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The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.

Medications almost always target symptoms and never address root causes.


This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.

The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.

Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.

Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.

[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.

A sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree.

>once I noticed it also affected my ability to experience color

A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.

https://pubmed.ncbi.nlm.nih.gov/34689697/

https://cdnsciencepub.com/doi/10.1503/jpn.200091

This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.

I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.

I'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed.

I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.

Sometimes willpower improves before mood.
This theory is a science-free zone. It seems far more likely that the drug induced sudden, overwhelming suicidal thoughts than someone said "I feel the best I've ever felt and life is looking up. I think I'll kill myself and make all the good feelings go away".

Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.

Finding everyone’s cow is expensive and time consuming: https://antidepressantcow.org/2020/02/the-story-of-the-antid...

But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.

That story doesn’t work for people with depression who otherwise have very good lives.

I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.

I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.

In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.

First of all, I want to write that I am glad you found something that worked so that you are able to remain here with us.

Though, I am curious about the, "otherwise have very good lives" part.

Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?

I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.

As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.

To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.

> I don’t think there’s a metaphorical “cow” that could have helped me.

The smart-ass in me can't help but suggest that maybe medication was your cow?

> Whose definition are you using?

To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.

> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?

I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.

> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.

*fist bump*

> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.

I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).

I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.

> The smart-ass in me can't help but suggest that maybe medication was your cow?

Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.

Take my baseless speculation for what it's worth, but could it be that you were depressed because your life was too easy? We humans are meant to struggle through adversity. Can you really appreciate your financial security if you've never faced financial insecurity, or appreciate companionship if you've never experienced loneliness?
It’s a reasonable question but I doubt it. We weren’t affluent at all and I worked my butt off for everything. And that’s good, because I agree that if things are too easy it turns into a curse.
> I don’t think there’s a metaphorical “cow” that could have helped me.

The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.

It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.

I think that's a huge stretch.

"Your community" isn't your doctor. This annecdote, to me, is cleariy an attempt to blame modernity for depression.

The story in the article that is being discussed here does not say that the doctor was explicitly not a member of the community that he served. You would have to just sort of make that part up and then come up with an explanation for how the doctor even knows that story if he wasn’t part of that community.

The doctor in the story exists in pretty recent history, which you would call modernity. If for some reason you’re using “modernity” as a way to say “systemic alienation of the individual” rather than “modernity” meaning “happening in the modern world” then yes, by your definition of that word, it is indeed a story about “modernity” being to blame for poor treatment for depression.

very interesting. would you be comfortable sharing what therapy uncovered as the cause for you?
People would very likely still develop depression in whatever utopia you could imagine.

For starters, everybody has a different utopia, so no matter how you change society it "won't work" for someone.

And depression isn't sadness.

Part of the diagnosis procedure for major depressive disorder is ruling out physical conditions that can cause similar symptoms. No one is going to miss that the guy had his leg blown off.
I mean sometimes. For me it was multivariate for sure. Biggest problem - wife and kid. Helped a ton. My specific wife, really. I doubt someone else would have helped me. I had a lot of self defeating thought patterns she helped me fix.

Second - light. Lots of light, specifically in winter time. Like this https://www.benkuhn.net/lux/

I had a horrible time with school because as finals rolled around in the fall semester I’d get extremely depressed and anxious.

My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
This is true overall, but it only works for a limited set of patients. It's pretty likely that what we're calling depression is a different set of diseases that manifest with common symptoms, and SSRIs + therapy work wonders for some variants, but not others.

In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.

Yes, this is what happens.
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.

I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.

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