[PragmaticPulp]

> Everyone wants a pill as a quick effortless fix, but IMO it seems a lot of our modern afflictions come down to an gross imbalance of exercise, diet, sleep, and social connection.

For what it's worth, exercise, diet, sleep, social engagement, and lifestyle changes are well-known inputs to addressing depression. Therapists will explore and encourage improvements in all of these areas. Good psychiatrists will as well, given enough time and a patient who is open to listening.

One of the difficult issues is that many depressed patients often don't want to hear any suggestions that depression might be due to anything other than external factors. This is why the pop-science version of the "chemical imbalance" theory became so popular in the mainstream: It gives a plausible explanation that depression is just something that happens to you due to no fault of your own, which is weirdly easier to accept for many people.

There are similar treatment problems with a host of health issues, such as obesity. The trend on social media and pop culture is to explain obesity away as a chemical or societal problem, minimizing the input of personal choice and actions. It's very popular to propose theories that "counting calories doesn't work" or hear anecdotes about people who claim to only eat less than 1000 calories per day but never lose weight (which isn't possible, even 100% sedentary coma patients need more calories than that).

[AnIdiotOnTheNet]

But Obesity isn't very much about personal choice, as evidenced by most people being able to keep a reasonable weight without counting calories or putting in any effort whatsoever, while people like me have to obsess over everything because if we ate the way we "naturally" feel like we should then we'd be blimps.

Or rather, it is about choice, but the choice for some is "obsess over it and suffer a lot more than the people around you for the rest of your life", not to mention generally being treated like not being able to fight your body's compulsions is a personal failing by people who don't have to fucking do that.

P.S.: And before you go shoving your fad bullshit advice of the week at me, it should be noted that at one point I had lost half my body weight and am still over 100lbs down. I have been doing this for over a decade, I have tried every trick anyone has yet devised to make this easier and none of the work for this kind of weight.

Any diet will work for 10-15lbs. Like, literally any diet. This has been shown multiple times. Losing real, serious, obesity-level weight takes significant effort and suffering continuously and anyone who says differently is full of shit.

...unless there's a drug involved. Amphetamines and the new class of diabetes drugs seem to actually work wonders. The former is obviously problematic and ill-advised.

[curioussavage]

I’ve seen some published studies recently about altered gut bacteria in people whose mothers experienced trauma, altered insulin sensitivity. It’s definitely getting clearer scientifically why weight is so much harder for some

[AnIdiotOnTheNet]

Yeah, there does seem to be a lot of data to support the idea that gut microbiome is a lot more significant to our brain function that we would have assumed, but until there's a reliable treatment I can get or self administer it is pretty much irrelevant to me.

[elric]

I think the folks on HN are generally aware that weight loss is incredibly hard, I'd be surprised to see anyone here trying to shove fad advice down your gullet.

[AnIdiotOnTheNet]

It happens almost every time. People show up when weight loss is discussed and talk all the pseudoscience behind intermittent fasting[0], Paleo, carnivore, anti-FODMAP, etc. and how that's the key and it changed their life because they are never hungry and blah blah blah.

[0] which I find hilarious because their definition is skipping one meal a day, not skipping entire days at a time the way I did when I was trying it. Skipping a single meal is not, nor will it ever be, "fasting" as far as I'm concerned.

[kar5pt]

I could flip this around and say that focusing on internal causes of depression is a way for those in power to avoid the social responsibility of having to change it. We can kick the responsibility ball back and forth all day.

Why is it so hard for people to get adequate sleep, exercise, a good diet and social interaction? Even most non-depressed people I know don't do these things well (except maybe the last one), so this isn't something unique to depression.

[ryanwaggoner]

Exactly this. We throw people into a sick society and then blame them for their lack of personal responsibility when they get sick themselves.

As an individual, yes, do what you can (which might mean changing to a less “sick” culture or subculture so you’re not fighting a sisyphean battle). And also, we should do better as a society.

[s1artibartfast]

Society is simply a collection of individuals and their behavior. It is not synonymous with politics.

For example, If people lack meaningful social and don't want to socialize with their neighbors, call friends, or have dialogue with their partners, you can't legislate solution to that problem.

