I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW.
I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thought Vanlafaxine was a comfortable ride but it raised my blood pressure to the "go to the ER" range. Call on the phone and lean in about adjusting your meds. (2) Getting an appointment for talk therapy can take a while these days. (3) In a hard case you can get a more complex medication cocktail from a psychiatrist but the wait could be worse than the talk therapy. (4) People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress. 2 hours a day of cardio helped me deal with a business development process that went on for years before ultimately failing.
The military does insane cardio because when the enemy knows where you are sometimes you have to run hard and fast in hopes you can get to safety before they can kill you. I've known people who likely would have died in Afghanistan without that insane cardio.
it might help with stress too, but that isn't as clear
> People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress.
This is giving the military way too much credit for organized stress management. If military people give the impression of doing "insane amounts of cardio" it's because that's what the physical fitness tests are biased towards.
And we also won't talk about the fact that getting a psych diagnosis, especially in fields like aviation, can end your career, while managing stress via alcohol gets a wink and a nod as long as you don't have an alcohol-related incident.
Or avoid medication for anything but treatment resistant depression.
SSRIs are not well understood. Their side effects are not great. Getting off them is miserable. I had them. I felt dead inside. Mission accomplished. Depression was gone, so was my desire to eat, have sex, or do anything else. I wasn’t depressed, I was a zombie. 8 adjustments and medications later I got off them and realized they’re yet another pill to fix a problem 98% of people can fix other ways if they tried.
I do not understand this intense desire to be medicated. Exercise, go outside, talk to people. Get good sleep. Once the rest of your life is squared away get some meds if necessary. Psychiatrists and psychologist walk the razors edge of quackery every single day. Talk therapy is a program to take tremendous amount of money from people and funnel it into their account. It’s absolutely nuts the average talk therapist bills at over 300 dollars an Hour. There is no reproducibility in mental health. in their “science”. Therefore, there’s no reason to believe their magical pills will fix problems they barely understand at a biological level.
As a final note people in the military do a ton of cardio because running and rucking is hard work you train for. It is certainly not to “stay sane”.
100% I have found the same, SSRI's definitely make things worse and I stay away from them, and regular exercise has offered the biggest consistent/persistent improvement in mood.
Medication is the fastest way to make some positive progress before you completely spiral and majorly fuck up your life.
Would you rather take a pill and keep working while you sort things out or would you try to rebuild everything after you burn it all down? Talk therapy and exercise may be just as effective or more so long term, but may not be effective enough in the short term.
Would you mind reviewing https://news.ycombinator.com/newsguidelines.html and sticking to the rules? We'd appreciate it. You're welcome here as long as you do that, but we really need commenters to stay respectful, avoid posting in the flamewar style, and (above all) use the site primarily for curiosity, not smiting enemies.
Dunno why you are being downvoted, probably cope. It is well known by now that antidepressants are only marginally effective on average [1-2]. You're right they should probably only be prescribed for quite severe or treatment-resistant depression. Although the treatment-by-severity effect has been somewhat disputed [3-4], it has rough support [5], and makes sense since it is dubious that we should be giving ineffective medication with serious costs and side-effects to people with moderate depression.
My take is pessimsitic estimates of AD effectiveness assume you get one Rx and don't follow up and adjust dose and medication choice. I was lucky when I took ADs to have a good primary care doc who had a psychiatric nurse practitioner working at his office and being a good self-advocate.
The "sequential treatment" or "tailored treatment" approach is at least plausible and what is done in practice, yes, if the prescribing doctor is good, and if this is feasible for the patient.
However, since this takes time, and most depression is temporary, it is hard to know if you really are tailoring the medication to the person in many cases, or it has just been long enough you are seeing regression to the mean (or a placebo response, which is still strong even in treatment-resistant depression https://jamanetwork.com/journals/jamanetworkopen/fullarticle...).
There aren't really any double-blinded or even just properly placebo-controlled / no-treatment controlled studies to test this, but the closest thing to looking at the sequential approach also doesn't find very impressive results (https://bmjopen.bmj.com/content/13/7/e063095.abstract).
I do believe the drugs help some people, and almost certainly take some experimentation / tailoring. The average effects are just very weak.
yeah... i did forget to add meaningful community and spiritual activities to that list but people can have just as strong objections to them as they do to the other things on my list!
Your experience is not the same as other people. No one cares if you don’t understand their own life and choices. Get off your high horse and stop assuming that “those dumb depressed fat people just need to sleep better, eat better, and exercise and obviously it’s just that easy”. If you had success with whatever method, that’s great. We’re thrilled for you. But what works for you is not a universal solution.
