Ask HN: Beating depression with or without anti-depressants?
Despite what other commenters are saying, if you ask for advice from internet strangers, I think it&#x27;s reasonable to receive advice from internet strangers, and not simply get told to &quot;go somewhere else.&quot;<p>So here&#x27;s my internet stranger recommendation.<p>First, Cognitive Behavioral Therapy is the &quot;gold-standard&quot; (<a href="https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;pmc&#x2F;articles&#x2F;PMC5797481&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;pmc&#x2F;articles&#x2F;PMC5797481&#x2F;</a>) in the therapy route.<p>&gt; &quot;(1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models&#x2F;mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behavior (e.g., information processing).&quot;<p>But often when people go to see a &quot;therapist&quot;, either they don&#x27;t do CBT, or the patient or therapist does not realize that all the worksheets and exercises really actually need to be done. CBT is a lot like physical therapy, if you don&#x27;t do the exercises, you likely won&#x27;t get better. If you have not tried CBT before, or are not sure, the book &quot;Feeling Good&quot; is the thing to pick up.<p>Second, to answer your specific question on SSRIs: SSRIs do have side effects. They&#x27;re not that bad. I was on them for some 6 years. However, I would rather have not have had the side effects, and not taken the drug, in part because SSRIs also didn&#x27;t make me in particular feel any better. That said, on average, SSRIs do work while you&#x27;re taking them for most people. SSRIs + CBT at the same time tends to be the most effective combo.<p>Finally, here&#x27;s my non-scientific advice from an internet stranger who has been where you are, and is no longer there. Take it as you will.<p>In your head there&#x27;s a little voice. It&#x27;s the one reading this right now! You can make it talk if you want. Here, make it say &quot;purple octopus fiddly pop&quot;. See? That&#x27;s not you. You&#x27;re the thing _hearing_ that voice.<p>That voice talks all the time.<p>When you roll over at night, maybe it says &quot;oh god, maybe I&#x27;m going to get fired&quot;. Maybe says &quot;oh, I bet I deserve to get fired&quot;. Maybe it says &quot;oh gosh, I can&#x27;t even get this depression under control, and if I don&#x27;t, everything is gonna collapse&quot;. You aren&#x27;t that voice!<p>Sometimes it plays a little movie, like the last time an embarrassing moment happened, or what you could have said as a witty come back. When the movie plays, you&#x27;re not really there, but your body doesn&#x27;t know that, and so it builds up all physical sensations of emotion.<p>That voice is a reflex in your head. When someone taps your knee, and your leg kicks into the air, it wasn&#x27;t you that kicked. It&#x27;s just a reflex.<p>Here, I&#x27;ll prove it to you. Set a timer for 3 minutes and try and not think about anything. Just pick a point on the wall, or maybe watch your breath. I&#x27;ll bet you can&#x27;t do it. The moment you try, there&#x27;s the voice again. Maybe it&#x27;s saying things like &quot;oh why I am doing this&quot; or &quot;this is boring&quot;. It doesn&#x27;t need to be articulating words; sometimes it&#x27;s just a feeling. When you wake up every morning, &quot;with a pit in my stomach that I carry around all day&quot;, that&#x27;s the voice.<p>Most of the time, when that voice talks, it&#x27;s wrong. It might say &quot;oh, I&#x27;ll bet so-and-so hates you&quot;. But did you check? Did you ask so-and-so directly? Out loud? Did they tell you to your face?<p>Or did you implicitly believe the voice?<p>The way out of the trap that you&#x27;re in is to notice when the voice is happening. It&#x27;s happening _all the time_. It&#x27;s probably made a comment while you were reading this. Did you realize? If, when the voice happens, you immediately assume it&#x27;s correct, and act as if it&#x27;s true, you train the voice to say more things.<p>It&#x27;s gotten into such a habit that you don&#x27;t even realize it&#x27;s happening. It&#x27;s like biting your nails; your hand moves before you even realize.<p>CBT is one way of breaking the habit. The most common CBT exercise (&quot;the 3 column technique&quot; or sometimes &quot;catch it, check it, change it&quot;) has you write down when that automatic thought or feeling happens. And by doing this, you train your brain to catch the thought before it leads you down a spiral.<p>Importantly, by writing down the thoughts, you hold the voice in your head accountable. When it says &quot;some terrible thing is going to happen tomorrow&quot;, you get to see that, actually, the voice in your head has no idea what is going to happen.<p>Another way is meditation. Meditation is not a calming exercise. It&#x27;s a way to practice watching your voice for a period of time. Over time, you build the muscle and train your brain out of the habit of constantly blending with the voice every time it has some demand.