[ryanwaggoner]

Who said anything about politics or legislation?

[s1artibartfast]

It seemed to me that you were proposing that (1) we as individuals do more and also (2) we as a society should do more.

Maybe we fundamentally agree, but I was pointing out that society IS the individuals. doing (1) is how you do (2).

Maybe this is pedantic or my own bias, but I think it is important to keep in mind. Some people use "society" as a substitute for "other people but not me".

When some people talk about changing social norms, they mean forcing other people to act opposed to leading by example.

At the end of the day, I think I agree with you that we do live in a sick society. The best remedy is to cure the sickness in ourselves.

[ryanwaggoner]

I agree, and it’s an excellent point. I guess I also wonder if we can be more aware as individuals of the forces shaping society and culture, and actively try to engage in changing them. But it still starts with ourselves.

[elric]

Same with drugs. There's a bit of cocaine-epidemic where I live. With lots of gung-ho politicians clamoring for a "war on drugs" and "zero tolerance" and "hold the addicts accountable", etc. But I don't hear any politicians talking about why so many people want to snort cocaine...

[goldfeld]

That's because they love their cocaine.

[curioussavage]

Nice points. You don’t even have to argue about internal vs external causes. The real question is about capability. To me when a person is not receptive to advice about lifestyle changes it’s less about stubbornness or ignorance and more the patient communicating apathy, lack of energy, motivation.

[curioussavage]

Worrying about fault and taking an adversarial perspective where you see patients as being stubborn or lazy and concluding that resistance to lifestyle changes is due to that is absolutely insane.

People are resistant to those things because they are being told - do all these things and make all these hard changes and you will feel better and have motivation and energy. While they are thinking, “but to do all those things will require a lot of motivation and energy”. So patients are being told to get the things they want, they need to already have them.

It doesn’t matter if depression is a chemical imbalance or whatever. The reality is people get stuck and medication is a very easy initial step that can get them moving. It’s well established that executive control varies among people. It’s not a moral deficit to be on the lower end of that spectrum and be unable to spontaneously will yourself out of a depressive apathy.

[2OEH8eoCRo0]

> One of the difficult issues is that many depressed patients often don't want to hear any suggestions that depression might be due to anything other than external factors.

I knew someone like this. She'd get new therapists until one of them tells her what she wants to hear.

You're nailing it IMO. If you get to blame society, genetics, or external factors then you don't have to take responsibility. You get a pass. (people think)

[PuppyTailWags]

To counterpoint your anecdote: I know a girl who is fit, eats great, gets good sleep, regularly goes on long trips with friends, still clinically depressed and struggles to experience any sort of joy which is why she puts in so much effort into trying to improve her life. Still got depression, baybee.

[whstl]

Funny thing. I actually got depression/burnout when I was preparing to run a half-marathon (I do it yearly).

It pissed me to no end that the couple people who got to know about it basically told me to "just exercise more and do volunteer work and it will go away", even when I told them that it was caused by work-related stress.

[rconti]

Telling a depressed person to just start exercising, eating well, and sleeping sufficiently is really not significantly more helpful than telling them to just be happier.

[Dma54rhs]

Telling them they can fix their problems without doing any of those is not working either.

[curioussavage]

And who’s saying that. I think that’s a ridiculous assumption that goes along with anti med opinions

[joescharf]

> This is why the pop-science version of the "chemical imbalance" theory became so popular in the mainstream: It gives a plausible explanation that depression is just something that happens to you due to no fault of your own, which is weirdly easier to accept for many people.

Yes, and "chemical imbalance" is totally legit but not like its predominantly being marketed. The chemicals (dopamine, seratonin, whatever) are already present in our bodies - they just aren't consistently expressed across the population. For many people, these chemicals aren't released as regularly or in sufficient quantities for a given time period. Often due to lifestyle, but also just differs from person to person. But hey, put in 45 minutes of Z2-Z3 cardio and it can be amazing how the cobwebs get cleared.

> The trend on social media and pop culture is to explain obesity away as a chemical or societal problem

The somewhat recent corporate opportunism targeting obesity and marketing it as completely normal and healthy, almost something to strive for, is incredibly concerning.