Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?
This is your opportunity to ask questions. No question too simple or too silly.
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Notes -
Perhaps not a small question, but I'm curious if folks here have dealt with depression/anxiety and if so, how have they turned it around or alleviated symptoms?
Looking mostly for success stories.
My recipe:
Reduce shit life syndrome. Gaining more money and thus security helped.
Lots of trauma treatment, mostly done on my own with guided meditations. This helped with the above point. Not relevant for most people, but really relevant for some.
Meditate for significant durations every day. Attained supramundane insights.
Good diet, good supplementation (omega-3 etc, which really helps, strong support from research)
Regular exercise, even if it isn't much.
Cut bad people out, subtly controlling narcissists etc. Quality > quantity, definitely.
Solve whatever sleep issue you may have. Important point. Sleep is crucial for repairing and rejuvenating body and mind.
You still seem to have a lot of reactivity & emotional difficulties based on our other interactions here bud. I'd recommend you look into emotional work for that. Joe Hudson & his Art of Accomplishment stuff is great, especially for folks who have meditated too much without any focus on the heart.
While I agree with both you and Scott that people who have supposedly been guided by meditation to transcend the self do not seem to show the godlike serenity one might expect, I don't think that this is a very kind or helpful way of putting it.
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Stopped drinking coffee and alcohol for a year (also did two periods of 6 months).
Exercised heavily.
Meditated (poorly - but I tried).
I’m still anxious here and there but just normal life stuff I think. Never been depressed however.
Long term I believe gut health and mind health is very important too - ie having a good diet.
If you don’t know what living without anxiety feels like, or you don’t remember, take a Xanax or Valium several times a month. All of a sudden seeing what your goal is, and what life can be like, is clarifying.
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It is not like I ran a trial, but there are a couple of things that correlated with a vague feeling of "now that I am thinking of it, I am doing mentally better than I was 5 years ago".
Physical exercise. Dunno what was your baseline, mine was quite low, so modest improvements felt like a lot.
Got a few appointments with a MD and a prescription for SSRI.
Got a hobby that is more fun than phone / social media / the internet. Perhaps it matters that I am doing creative stuff and "accomplishing" something, but probably it's just that it is easier to replace social media habit with something else than just cutting it down.
What’s the hobby?
Anything.
Learn to fish.
Exactly so, exact details are highly idiosyncratic. I suppose for me, what I picked is a form of creative writing.
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(Now available on Substack.)
I appreciate that some of the below may seem obvious to the point of coming off as condescending, but the reason obvious advice is seen as obvious is because so much of the time it really works. I will be limiting myself to lifestyle choices you can do yourself without interacting with a healthcare professional or therapist. Ranked in order from most to least importance/effectiveness/relevance:
I have not followed all of the above advice consistently: I still drink too much, I still eat too much fast/junk food, my sleep schedule is far from consistent, I spend far too much time looking at my phone (including social media) and so on and so forth. But even following some of the above advice some of the time, my mood, energy levels and so on are leaps and bounds ahead of where they were during Covid, which in turn were leaps and bounds ahead of my worst depressive periods in 2015-17. For large chunks of the latter period, I was drinking too much, eating mountains of shitty fast food, never exercising, staring at my phone for hours, smoking weed several times a week, watching too much porn, taking naps whenever I could and shutting myself off from the outside world – and this was while taking antidepressants (in addition to antipsychotics, some of the time). We can play the chicken-and-egg game all we like, but what would it accomplish? Even if doing these things didn't make me depressed, I have little doubt that they exacerbated my depression. I still have days where I feel down, but they're nowhere near as bad as my worst days.
[This concludes the "advice" portion of my comment.]
