[ejfox]

This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

Depression may be affected by real life problems but it is more life-enveloping than that. I've been the most depressed at times in my life when things were going objectively great. The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

[jdietrich]

>This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

There's no mention of that in the DSM or the ICD.

People with miserable lives can still be depressed; people can have miserable lives without recognising that their lives are miserable. There is no such thing as an "objectively great" life; attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself. Part of living a good life is developing an individual and personal sense of what is valuable and meaningful.

The current gold standard of treatment for depression, cognitive behavioural therapy, is in large part a coaching programme to encourage patients to do things to improve their lives. The cognitive aspect of CBT is secondary to the behavioural aspect - cognitive and metacognitive skills are taught in order to facilitate behavioural change.

[yellowapple]

"There's no mention of that in the DSM or the ICD."

Maybe not in those words, but the DSM does appear to distinguish between a depressive episode and e.g. bereavement: http://www.mental-health-today.com/dep/dsm.htm (I don't think this is the actual text, but it's the best I can find without a copy of the DSM-IV-TR on hand).

IANAPsychologist, but as an ordinary person, the article's distinction between sadness and depression seems reasonable and intuitive enough for a layperson to understand, and that's a step in the right direction in a world where laypeople (including people who might very well themselves have depression) rarely understand anything about the actual nature of depression.

[cpncrunch]

Having a crappy job or psychotic boss is more long-term than an "episode" such as bereavement, and definitely can lead to depression.

[yellowapple]

Perhaps. This is probably why I ain't a psychologist :)

The definition linked above does seem to generally imply (and in some cases explicitly state) that depressive episode/disorder symptoms better explained by some other diagnosis or situation (like schizophrenia or bipolar disorder) should be taken as further symptoms of that disorder/situation rather than a separate diagnosis of MDE/MDD. I guess the question is whether or not symptoms induced primarily by external stimuli (as opposed to when the symptoms are expressed as irrational thoughts regardless of external stimuli) ought to be under a similar banner of "these are symptoms of $SOME_OTHER_CONDITION rather than depression". My (again: non-professional) opinion leans in favor of "yes" being the answer, since it likely has different treatment implications (remove patient from symptom-causing stimuli v. prescribe cognitive behavioral therapy and/or medication to patient), but that's the thing about brains: nobody really understands how the brain (and thus the mind) works, and thus it's unclear whether or not such a distinction would actually be useful.

[cpncrunch]

It's difficult to determine whether or not depression is caused by life situation, unless there is something obvious like a recent bereavement.

It seems likely that both external stressors and internal thought processes can both be the cause of depression (and in many cases, a combination). CBT addresses the internal thought processes, but doesn't do anything to address external factors. My wife underwent CBT and took antidepressants, but they didn't really cure the depression. Quitting her crappy job fixed it for good.

[kkielhofner]

Much has been written about the removal of the "bereavement exclusion" from the DSM 5.

[yellowapple]

Good to know. The vast majority of what little knowledge I have of psychology is based around the DSM-IV, so that's where I tend to stick.

Do the other factors in that particular condition still apply? Namely, "the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation."?

[mmirate]

> attempting to define the quality of your life in reference to fixed external criteria is arguably pathological in itself

Isn't this merely inaccurate rather than pathological, since external criteria are almost never fixed? (cf. inflation)

[lightedman]

"There's no mention of that in the DSM"

The DSM changes so often that I wouldn't really rely upon it for a definition.

[yellowapple]

Our understanding of psychology and the human brain changes so often that I'd have a hard time trusting a source that hasn't been recently updated.

Even with that said, the average time between DSM revisions is, what, every 15 years, give or take? I wouldn't exactly call that "often".

[lightedman]

I can't trust the DSM because so many studies, experiments, and results regarding psychology and psychiatry simply cannot be reproduced or repeated with any degree of reliability.

[lobotryas]

I try to be very respectful about the topic of depression precisely because of the many things you write. That said, there has to be some more gradation between the extremes of "sad" and "depressed". I say this because there were many times in life I was "sad" for a very long period of time and it took a lot more effort to exit that nose dive than going to bed and waking up with a fresh perspective on life.

[infogulch]

The problem is that long-term sadness and depression feel very similar and they can be difficult to distinguish. Sometimes you can feel sad about some situation in your life and not even realize it. Or feel sad about something but you're suppressing it because of social pressure. These can look like depression.

Take a really hard look to find things that are making you sad. Especially things you're telling yourself that you're not sad about. If you find it, fix it like GP says. If you don't find it, pursue depression treatments such as the post.

[potatototo]

> The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

As someone who lives with someone depressed, I find myself guilty of doing this and I don't know any other way to be present for that person. What kind of approaches have you found helpful?

