[DanBC]

I'm often surprised by non-doctors giving medical advice to someone who has a potentially fatal illness.

It feels really irresponsible to me. As irresponsible as telling a cancer patient to try carrots.

Although I accept that you're showing compassion, and that's important. And that you're not being judgemental. And that you have some evidence that exercise works to treat depression - you're not talking obvious nonsense. (Although that evidence isn't as strong as you think it is, especially for major depression.)

[dang]

We detached this subthread from https://news.ycombinator.com/item?id=11368005 and marked it off-topic.

[nommm-nommm]

This happens with any chronic illness especially ones where the cause and treatment are vague.

"You need to do X."

Suffer from a chronic illness and you'll get all sorts of unsolicited comments from strangers to give up or get more Y. While perhaps we'll meaning these comments are grating, overly simplistic, and unhelpful - most people have tried everything under sun and more. Their medical issues aren't as simple as you make them out to be.

Exercise is probably helpful for someone moderately depressed or just feeling a little down. Probably not very helpful for the seriously depressed. I know it was unhelpful and somewhat harmful for my [very serious] depression.

[shanusmagnus]

The evidence for physical activity being good for just about every ailment under the sun is about as incontrovertible as the evidence for water being wet. Considering that it's vitally important, often ignored, devoid of negative side effects, and free to implement, I think you're the one being irresponsible.

[0xcde4c3db]

> The evidence for physical activity being good for just about every ailment under the sun is about as incontrovertible as the evidence for water being wet.

No, it isn't, but people really, really like to think that it is [1]. Like most other interventions worth talking about, there are situations it improves, situations where it doesn't change much, and situations it worsens (those "consult your physician before starting an exercise program" disclaimers aren't just for show).

[1] http://blogs.discovermagazine.com/neuroskeptic/2010/11/30/ex...

[a3n]

Anecdote of one: Looking back, I've been depressed most of my adult life, from 20 to my current 58. A few years ago I went to CrossFit for a couple years. I went from not being able to do a single pullup, to being able to crack off 20+.

It didn't help. For me. I still wanted to kill myself, and all the while I went to the gym I felt it was pointless.

Again, that's an anecdote of one. The cause of my depression and someone else's, and the effective treatment, are potentially very different.

Great if exercise helps a particular depression. But if it doesn't, the that person is fit and depressed.

A mental health professional is the best bet.

[NikolaeVarius]

I can relate.

I went on a fitness binge a bit back. These days I can run a 10k in 45 minutes pretty easily, hit very good lifts for my weight class, and eat salads basically every single meal.

After work and after the gym, all I want to do is drink or anything similar to get rid of all the thoughts in my head about how pointless it all is. Why the hell do I care if I can do all that crap.

I feel like how others do. I work 60-70 hours a week because work is the only thing that keeps me away from more depressive thoughts. I don't enjoy doing anything. I've tried going on vacations, hiking, all the things people say young people should do.

All it ever does is make me more depressed that I don't enjoy these things at all, especially since I'm in my early 20s. I've tried doing hacking with Arduino and Raspberry Pi's because I'm supopsed to enjoy that, but no matter what, I don't care because it all seems like junk. I don't care about that shit at all.

I sold a majority of my stuff, and the majority of my possessions fits into a single SUV. No permanent furniture, nothing that costs more than a grand.

Owning stuff brings me no joy, so why even bother having it around.

[ZeroGravitas]

One of the symptoms of depression is losing interest in things that you previously enjoyed.

I was mildly depressed for a while and even things that previously gave me great joy, like music and hanging out with close friends, lost their charm. I believe the technical term for this is ahedonia. Luckily I got better and the joy came back.

So perhaps you do enjoy some of the things you've tried, your just not in a physical state to feel it at the moment.

[a3n]

Yeah, this is how most things felt for me. Why do I care? And then I'd look at other people enjoying their lives, doing things they do, things that I do too, and wonder WTF? What's wrong with me?

For me, with treatment, I've gained back the capacity to enjoy life. I've gained myself back. It's not happy pills and shining eyes, it's just me, still with my individual qualities and quirks, who's been in there all these decades.

I hope you get help. It's hard to think that help is worthwhile, when everything else seems pointless. But it's worth talking to your doctor or other professional, and it's worth continuing to try if the first methods don't work. You are in there somewhere.

[mistermann]

Do you hate what you do for work?

Kudos on being able to accomplish all the fitness goals under the circumstances, fwiw.

[NikolaeVarius]

No, I actually somewhat enjoy it. I do wish it was a bit more technically challenging, but really, if I didn't work as much as I did and at the very least took a bit of enjoyment out of it, I probably would have killed myself last year. It's the only lifeline I have.

[mistermann]

I was just thinking maybe you could find something you love. At this stage the salary you receive probably isn't terribly important. If you're that close to the end of your rope, trying fairly random solutions maybe isn't that bad of an idea.

[studentrob]

Are you curious about anything? Travel, girls, sports? Could you put yourself in a new environment to renew some curiosity?

[NikolaeVarius]

Tried out travel. Went to about a half dozen countries. Didn't do it for me. Everywhere is pretty much the same. People trying to live their day to day lives with minor difference in culture. Meh.