We've asked you to stop posting like this to HN. I understand that the topic is sensitive and personal, but being this aggressive in HN comments is not ok and we ban accounts that do it.
You've been a good contributor to HN for a long time and most of your comments aren't like this, but there is also a long history of us asking you to stop posting personal attacks:
I don't want to ban you but it's important to preserve this place for its intended purpose of curious conversation (which depends on thoughtful, respectful comments), so if you'd please review https://news.ycombinator.com/newsguidelines.html and stop doing this going forward, we'd be grateful.
As a long time Usenetter, I don't care about the first two sentences being abrasive, but the material in quotes is insinuating that the replied-to grandparent at some point contained that verbatim text. I have a hunch that it did not, which is not cool. Particularly because the text is negative, making the false attribution defamatory, which is a different category from insults.
Yes, using quotation marks to make it look like you're quoting someone when you're not is a trope of internet aggression and something we've long asked HN commenters not to do: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que..., and is one of the reasons why the GP comment was abusive.
I won’t argue against you. It’s clear you would’ve been in complete support of the lobotomy craze. Exercise, diet, sleep, and good company are the most universal cure for the average form of depression. I specifically called out treatment resistant depression as requiring medication. Surely your basic bitch depression caused by being overworked, underfed, and slammed with bills can’t be fixed with anything but a simple pill.
You missed the greater point that medicines are overprescribed and OP all but made a Pfizer ad out of their post. HNers lack contextual reading ability, and life experience. It’s a shame really. The over prescription of drugs is a tremendous problem in the west.
My “high horse” is supported by actual medical science. Unlike the entire field of mental health.
Pfizer ad or not I'll say my AD experience was positive. I got it prescribed by a psychiatric NP in a time when my job situation was about to go to hell but I was planning to tough it out till I got the project done.
I did get the sexual side effects but because men often come too quick it can be a blessing as much as a curse, personally I found it took longer to orgasm and when it did happen it was a much more complex and richer experience with a definite periodization I haven't had before or since.
When I was taking ADs I did have problems I blamed on the ADs that really had to do with the "non-drowsy" antihistamine I was taking crossing my blood brain barrier anyway.
When I did stop ADs I tapered over a month and the physical effects were not bad at all. It was the beginning of a time of personal growth that I can look back on now and think it worked out great but was challenging for the people around me for a while.
I went to school in New Mexico and had really mixed feelings about the culture around Los Alamos and Sandia.
There are a lot of brilliant people there both in terms of science and project management. However, the best person I knew got driven out. But I think also a lot of nepotism and a security clearance culture that filters out really interesting people and leaves behind the dangerously milquetoast.
I think it's a good rule of thumb. When they send robots into something like the Fukushima site they don't last long.
My first take is that I'm not surprised from a fermi problem standpoint that you can destroy two computers made from small parts smashed by radiation with a similar dose. But maybe that intuition is wrong because your brain could survive losing a few neurons but a microchip could be 0% functional after losing one transistor. My rule of thumb is about right for conventional chips but you can certainly get rad-hard chips that hold up better:
I have a strong preference for checking in docs with the source code but I'm a software dev.
We have a data team where I work that has a huge Confluence Wiki that helps them maintained shared reality about procedures and standards. I never log into it, if I need to know something from their point of view I go next door and ask one of them.
was an example of where that "empowerment" went wrong. It is usual for workers in Japanese factories to make continuous improvements in process for quality and cost and it is usually a good thing... but criticality accidents involve invisible dangers and "following procedures strictly" in that kind of work saves lives.
Notably Japan has been the world leader in nuclear accidents since the 1980s and some of that is that they kept working on things like fast reactors after many other countries quit and others that are cultural. For instance at American BWR reactors it is routine to test the isolation condenser whenever the reactor is shut down so everybody knew what it sounded like (LOUD!) when it worked but when somebody at Fukushima was asked if it was working they saw a little steam coming out the ports but had never seen it work before and didn't know what to expect.
I also want to put things in perspective: far, far more people are dying from fuckups with fossil fuels, but like "Florida man" (Florida has a law that crime reports must be published) we actually report and collect accidents involved in Nuclear production, so you can see every mistake. But you don't see mass protests because natural gas infrastructure failed in Texas and building pipes burst and people froze to death, including a young boy.
