults too). Physicians use patient mood-self-rating scales (which have been carefully validated over the years for monitoring treatment)[3] as a reality check on their clinical impression of how patients are doing.
As the blog post kindly submitted here points out, a patient's mood disorder influences the patient's whole family. The more other family members know about depression, the better. Encouraging words (NO, not just "cheer up") are important to help the patient reframe thought patterns and aid professional cognitive talk therapy. Care in sleep schedules and eating and exercise patterns is also important. People can become much more healthy than they ever imagined possible even after years of untreated mood disorders, but it is often a whole-family effort that brings about the best results.
[1] http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec...
[2] Combination psychotherapy and antidepressant medication treatment for depression: for whom, when, and how. Craighead WE1, Dunlop BW.
Annu Rev Psychol. 2014;65:267-300. doi: 10.1146/annurev.psych.121208.131653. Epub 2013 Sep 13.
[3] http://emedicine.medscape.com/article/1859039-overview