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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.
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.
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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