[eiriklv]

So many people (including doctors) seem to be set on the idea that serotonin makes you happy and therefore is the solution to depression. This is only half true, and not in the way that most think. Serotonin (if high) makes you numb [1]. But that might be the lesser of two evils when it comes to depression [2], which is why it’s become popular as a mechanism to treat it. It not a solution, it’s just masking the underlying problem by replacing one set of symptoms with another.

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989833/

[2] - https://www.health.harvard.edu/depression/is-your-antidepres...

[api]

That is one alternative hypothesis. The reality may be even more complex than that. We don't really understand these brain systems and of course they're all tangled up in feedback loops with each other.

I do wonder though if it does make you numb if that isn't always bad. For some people depression might be related to an excess of sensitivity or some past trauma. Numbing that a bit might help them move past it and might be beneficial to their healing. Of course this might not be the case for people whose depression has some other source and it might not be the case for continuing treatment. It's possible that some people might benefit from taking certain drugs for a period of time but not forever.

It's all quite complex, individual, and not yet anywhere close to fully understood.

[dkersten]

I think numbing might be useful if, for example, you’re currently incapable or illequiped to deal with whatever underlying thing is causing it, but its not a soltuion by itself, but rather a delaying tactic until the point when you can deal with or treat the issues.

[laythea]

That does beg the interesting question that if you don't feel depressed, are you really depressed?

[crdrost]

You are not, on present definitions.

This is one of those things that a lot of members of the public at large do not seem to know; they think that depression is defined as some sort of chemical imbalance in the brain, and it is not. Depression is defined in the DSM more or less as, being sad too often, except in cases of mourning etc. where people are often incredibly sad. It is literally defined as an overabundance of feeling.

This matters to me because I no longer have depression—I am “cured!”—because I am no longer too sad often enough to qualify for the diagnosis. I did not use medicine but developed better coping mechanisms. The cause of my depression is still around—my negative thoughts will on average trigger one or more additional negative thoughts until I am paralyzed with self-doubt and negativity. Indeed, and this is somewhat hard to explain to folks who have never had this problem, I will sometimes luxuriate in those negative emotions because they have a sort of familiarity or nostalgia, I spent so much time being so sad that it is sometimes desirable to feel unpleasant again. That sort of complicated “if you seek out sadness is it really sadness” type of question is 100% interesting and valid.

But I developed coping mechanisms to deal with those sorts of emotional overloads and recognize that they are happening and escape them, and I do not frequently return back to those unhealthy thought patterns. In that respect I am cured. The psychiatrists define depression so that that is what cured looks like: we have not necessarily addressed whatever the underlying cause is, but we have treated the symptoms.

So it is literally impossible to be depressed if you don't feel sad often enough; it is part of the definition. Anyone who says “oh I get really sad and maybe even suicidal, but I am not depressed” is making a nonclinical statement that would not be directly translatable as a clinical one.

[uneasy-sausage]

Care to expand on the coping mechanisms you developed? Emotional regulation and stamping out rumination seems to be a wonderful life skill to develop across the entire board.

[crdrost]

Sure, but my physicist training requires me to add the standard caveat about sample size of 1. Depression comes in many forms and what works for me and my form of depression may not work for yours. In addition there is some research that suggests that depressed people simply grow out of depression often enough; if you sent what I know now back in time to when my depression was worst there's not even a guarantee that it would have worked back then.

So there were two key developments that helped me personally.

The first was a unified theory of righteousness, manifested in five commitments I made to myself. They are commitments that I view as essential to a good or heroic life, they are interdependent and when they are in conflict they require wisdom to resolve the tension. They are commitments of love, honesty, ambition, compassion, and humility. So the idea that I had stable commitments started to anchor me: I was not totally worthless because I had understood the basic axioms for being heroic. So this is a core environmental change. I could go on and on about what each of these mean but it is perhaps not the right context or time for that just here.

The second major change was an adaptive change in crisis moments. I have a strange religious history where I started Catholic, became a fundamentalist, became an atheist, became a Buddhist, became a mystic Christian again. Somewhere in the atheist phase after fundamentalism I had started learning about Buddhism as part of a general interest in world religions and their models of heroism but before I had really started meeting Tibetan Buddhists in person. This introduced me to meditation, but that was not quite what I use: meditation is something of a constant attention-strengthening exercise, this is more of an acute stress response. The idea is that I simply try to sit still in the middle of these swirling negative emotions. My problem is that each negative thought causes, on average, more than one negative thought: this change in what I am paying attention to and how I am organizing my activity, takes that number less than 1. I would not say that it is fully zero. But the point is, that then my negative emotions behave more like others', they multiply a little bit but eventually peter out. So just by finding that eye of the storm, I can eventually gain control of my mind again.

[xkcd-sucks]

Most "Clinical *" diagnoses are predicated on "causes problems for you or others", so probably not. Unless somebody else feels you're depressed and is really convincing.

[eiriklv]

If you don’t feel anything - are you really living? Look up emotional bluntness and anhedonia.

[laythea]

Yes but, the lack of feelings can be classed as a feeling also. Where does that leave us! :)