Save Some Compassion for Yourself

My gf, who suffers from depression (as I do; but hers is much worse), beats herself up a lot. She says horrible things about herself “I'm a terrible person.” “I have nothing interesting to say.” “My thoughts don't matter.” “I'm a failure at everything I do.” "I'm broken" "I'm Irrational, and there's nothing to do" I too have that voice in my head sometimes, but mostly when im having a bad day at basketball or a shit interaction by going all impulsive. If you're constantly beating yourself up, take a step back; give yourself a break. You're suffering too much as it is. Would you knowingly insult a stranger if you knew that person was suffering with some horrible illness? Would you bully a war vet who's in a wheelchair? No? Then why are you doing that to yourself? Defer today's self-punishment. Replace it with compassion. You’ve experienced traumas (big and small) in your life. Add them up sometime. Make a list of the traumas you’ve lived through. You might be surprised how long the list is. The traumas start in childhood, after all. Have a talk with your inner child; the child-you that’s still lurking inside you, somewhere. Console him or her. Acknowledge the hurt. Acknowledge the legitimacy of the hurt, the fact that it’s okay to hurt; it’s appropriate. This is not a pep-talk, so don’t sugar-coat things. And don’t judge. Just acknowledge that you’re entitled to feel what you’re feeling. Getting other people to acknowledge your pain is not as important as reflecting on it yourself, first and foremost. When you’ve recognized your pain, and its roots, in its awful totality, you will be able to console your inner child; and you’ll both mourn. At that moment, you must put away self-recriminations and self-loathing.

Know Your Enemy

If you suffer from depression or any other kind of mental condition, you owe it to yourself to become educated on the condition. That doesn’t mean reading Psychology Today articles or Wikipedia entries (although that’s a start). It means digging deep, reading up on the science, becoming truly informed. Why is this so important? Because there’s a lot of misinformation out there, and (sad to say) mental health care providers are not always up to date on the latest research. Or even the older research. Ignorance is dangerous, especially when it comes to your health. You can’t afford to buy into myths, half-truths, or someone’s well-intentioned (but misinformed) feel-good philosophy that’s based on little more than wishful thinking. You need to know the facts. Doctors, nurse practitioners, licensed mental health counselors, and psychologists are only human. Some of them have unwittingly bought into a lot of the same myths you and I have been fed by the drug industry, NAMI, NIMH, APA, and others who have their own special agendas. I believe in evidence-based medicine. (I’m not an anti-psychiatry crackpot. I do believe in looking critically at what goes on in the field, though.) I read a lot of scientific papers. You should too. It’s not that hard. You should also seek out evidence-based books on mental illness. There are plenty of good ones out there. For starters, you should consider reading Robert Whitaker’s books Mad in America (2002, Basic Books) and Anatomy of an Epidemic (2010, Broadway Paperbacks). Whitaker is a former Boston Globe journalist. He has no ax to grind; he’s just a great journalist and ace science writer. His books are filled with solid investigative reporting, backed up with tons of footnotes. They’re easy to read , informative, and entertaining. If you’re taking antidepressants, you’ll want to be sure to seek out Irving Kirsch’s The Emperor’s New Drugs (Random House and Basic Books, 2009 and 2010). Kirsch is a researcher and lecturer in medicine at the Harvard Medical School. His book is easy to read and filled with insights. It will give you much needed perspective on drugs for depression. Also please consider my book Of Two Minds (Author-Zone Books, 2015)[4]. It’s a much longer book than this one (400 physical pages, counting front and back matter), partly based on personal experience (in other words, part memoir) and part science reporting. It has over 300 footnotes, to give you direct pointers to the literature on depression, schizophrenia, antidepressants, talk therapy, studies about drugs, exercise, and so on. It’s designed to be easy to read and entertaining. It busts myths and provides straight talk on therapeutic options. I can’t recap all the information you need to know in just a few pages. But I can give you a head start. Probably one of the biggest myths about depression is the (mistaken) idea that it never goes away on its own. (Don’t take this as advice to do nothing! I’m not saying to sit around and wait for it to go away on its own.) Depression is typically (though not always) episodic and often resolves on its own, without any professional or other interventions.[5] This fact is seldom discussed in books and articles on mental illness, yet it’s fundamental to understanding the disorder. Emil Kraepelin (1856–1926), who coined the term “manic depressive,” found in his own research that in contrast to his patients suffering from dementia praecox (schizophrenia), those suffering manic depression had a relatively good prognosis, with 60% to 70% of patients suffering only one attack, and attacks lasting, on average, seven months. Do we have modern, scientific evidence that people really get better on their own? We do, actually. In the Netherlands, in 2002, researchers looked at the progress of 250 patients who had presented with an episode of major depression. Two thirds of the patients were female, and for 43%, it was a repeat episode. Some patients sought treatment at the primary-care level; others sought mental-health-system care; others sought no care. The researchers found that the overwhelming majority of patients eventually recovered (defined as “no or minimal depressive symptoms in a 3-month period”), regardless of the level of treatment.[6] Duration of major depressive episodes has been found to vary widely, with median durations between 3 months and 12 months and rates of chronicity (duration 24 months or more) between 10% and 30%.[7] In the Dutch study just mentioned, the median duration of major-depressive episodes was 3.0 months for those who had no professional care, 4.5 months for those who sought primary care, and 6.0 months for those who entered the mental health care system. The differences in episode duration could reflect severity. In other words, the people who recovered quickly on their own may have done so because they were less depressed to begin with. It stands to reason that those who sought help at the mental-health-system level were probably more depressed, hence took longer to recover. Nevertheless, the Dutch study results show quite clearly that people who sought no professional help saw their depression get better in a shorter time frame (3 months) than people who sought care (4.5 to 6 months). That’s not to say you should seek no care! I’m just telling you the facts. People do get better on their own, much of the time. So even if traditional sorts of interventions don’t work for you, that’s not reason to give up all hope. The other thing you should know about depression is that it correlates with age. The older you are, the more likely depression is. Why should depression be more prevalent in older people? First, there’s the obvious fact that the burden of disease is greater in older populations. We know that a diagnosis of serious somatic disease (diabetes, cardiovascular disease, obesity, cancer) is, for many, a trigger for depression. Also, the older you are, the more likely it is you’ll experience loss: loss of a loved one (to death, disease, divorce, etc.), loss of a job, opportunity loss. Children grow up and leave home. Stuff happens. Life happens. Whites (surprisingly enough) are more apt to complain of depression than other races. Women are more apt to self-report as depressed than men. In all likelihood, the gender gap here is not as great as one might think. Men are famously self-reliant and unlikely to ask for help. “If I get myself in trouble, I’ll get myself out” is a prototypical male response to getting lost while driving. It’s the same with depression, most likely. Women ask for help right away. Men don’t. Many studies have found an inverse correlation between income and depression. Data from the CDC (2011) show that if you are living below the poverty level ($11,490/yr., in the U.S., if you’re single) and you’re between the ages of 20 and 64, you’re at roughly five times greater risk of depression than if you’re making