To get philosophical for a minute: there are many people in the West who purport not to be religious, who purport not to believe in souls or Heaven or Hell or the rest of it – and yet many of these people still reflexively, unthinkingly adopt a worldview which is implicitly dualist. This comes out in many forms (per my recurrent hobby horse, "I don't believe in souls, I just believe that everyone has an innate gender identity unrelated to their physical sex and knowable only to themselves"), but perhaps the most common is a conception of mental health as something wholly uncoupled from their bodies and what goes into (and out of) them; mental illness as a disease of the mind, not a disease of the body. But we don't have minds: we have brains, and every mental sensation we feel is ultimately a set of neurons firing inside them. It therefore follows that all of our moods (incl. mood disorders) are ultimately products of i) our underlying neural architecture; ii) the mechanical processes our bodies undergo (digestion, hydration, cardiac exercise etc.) and iii) the sensory stimuli we experience*. Small children have to consciously learn the causal relationship between eating and needing to defecate the following day; even many adults don't drink enough water and wonder why they have headaches and feel nauseated all the time. And a great many adults have this implicitly dualistic conception of moods as things that just happen, independent of ii) and iii) above. (The more scientifically literate will simply overweight the role of i) while downplaying ii) and iii) to the point of complete negligence, insisting that their propensity for negative moods is just "how they're wired" or a "chemical imbalance".)
What all of my recommendations have in common is that they are designed to force you to recognise the importance of ii) and iii) in determining your moods. Scrolling on Instagram and watching porn will make you feel worse, regardless of your underlying neural architecture; eating healthy food and exercising will make you feel better. It is incredibly easy to rationalise away your depression as solely the product of i) and deny utterly the role that ii) and iii) play in determining it. I know a girl who has been diagnosed with depression and is taking antidepressants. What kind of lifestyle does she lead?
Is she "here for a good time, not for a long time"? No – every time I see her she moans about how depressed she is. Gee, I wonder why?
Sometimes this failure to draw reasonable causal inferences is the result of denial or motivated reasoning (e.g. the alcoholic who pretends not to know why he always feels depressed the morning after going on the piss) – but in other cases, people appear to have so totally internalised the idea of "mental health" as something distinct from "physical health" that they simply don't recognise a connection between the things they do and how they feel: bad moods just happen to them, for no reason. This was made most apparent to me in Theodore Darlymple's magisterial piece "The Rush from Judgement", which ought to be required reading for every would-be doctor, therapist or social welfare: so many of Darlymple's patients appeared to believe that they felt depressed because they suffered from a medical disorder, and simply failed to join the dots with the fact that their lives were depressing (as @self_made_human calls it, Shit Life Syndrome): if you don't have a job, are dependent on the state for everything, have no interests beyond watching TV or going to the pub, are in a relationship with a man who doesn't respect you and who hits you – is it any wonder you feel miserable all the time? Moreover, Darlymple prescribing these women antidepressants would not come close to addressing the root cause of said misery. If they wanted to not feel like shit all the time, they had to change their lifestyles – they had to change ii) and iii).
Darlymple's patients are extreme cases, but that failure-to-join-the-dots, that conception of bad moods and negative thoughts as things that just come upon you for no reason in particular (as opposed to the inevitable outcome of the mechanical processes your body undergoes, the sensory stimuli you take in and your underlying neural architecture) is something that afflicts even the educated and gainfully employed. I very much doubt Phoebe O'Brien attributes any of her negative emotions to the fact that she spends hours every day staring at her phone – it must be the "rise of the far-right" that's got her feeling down. Yeah, sure.
To clarify: am I saying that everyone who eats right, gets enough exercise, sticks to a proper sleep schedule and uninstalls Instagram will feel pretty much okay most of the time? No – I'm not denying that one's underlying neural architecture plays a role in one's mood, merely arguing that people overweight it relative to the other factors. And I'm sure someone will have a counter-example of a high-earning CEO who ran five miles every day, stuck to his macros, was 100% teetotal and still killed himself. But these counter-examples inevitably remind me of the obese people who talk about how Dr. So-and-So completely overlooked that Patient Such-and-Such had a tumour because they were convinced that Such-and-Such's health problems were caused solely by his weight. Mistakes can happen, on the margin, but the existence of people who eat right, get enough exercise, don't use social media and still feel depressed should not blind us to the fact that the average person doesn't eat right, doesn't get enough exercise and uses social media too much, and that most people would feel happier if they improved their diet, exercised more and used social media less.