The main difference is that tiny mistakes in the nuclear industry can have massive consequences. A seemingly-trivial change can lead to continent-sized damages and permanent condemnation of city-sized areas of land.
Accidents in the fossil fuel industry are far more localized. Sure, you can blow up your own plant and kill a bunch of people, but it's not too hard to clean up the mess afterwards. Even something as horrific as the Deepwater Horizon disaster won't have much of a residual impact 10 years down the line.
> A seemingly-trivial change can lead to continent-sized damages and permanent condemnation of city-sized areas of land.
Chernobyl wasn't a "seemingly-trivial change" -- it was several successive groups all choosing to do the worse-possible thing, and it still killed and harmed fewer people than the https://en.wikipedia.org/wiki/Bhopal_disaster
Let me rephrase that. People need to feel empowered to stop a potentially dangerous process. They definitely shouldn't be empowered to implement new dangerous processes without external review.
Or modify them. For instance the people at Tokaimura felt empowered to take steps to speed up the mixing, that, plus them mixing a higher enrichment blend led to disaster.
Myself I am not a big fan of the NBA. I love college games at my Uni which is not the best basketball school but I get $8 tickets as a staff and just enjoy the whole vibe including the band, cheerleaders, two dance teams, audience participation, etc. I'm sure I could find better quality play somewhere else but as entertainment I couldn't ask for more.
Notably the authors made additive-free polystyrene particles that were labeled with gold.
On one hand it lets them say what PS particles without additives do, on the other hand, real plastic particles have additives and that is what you're exposed to.
(micro|nano)-plastics are not all the same, additives and morphology make all the difference.
It is an interesting thing about the best military organizations is that they have hierarchy but also push a lot of responsibility downward. E.g. we don't see anything noble about The Charge of the Light Brigade
An infantry platoon does have leaders, it does follow orders, it is the thin edge of a very long wedge, but it has a lived reality of the members improvising under pressure.
which describes issues that people struggle with to this day. When it comes to activism I think the most effective organizations I've been in have been "structureless" like that with a few people who lead because they are dedicated and have time and energy.
Personally when it comes to structure and the issues Jo talks about the cure (structure) is worse than the disease and once we start talking about Robert's Rules and bylaws and fundraising you are already losing people and going off mission. All the discussions about the perception (and somewhat reality) of "Class X of people is not being represented here" tend to turn into knock-down drag out fights, "Class X" never stepping up, and the ultimate reality of nobody being represented except for Robert and bylaws and fundraising.
It's not to say structureful organizations aren't useful but I would say organizations are basically right-wing in that they embody social hierarchy and if you feel your structureless organization is fun and exciting and making some difference in your bit of the world the way to save it when structure encroaches is to tear it down and start another one.
"Sustainable" groups tend to become what they oppose, structureless groups can seem to come out of nowhere, strike a decisive blow, then melt into the crowd.
The purpose of RRO assumes majoritarianism while ensuring the minority is heard.
As you know, there are light weight versions, for boards and committees. But nothing I'd advocate for product development.
> the most effective organizations
As a fellow recovering activist, you might be interested in Vincent Bevins' If We Burn. https://en.wikipedia.org/wiki/If_We_Burn Connected some dots for me. Things I experienced but wasn't smart enough to sus and articulate.
I agree there is more than one way to look at it. There are good points to RRO but I think the legalism drives away a "silent majority" [1] of people who out of their background or temperament are particularly repelled by it.
Over the long term I've seen the governance of organizations like my food co-op be quite complex and not what I thought when things were going on. For instance we had a conflict that boiled for years which looked like a conflict over the vision of the organization but in retrospect it really was the bad personality of the manager because that manager left and went to run Borders [2] and had the same problems over there whereas the conflicting camps reconciled pretty quickly when that manager was out.
But there really are tensions over professionalism, vanguardism, and such that we'll be arguing about for a really long time. The asymmetry between the left and right wings is also interesting -- I think left wing organizations have an unhealthy tendency towards centralization because fundraising is more difficult and you get the "membership organization" model that inevitably fails because of the issues pointed out in [3] [4] vs many right wing millionaires that fund parallel right wing causes that compete in a healthy way and always stay on mission because they can be defunded when they go off mission.
In 2026 I have a new commitment to activism but Jacobin magazine would rip into my approach as being radically apolitical but I think that is what is needed in 2026.
[1] 20 years ago I didn't think I'd be talking like Nixon...
[2] Personally I am not inclined to blame individuals, plus that manager had allies, which is why it took me so long to see it
The flip side of that is that spam can eat you alive.
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