[dvt]

Depression is a sort of severe introspection where your thoughts (often negative) take over. The solution tends to be getting your mind off things.

Instead of asking "why sad," try to simply do things with the person that will get their mind off their own negative feedback loop. This is easier said than done, and if the depression is lasting for weeks or months, I suggest seeing a mental care professional.

[ars]

I agree. The best way to deal with true depressions (which is not caused by circumstance) is to simply do things.

Anything. (But not passive things like watch something, or read something.)

Make something, drive, hike, volunteer, clean, garden. Whatever.

You can help them by thinking of what activity they often do, and doing it with them. But remember to think of what they do, not what you do.

[robertbaruch]

I've found Zoloft helpful for my depression.

[sixo]

These terms are tricky. I wrote the above because I wish a message like that had gotten through to me (probably just saying it isn't sufficient) at any point in the ~half my life so far where I was, according to this terminology, sad by some circumstance like the above, but also depressed basically I think as a result of being sad and basically having surrendered to it as an inevitable thing: life was by any reasonable measure going well, but I was never happy with it. Some of the above examples reflect my experience, some the experiences of other depressed people I've known. Likely this does not apply to all (maybe most) cases of depression, maybe it wouldn't have helped mine. But I basically feel now, with most of it behind me - I hope - that I never really realized that these sorts of problems could be addressed, or felt ashamed of being unhappy with my situation and therefore decided they didn't deserve to be fixed.

[cpncrunch]

The article clearly shows that in his case, his depression was caused/triggered by life events. Clearly in his case things weren't "going well", as he had just been fired from his job.

[mkagenius]

That quote seemed wrong, the parent comment actually tries to make that correct.

> The people who asked "what's making you sad?" or tried to "fix" my "problems" were the least helpful.

That's why parent comment says to seek professional help. I believe they wouldn't ask or say those things.

[mrec]

Agreed, although it's worth noting that even if you can climb out, it's going to be a lot harder to stay out of depression if the next rung up is something like Freud's "ordinary misery", as opposed to your "objectively great".

[ZeroFries]

- This is advice for sadness, not depression. This is the opening quote in the article: "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

That just means you cannot identify the reason you're feeling depressed. If everything was going well (including your own health), you would not be depressed.

[tyree731]

I understand what you are saying sounds reasonable as a person who doesn't have depression, but it is not correct. I mean, unless you're defining "going well" to include "not having depression", at which point I agree, but then what are we even discussing?

This is a good starting point for the medical definition of depression (https://www.nimh.nih.gov/health/topics/depression/index.shtm...). Note the variety of treatments proposed that don't involve psychotherapy. These treatments aren't people taking the easy way out, these treatments are for people treating chemical imbalances in their brain that make it difficult for them to function in their daily lives.

For a more lighthearted discussion of depression, the new podcast "The Hilarious World of Depression" features interviews with comedians who suffer from depression, and how they've struggled with and managed from the disease.

[ZeroFries]

I include physical health in "going well". You clearly do too, hence "chemical imbalances in their brain". I think the problem is, we're trying to parse the world into discrete categories (this is a disease, this is not, this is an external factor, this is not), when the world is not really that easily parsable. All abstractions leak eventually.

[iak8god]

> If everything was going well (including your own health), you would not be depressed.

This is tautological, and hence true, but an uninteresting point. Just pretend it says "... Depression is when you feel down even when all is going well except of course for the disorder in your brain."

[ZeroFries]

No, I'm saying depression is when you feel down but cannot account for the cause.

- Depression is when you feel down even when all is going well except of course for the disorder in your brain."

I'm saying this is not a possible situation. The disorder is a result of things not going well, including your own physical health.

[iak8god]

Oh. Well, no, that's not what depression is. That's what sometimes causes people who are not clinically depressed to say "I'm depressed about X," but that's not what depression is.

[ars]

> If everything was going well (including your own health), you would not be depressed.

Sorry, but that just isn't true. People can be depressed for no reason whatsoever. See my reply here: https://news.ycombinator.com/item?id=13367913

[cgriswald]

Sometimes the reason you are feeling depressed has nothing to do with how things are going. My depression was caused by things that had happened in the past and that I didn't spend any time consciously thinking about. Dealing with that stuff took some work, but once I did, my depression lifted and hasn't returned.

Depression means, even if things are going well, you can't feel good about it.

[ZeroFries]

Every effect is caused by something that happened in the past. The physical trauma of past situations reared its head. Sounds like an external factor to me.

[cgriswald]

I agree with the other poster. Either your point of view is tautological, or you aren't really talking about depression.

[Alex3917]

> "Sadness is when you feel down because things aren’t going your way. Depression is when you feel down even when all is going well."

Sadness is the feeling you get when something bad happens and you are upset about it.

