Hear. Hear.

As participants in an online community, let's try to help one another. Raganwald has been very constructive in discussions about depression treatment here on HN. I try to do the same, and am always happy to upvote one of his stories or comments on the issue. One of my most disappointing memories of my early participation on Hacker News is hearing that Dan Haubert of Ticketstumbler (HN username "fallentimes") had died.

http://news.ycombinator.com/item?id=859117

Just shortly before that, there had been a thread here on Hacker News in which too many users were taking the point of view that people who seek effective medical treatment for depression are weak or fools, and that they should just man up and not talk to a doctor about how they are feeling. I'd hate to think that someone here pushed fallentimes to taking his life, by trash-talking the help that anyone feeling depressed can seek from professionals.

The paradox of mood disorders is that they are disorders of thinking, either being glum beyond the warrant of objective life facts (depression) or elated beyond warrant (mania). Prescribed medication is one means, and thoughtful cognitive therapy is another means, to help people who have mood disorders get back in touch with the reality of their lives and go on coping with the uncertainties of human life. The prescribed medicines usually work more effectively when combined with the cognitive therapy, and cognitive therapy, which is very helpful, often meets a person's needs better when the person is also taking prescribed medicine.

Because the human brain is enormously biochemically complicated, and because mood disorders are largely a disruption of a complicated regulatory system ("mood" has many interconnections of cause and effect with other aspects of human behavior), it is currently hard to predict which medicines will be helpful for which patients. Sufferers of mood disorders do not all have the same genetically influenced biological substrate for their difficulties in mood regulation. So part of medical practice in dealing with depression is still quite empirical--prescribe a first-line medicine, and see if it works, and then try something else if the first medicine doesn't work or if it has debilitating side effects. Patients who have a history of both low and high mood states have to be particularly careful in choosing medicines, because some effective antidepressant medicines can prompt episodes of mania. (Some medicines are categorized as "mood stabilizers" and are helpful for the downs of depression and the ups of mania.) But doctors who have a strong clinical experience base can help patients a lot with advice on which medications to try first, and many patients benefit soon after starting medication by being much better able to gain from cognitive therapy and much better able to cope with life stresses.

By the way, repeated studies of life stress and its relationship to mood disorders show that generally people who suffer bad mood disorder symptoms are persons who have more stressful life events (family, employment, housing, or other major changes) than related persons who have don't fall victim to mood disorder symptoms. And the usual twin study methodology and other behavioral genetic studies show that mood disorders plainly have some genetic influence, although genome association studies have yet to show ANY particular gene with a strong effect on mood regulation. Simply put, mood disorders appear to be a polygenic, multifactorial disease with diverse underlying genetic vulnerabilities leading to greater risk from life stresses than some other people undergo. More research on the issue is still being done, but meanwhile seek competent current treatment, and don't give up.