I'm terrible with people in general. I'm generally a huge bummer to be around and people don't really interest me too much.

Sports are boring as hell to me. I used to play tons of soccer, but I don't quite enjoy it all that often. Tried hiking and mountain climbing and never really enjoyed it. Even after dozen hour hikes, mostly just got a dull sense of meh.

[studentrob]

Fair enough. Can I just say, you don't know for certain you're a huge bummer to all others. That is just your perspective. There are people who enjoy being around people who others consider a huge bummer.

I get that you don't like being around people yourself. But I know there are some who'd enjoy your company despite your own feeling. I don't have a magic solution for how to find such friends.

My only other suggestion, aside from speaking to a therapist, would be trying meditation. Taking a few deep breaths in a quiet space, sitting in a relaxed but upright position, and trying hard to think about nothing, or only your breath, for 20 minutes, can do wonders. It is harder than it sounds and can open your mind to a lot of possibilities that previously seemed impossible. I recommend the book Mindfulness in Plain English if you're interested to learn more. It's free and available online. You're as valuable as any other person on this planet. We're all equals. Once you believe that, you can do anything you set your mind to.

[Zeeem]

I don't recommend giving this advice to people who are seriously depressed. Speaking as someone who went through that for two years, it's more of a disease than a lifestyle problem. I could have done all these things and still have been miserably depressed.

What helped me was talk therapy, medication (the biggest factor), and having really supportive friends.

[studentrob]

What is the process of talk therapy? Isn't it just asking questions? Did I actually give any advice there?

For sure friends are best. But if someone vents online, how are we to know whether this person will go elsewhere or not for support? I'm not offering to take the place of a professional but I wonder if it really hurts to converse with a depressed person online by asking questions. Silence certainly isn't helpful. And if everyone just says, seek professional help, is that really empathetic? Sounds a bit robotic to me.

[DanBC]

Here we have a person expressing psychologic pain. And then another person, with no medical training and no psychologic training dismisses any possible cause of that pain and says "go for a jog". It's not a helpful way to give that advice. And it might not be useful advice.

> The evidence for physical activity being good for just about every ailment under the sun is about as incontrovertible

How do you explain the meta-analyses that show weak results for exercise?

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> However, it is not clear if research actually shows that exercise is an effective treatment for depression.

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

> Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies.

> Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies.

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

> The evidence about whether exercise for depression improves quality of life is inconclusive.

[farresito]

dismisses any possible cause of that pain and says "go for a jog" Well, thank you. Apparently recommending to incorporate jogging is dismissing any possible other cause. Furthermore, I say that I still haven't beaten depression, even after doing sport, which implies that even I do not consider the lack of sport to be the only cause.

[forgetsusername]

What is there to explain?

From your post it looks like exercise can have positive effects on depression. I haven't read anywhere here that it's the only solution. But it's sometimes as effective as other known treatments (according to your own link) and it's cheap and easy to implement.

Anti-depressants and therapy don't work for everyone, either.

There are people in this thread crying for help. They are looking for advice. Yes, going to see a doctor should be at the top of your list. But let's not pretend the medical system is perfect, or that we all live in San Francisico with a ton of progressively thinking doctors. There's still a stigma with mental health, even in the medical field.

[DanBC]

> Anti-depressants and therapy don't work for everyone, either.

No, they don't. But they are more likely to work than exercise, and they're easier to try than exercise. The problem with recommending exercise is that it's not effective for most people, and can increase feelings of hopelessness and despair in people who try it but who see no effect. This makes it harder for them to seek help from a qualified professional. It also requires considerable effort - 30 minutes of exercise 5 times a week isn't something that most people with a severe depression can do. (And here the recommendation was more than that! 30 minutes a day.)

Here the suggestion was not "try exercise on top of seeing a doctor", the suggestion was "try exercise".

Don't forget that suicide is a leading cause of death (second leading cause of death in US males aged between 13 and 35 http://www.cdc.gov/men/lcod/ ) so there's a risk of real harm here.

If people are going to give unsolicited medical advice to someone with a potentially fatal illness they should probably spend a bit of time to see if there's any evidence to support their advice, or they should make it much clearer that they're sharing their anecdotal experience in an attempt to empathise.

Every single time depression is mentioned on HN someone will say "try exercise".

It's a meme that needs to end because it's potentially harmful, mostly not helpful, and it can feel really dismissive to people with depression.

[shanusmagnus]

A reasonable person will not hear the suggestion "try exercise" and infer that since "drink water" was not mentioned, that they ought to stop drinking water.

Unless you have some weird heart condition, or are attached to an IV pole, or are not subject to the laws of gravity and therefore are in danger of floating off into space should you leave your apartment, exercise will probably not hurt you, and may possibly create a positive change in your circumstances, whatever they happen to be[1].

[1] I trust the majority of HN readers to figure out when disclaimers apply.

[facetube]

It's a great adjunct IMO, but it doesn't necessarily fix the underlying problem reliably. I got my usual run up to 21 miles before I developed fractures in my shins and the coping strategy fell apart. I should have spent some of that time with a doctor.