400% or more of poverty level income ($45,960/yr, if you’re single)[8]. The two most popular therapeutic options for depression are drugs and talk therapy. Depending on which studies you read, drugs are either extremely effective or barely more effective than placebo. The literature is skewed in favor of drug effectiveness, because (as Kirsch and others have demonstrated) many clinical trials that fail to show positive results simply don’t get published, and most of the trials that do show strong results are underwritten by drug companies (and often use professional ghostwriters, with big-name doctors attached later as “guest authors”). The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study was easily the single largest study of its kind, ever, lasting six years and involving almost 4,000 patients in more than 40 treatment centers. It was a real-world study of patients in real-life clinical settings, not “controlled trials” settings. Over 100 scientific papers came out of that $35 million study. I talk about the STAR*D results in greater detail in Of Two Minds. But basically, the upshot of the study was that, using remission as an outcome standard, only 32.9% of patients in the initial phase of the study got better (taking Celexa). Patients who failed to get better in the first phase got to try a different drug in the second phase. In that phase, 30.6% of patients got better. In the third phase, 13.6% got better, and in the fourth and final phase 14.7% got better. These numbers are not additive. They represent raw success rates for independent phases of the trial. You should average them, not add them. Almost exactly half of clinical trials submitted to FDA for approval of SSRIs (modern antidepressants) failed to show separation from placebo. In plain English, this means about half the time, studies designed to prove efficacy failed to prove efficacy. It doesn’t mean no one got better in those trials. It means the number of people who got better on the drug was about the same as the number who got better on the placebo. In trials that do show efficacy, results vary widely, but it’s not uncommon to see 30% to 50% improvement (in averaged Hamilton depression-scale scores) for drug “responders” versus 20% to 30% improvement for placebo-takers. Bottom line, the drugs work for some people, but can’t be said (with a straight face) to be hugely effective for a majority of users. Does this mean you shouldn’t try the drugs? No, that’s not what I’m saying at all. You should try anything that might work, even if the odds are 50-50 (or less). The drugs might work for you. You won’t know until you try. A problem is the mental sideeffects, the friends i have, seem to lose information and not learn new one. their identity seems stuck someplace, with no new concepts sticking in, but there's also the physical downside of pillpopping(and financial if u want).

The best predictor of outcome was the quality of the relationship between patient and therapist (as perceived by the patient) early in treatment. (Note that patients who did not take medication had lower rates of relapse. Also note, 32% of patients dropped out of the study early; 9% got worse. Most studies simply look for improvement. In those that look just for improvement, response percentages tend to be higher, of course.In medicine (and psychology), there are a lot of what I like to call “31% solutions”—things that tend to work about 31% of the time.Antidepressants tend to work about 31% of the time.Placebos work about 31% of the time.Talk therapy arguably works more than 31% of the time.Low-dose shock therapy works about 31% of the time (but so does sham ECT). Shock therapy is damaging to the memory, however. Alcoholics Anonymous seems to work about 31% of the time.Physical exercise tends to work about 31% of the time.People who seek no treatment at all tend to improve about 31% of the time.No one’s done the study, but I imagine talking to your dog tends to work about 31% of the time.All of these things work for some people, some of the time. But because every person’s situation is unique, they all work for different people. And you won’t know what works for you until you try it.So do your research, and try the therapeutic options that seem best suited to your sensibilities. If one modality doesn’t work, try another one. Eventually, you’ll find something that works.Don’t simply buy into the myths that drugs work all the time, that antidepressants fix a “chemical imbalance in the brain” (there’s no credible scientific evidence for that theory), that CBT is more effective than other modalities (it might be, for some people, but overall it’s not), that shock therapy is guaranteed to work (it definitely is not), etc. The myths will lead you astray and leave you bitter. Don’t buy into them. Do your own homework. Do what works for you. Hack Your Depression - Kas Thomas