*Really a subset of ii), but it's such an abstract framing that it's easier to understand if you uncouple them. "I saw a photo of an OnlyFans model on Instagram, which caused neurons to fire in my brain and in turn triggered a surge of blood into my penis resulting in an erection" is hardly an intuitive way to frame that sequence of events, even if it's literally true. It's mechanical processes all the way down.
Just wanted to say thanks for posting this.
I've been in a bit of a depressive spiral for the last few days and this post really helped.
Not at all, I hope it helps.
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It's kind of sad that the socialization part is both maybe the most important of these and the one least solvable just by you acting in a disciplined and regimented way yourself. If the people around you aren't your people and they don't care about things that you care about and you don't care about things they care about and every time socialization happens it's around things they care about and you don't, at some point you just become too tired and stop going.
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Good post, even if I studiously ignore most of the lifestyle advice for myself. For what it's worth, the antidepressant effects of exercise are significant (g of - 0.63 when walking briskly, which compares favorably to both CBT and most antidepressant drugs). Even better, you can capture the majority of the benefit with about 2.5 hours of brisk walking a week. I knew that living so far from the bus stop was doing something for me, that isn't just wearing out my shoes.*
*I don't think it did anything for me, but defer to RCTs over the anecdotes of a very lazy man
To be fair, it could both do nothing for you and also be very effective for the average person. Now you can claim hipster points for not being like the great unwashed masses.
And that is precisely what I said, so I'm not sure what your point is. I'd rather have had bog-standard uncool depression instead.
I was trying to make a joke, since you said you defer to the RCTs as correct over your own experience. But whatevs, joke didn't land I guess.
Sorry dude, I'm the one who is very sleep deprived. Not your fault, and looking at it with a coffee in me, I understand the riff.
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Interesting! I have had substance issues in the past but feel I'm in a decent spot now... albeit I do drink a tad more than I'd like. Why so teetotaling here?
Luckily am already doing a good bit of these... the biggest ones I struggle with are diet, and overthinking. Good advice overall. I appreciate the detailed overview, definitely highlights some areas where I could be doing more.
I tend to think that it ties in with the Socialization point. Drinking at home alone is generally pretty bad for your mental state in my opinion, and ditto any other drugs. I would even agree with pouring out any alcohol you have at home. Drinking with a bunch of friends or at a bar is mostly pretty good, presuming you are capable of not overdoing it. Even going to a decent bar by yourself, where you are getting out of the house, and maybe have the opportunity to chat a little bit with a bartender or some other customers, or maybe possibly even make a friend or two, overrides the negative effect of the drinks and even of some not super great food.
I'm not sure where it belongs on an ordered list, but I think there should also be a point for taking care of yourself and your spaces. I mean like, take a shower every day, shave, trim nails, get regular haircuts, any other standard grooming tasks that apply, put on fresh clean clothes every day, that are in good condition, no holes or stains or whatever. Do it every day, no matter what, whether or not you're feeling great or planning on going anywhere. If you don't have any decent clothes, go buy some. Do laundry and wash the dishes regularly too. Whatever space you live in, vacuum, mop, dust, scrub, and otherwise tidy up regularly. Not necessarily every day or perfectly, but don't let anything get too dirty. Make your bed every day, put away dirty laundry, clean up half-finished projects, etc. Fix any broken stuff around the house too. Generally take care of everything along those lines. This creates a reasonably nice and clean space you can take a little pride in all the time. It helps you see and feel that you're not completely falling apart. It's nice, positive work to do that keeps your mind off of all of the negative influences listed above. And if you get a unexpected urge or invitation to go out and do something, or have friends or family over, you don't have the automatic excuse of looking like a slob or your place being a disaster area, you can just do it.