Depression is the feeling you get from brain inflammation, which might feel qualitatively similar to sadness, but which is usually caused by one or more of: chronic stress, lack of exercise, nutritional deficiency, poor sleep habits, lack of sensory stimulation, infection, or twenty other things.

Once you can differentiate between them, depression isn't actually that hard to fix, at least at the early stages. It's like right now if I were to gain five pounds I'd get acid reflux, but I know that, so if that starts happening I just stop eating as much for a couple days and the problem fixes itself. Same deal with mental states.

[yellowapple]

[citation needed] ^

In particular, it looks like you're mixing up cause and effect, and I haven't the slightest idea from where you're getting the "brain inflammation" thing (it sure as hell ain't in the DSM-IV, last I checked (it's been awhile, granted, but still)).

[Alex3917]

> I haven't the slightest idea where you're getting the "brain inflammation" thing from

http://lmgtfy.com/?q=inflammation+depression

[ajkjk]

You shouldn't post this way on this site.

You're claiming matter-of-factly that brain inflammation causes depression. Well, I (we) don't believe you, because that's a far from widely accepted theory. Your condescending google links don't help.

[Alex3917]

> Your condescending google links don't help

Which I posted in response to getting blatantly gaslighted.

I don't care if you disagree with me, but pretending you don't know how to use Google to try to discredit someone is a lame debating technique.

[ajkjk]

You weren't gaslighted. That's not what that word means. And everyone here knows how to use google. The problem here is that you said "Depression is the feeling you get from brain inflammation" instead of "there's a theory that depression is sometimes linked to brain inflammation". The former is far from factual, and it's dead wrong to claim it matter-of-factly.

Totally not surprisingly, when you google brain inflammation and depression, you get lots of references that suggest a possible link and none that justify claiming it as a fact. So, [citation still needed], and it's not because we're bad at using google.

[yellowapple]

For reference: https://en.wikipedia.org/wiki/Gaslighting

"Gaslighting or gas-lighting is a form of manipulation through persistent denial, misdirection, contradiction, and lying in an attempt to destabilize and delegitimize a target."

There's a clear difference between that and calling out (EDIT for clarification: what I believe to be) incorrect information, and my admittedly-biased opinion is that my previous two comments in response to your own are squarely in the latter camp versus the former. I'd also hardly call one or two comments "persistent", though - again - my viewpoint is obviously biased in my favor.

I'll admit that pulling a [citation needed] was excessively snarky, though. I'm sorry. I ought to know better than to be a jerk, no matter how right I think I am.

----

With that said, "just Google it" (and similar approaches, like linking to a search engine query or some snarky wrapper thereof) is a very poor rhetorical technique in general; as I've already demonstrated, it's not guaranteed to actually prove one's point, and it reeks of either or both of two hidden meanings:

1. "I don't really care enough about the topic to give a meaningful citation, so I'm just going to tell the other party to find citations oneself"

2. "I don't actually have any source for the information I've provided (maybe I did once upon a time, but I sure don't anymore), so I'm going to tell the other party to 'just Google it' and hope that said other party is somehow impressed by the number of search results regardless of the sites in question or what the linked pages actually say"

Thus, it's generally a good idea to avoid those potential hidden meanings and just provide an actual source.

[yellowapple]

From your Google query: http://www.medicalnewstoday.com/news/severe-depression-linke...

"The Duke team concluded that depression, therefore, is more likely to contribute to inflammation in the body as opposed to arising as a consequence of inflammation."

[Alex3917]

The Duke research is interesting.

But saying that because they didn't find a pathway that inflammation is unlikely to cause depression doesn't really make any sense, given that major triggers for depression are surgery, infection, autoimmune diseases, etc.

I don't think anyone is disputing that depression also causes inflammation, but the idea that the causality only goes one way just seems very counter to everything else we know.

[yellowapple]

The point is that there's no clear causation in either direction, and certainly not in even a significant minority of cases (let alone all or even a majority). We just don't know nearly enough about how the brain works to be able to chalk up something as complex as major depressive disorder to "your brain's inflamed; take some Aleve".

In fact, the DSM definition of major depressive disorder/episode (or at least this summary thereof (I unfortunately don't have a copy of any DSM version on hand): http://www.mental-health-today.com/dep/dsm.htm ) explicitly excludes cases where the symptoms are caused by some other physical case:

"Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations."

I would think brain inflammation would count as a "general medical condition" in this context, though whether or not "clearly" is applicable is admittedly very unlikely. Regardless, the DSM seems to maintain a distinction between "depression symptoms caused by some other disorder, whether psychological or physical" v. "only exhibiting symptoms of one or more major depressive episode(s)". In the former case, yeah, totally work on fixing that inflammation with lifestyle changes or whatever. In the latter case, it ain't really that simple.