[kzhahou]

It might help, but the advice to Get Physical, just by itself, isn't useful. The disease itself works against a will to exercise.

The best advice and only one worth giving is to please seek professional help if you think (or know) you have depression.

[grahamburger]

I get so tired of comments like yours. What are we supposed to do then? Just give up and watch them go? If someone can't or won't go to the doctor, they're done for? What about all of the other people reading, who might now or at some time in the future suffer from depression? Is it really 'irresponsible' to suggest that there are ways to prevent/decrease depression besides going to the doctor? Compare it to cancer. There are things people can do to lessen their risks for getting cancer. (Including exercising). Obviously if you have cancer, go to a doctor. But until then it's not irresponsible to suggest that you get some exercise. Or eat carrots, for that matter.

[a3n]

> I get so tired of comments like yours. What are we supposed to do then?

The best first advice is to get professional help. That doesn't mean "get drugs," it means start the evaluation process, which may or may not include drugs, therapy, exercise, whatever.

Go ahead and recommend exercise or herbal remedies or whatever, but I believe one should strongly direct a sufferer to professional help first. The closer and more credible to a person you are, that may be more like telling them to go, or even bringing them there.

Everyone's depression is unique to them. Sure the causes and treatment may be common with other people, but what works for one, or doesn't, is not necessarily the same for another.

Treatment for depression needs to be directed by a doctor or other trained professional.

[grahamburger]

Of course, suggest getting professional help first. But as a random internet board commenter, I can't drive them to the doctor. And for many people suffering from depression (I've been there, many of us have) getting to the doctor may as well be getting to the moon. But for me, if I could just get outside, things started to look just a little bit better, and maybe I could make it down the street. And then things looked a tiny bit better again, and pretty soon I could remember that there were people who cared about me. I doubt I'm entirely unique. Maybe there's someone reading this thread for whom the first step to getting help is just to get outside, and I'd call it irresponsible withhold that information.

[DanBC]

> Maybe there's someone reading this thread for whom the first step to getting help is just to get outside, and I'd call it irresponsible withhold that information.

I don't think that's what the post I responded to was saying. I think the post I was responding to was recommending exercise as a treatment for exercise, not recommending just getting out of the house as a first step to seeing a professional.

> Of course, suggest getting professional help first.

the post I responded to did not do that.

You've described how hard it is sometimes to leave the house. Do you think it's realistic to expect a person in that situation to start doing 5 sessions per week, 30 minutes per session, of vigorous exercise?

[studentrob]

Amen. The drones in this thread calling only for professional help and accepting no other comments are mind numbing and pedantic.

Depression can be deadly but it isn't the same as cancer. Good friends and family support and understanding don't make cancer any better. They may not always help with depression either but it is possible.

So, there is no problem calling for people to propose professional help first. But in a thread where that is mentioned a hundred times, to demand that every commenter preface their feedback with this line seems so pedantic to me.

[DanBC]

But the "get some exercise" suggestion was not made as a way to build resilience to prevent depression! It was given as a method to treat a current illness.

Here's why I think suggesting exercise as a treatment for depression is a bad idea - it might not work. https://news.ycombinator.com/item?id=11368202

If someone can't go to a doctor that's something that needs to be fixed, and if they can't go to a doctor they're unlikely to be able to get the 5 * 30 minutes per week vigorous exercise.

EDIT: I mean, it's an anecdote. "Exercise worked for me". The trouble is I can find you plenty of people (and I speak to them in mental health hospitals and community settings) who've tried exercise, and it didn't do anything and they felt worse because it didn't do anything.

It is really important for people taking mental health meds to get more exercise, but that's not because of the possible treatment effects of exercise, but to try to mitigate some of the side effects most meds have, and to try to build resilience for the future.

[0xcde4c3db]

> Is it really 'irresponsible' to suggest that there are ways to prevent/decrease depression besides going to the doctor?

If the methods you suggest don't actually help, it risks making the depression worse, because it matches the pattern of "Why try anything? Nothing works.".

[grahamburger]

> "Why try anything? Nothing works."

That seems like a better outcome all around than not knowing what to try. At least you know you have some options. For some people, it might help - at least enough to get them to the next step.

[0xcde4c3db]

What I'm saying is that when you convince a depressed person to spend their scarce reserves of effort on useless measures, you risk diminishing their ability to convince themselves that the "next step" is worth taking.

[grahamburger]

Right. If you know the person well, you can probably make a reasonably good decision if it will help or hurt. But on a random internet message board, we don't. Undoubtably there are some people listening who would react as you've described, and some who might actually find a benefit from getting outside. So, if you're listening and suffering, go see a professional. Just keep in mind that if that seems impossible, start by getting yourself out the front door.

[qplex]

Doctors mostly do their work inside the system and their knowledge is limited to "legal" options. In my experience you cannot even mention weed without being stigmatized as a "drug user".

For me, weed works very well, I feel more energetic and happy as long as I can get my daily dose.

In the eyes of society I'm a criminal though... and that is something that makes me depressed. Quite a dilemma.