Better still would be to go to the bar but stick to non-alcoholic beers, but I agree that the benefits of socialising with your friends would probably outweigh the costs of drinking a few alcoholic beverages.
Your latter paragraph is so important and I'm kicking myself for not including it in my original comment. Forcing yourself to take a shower, comb your hair and brush your teeth is absolutely vital for pulling yourself out of a slump, as is keeping your living space clean and tidy.
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"Not drinking" makes for a good Schelling point. Notorious alcoholic and drug addict Matthew Perry (RIP) claimed that he can choose whether or not to have the first drink, but having had the first drink, every subsequent drink is entirely out of his hands. I don't believe this and agree with his interlocutor that he does have a choice about whether to drink the subsequent drinks: as Bryan Caplan would say, if Perry had one beer, and somebody put a gun to his head and told him they'd shoot him if he had another one, I'm sure he could summon the willpower to stop there. But that preamble aside, for most people, if you have one drink, the temptation to have another will be much greater compared to if you didn't have any. And two drinks turns into three, three turns into four, and before you know it it's the following morning and you're feeling like shit, much worse than you felt before you started drinking. Hence, the most effective way to prevent yourself from drinking to excess is simply not to start drinking in the first place, and not trusting yourself to have the self-control to only drink in moderation.
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Disclaimer: I still struggle with depression and anxiety, very much a work in progress.
Me from two years ago would absolutely hate this answer, but therapy. I found a really good therapist focusing on CBT and exposure therapy, who made sure to explicitly affirm he's working within my values (e.g. I told him there's a certain level of stoicism I refuse to sacrifice in the name of healthy communication, and that it is important to me as a man that I project a feeling of security toward my loved ones. Once he understood this was a value thing, not an anxiety thing, he enthusiastically embraced it and adjusted his treatment accordingly).
Sure, most of the stuff he works woth me on is fairly basic and readily available for free online. There are dozens of self-help CBT programs, complete with literature and worksheets. But for me, a therapist offers two things self-study can't:
a good therapist calls you on your shit and keeps you honest in a way that is almost impossible to do on your own. We're so good at lying and rationalizing to ourselves that you really do need an impartial outside party who is both able to recognize when you're doing it and willing to bluntly call you out.
meeting regularly with a therapist is good for accountability and consistency in the same way a personal trainer is. It's a lot harder for me to break a public commitment to another person than a private commitment to myself. As I slowly build up my good habits, I've been tapering off my meetings, but the extra accountability was super helpful, especially during those early stages where I had no good habits and little motivation to build them.
If you're not able/willing to start therapy at the moment, my best advice would be that inaction and isolation are the ultimate enemies. The best way to deal with anxiety is to run headlong at whatever is causing it, preferably accompanied by trusted friends, over and over again until it doesn't scare you anymore. In my case, my depression is mostly downstream of the maladaptive coping mechanisms I've developed to deal with the anxiety, so this is also the best way for me to deal with depression. I've never had any luck with the pharmaceutical options I've tried (all zoloft did was make my dick stop working while I was on it), but your mileage may vary.
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I had a sort of mild depression my whole life, that would sometimes escalate to above mild. Felt like I always had a reason for it for a long time. About a decade ago life was going stupidly well. I was getting married, had a good job, lots of friends, etc. And I still felt kinda like crap. I reached out to Scott and he pointed me to his old article Things That Sometimes Help If You Have Depression. Followed his advice and just talked to a regular doctor. They were able to prescribe me a low dose SSRI. It helps. The mild depression is gone most of the time, and instead of occasional escalations to above mild depression, I'll have rare escalations to just mild depression. I'd say it has been a success story.
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In my case, theater was a lifeline. I do better socializing in structured environments, and after graduating college and having my then-fiancee leave me, I went into a pretty terrible spiral that caused me to withdraw from society.
Theater gave me an environment where everyone was there for the same reason, and I didn't have it in me to be social, I could just privately run lines or something. At the same time, the nature of being on stage forced me to interact. I made a bunch of lifelong friends that way, and it gave me a real chance to crawl out of the hole I was in.
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Depression: I think a major factor was having a job where I had to put on a fake face. The mind affects the body and the body affects the mind. Smile, and it will trick the treacherous mind into being happier. Though, that job also involved organizing stacks of heavy boxes, so it was simultaneously good exercise and a constant source of satisfaction for my 'tism tendencies.
For anxiety, the only solution I know if is to brazen through. Exposure therapy. IME, it really doesn't take that much.
Yeahhhhhh I have worked in sales and marketing my whole career and I think that is a big contributor. How did you get out of that situation?
I was saying that job was the solution. It wasn't sales, but the social pressure of not acting like a moody bitch at random customers (and instead getting to solve problems and generally make them happy with me) sort of slowly rewrote the offending part of my brain. Actual sales is not something I am a great fit for. I loathe upselling, and would rather autistically drill down to a clients actual needs, even if that's only a minor sale or even recommending them a different business that better fits their needs.
Luckily, that's been working out decently well for me and my small fiefdom of Globocorp.
I don't have any specific advice for someone who is experiencing depression/anxiety from working sales, though I think I get exactly where you're coming from. Maybe seek some kind of lateral move that involves more sorting than maximizing?
I’m the kind of guy that absolutely loathes customer front facing work, but I do it quite a lot, both with staff and everyone else; and they all tell me I do pretty well even though I don’t particularly enjoy it. My personality has always been more of the inward, thoughtful, mad scientist up in the high tower of the castle, thinking up crazy ideas. But the anxiety of dealing with people on the ground is almost always worse than the reality of it, and it’s a product of overthinking. The only way I’ve found to get out of that mode of thought is simply by doing the work, and you can see how out of register your anxiety is what the work that stands before you.
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I suspect that my depression was, in hindsight, mostly due to a case of Shit Life Syndrome. Recently-ish, life improved and so did my mood.
However: I've written about my experience with a clinical trial for psilocybin. It worked wonders, even if the chemical didn't change the material aspects of my life or work. That was all the existence proof that I needed that I could be in a bad place, unhappy with how things were going, without necessarily feeling depressed about it. I've been on plenty of standard antidepressants, and they did fuck-all for me. That is not a general indictment of the class, the drugs aren't perfect, but they do work. For some people. Some of the time. NNT between 5-7. I feel this discrepancy in my bones, more than most psychiatrists do.
Then I dabbled with other substances, after my life got better. I would like to claim they helped, but the problem is that I was already feeling pretty good when I took them, and my main goal was to make the euthymia stick. It's been a month, and I'm doing well. I remember being terrified that I'd immediately relapse when I'm back to work, and that hasn't happened yet. Thank $Deity for that. If it does happen, I'm going to go see a psychiatrist and ask for IV ketamine, it's effective, particularly for treatment resistant cases like mine, and doesn't have the memory-loss issues of ECT.
And hey, if you need more tailored advice, DM me.
I have done a bunch of drugs recreationally, including a ton of psychedelics lol. Not tooooo interested in those, though perhaps I am overdue for another trip. Has been a few years.
$Deity has helped me quite a lot but yeah, I think a lot of it is refusing to change my life circumstances. $Deity has told me that before, now that I think of it...
All I can really say is that it's easier to treat depression and make lifestyle changes than the other way around, particularly for moderate to severe depression. At least that's my personal experience, there's enormous heterogeneity here.
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I think you’ll get better results on the Wellness Wednesday thread, friend.
Yeah but I hate posting in em so late. Maybe I'll repost next Wednesday.
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