There are some excellent, evidence based, modern talking therapies. Cognitive Behaviour Therapy is probably the most well known. You may need some medication and support until you're ready to get started on CBT.

Discussion about depression treatments can be frustrating. People sometimes try to make a distinction between types of depression - "My depression can't be treated by a talking therapy because it's not just in my head. It's real, it must have an organic cause, it must be a weird balance of brain chemicals". This is not true. While we don't know a huge amount about depression or about medication to treat it we do know enough to do a good job for many people.

Obviously I'm not a doctor and this isn't medical advice. But you really should go and talk to a doctor as soon as you can. It'd be great if you could make the appointment today.

May I ask what country you're in? Feel free to not answer this question.

Sadly I've had more than one friend die from suicide, and in one case my friend assumed that he wasn't troubled enough to really need help — which is what did him in.

Suicidal thoughts are much more of "red alert" situation than episodes of depression or feeling isolated.

I don't know where you are, but in the US you can always call the National Suicide Prevention Lifeline at 1-800-273-8255

We are products of our rituals/habits. To change my thinking and spawn out of my depression I realised I had to take consistant action. So, now I spend an hour every day working out and another hour listening or watching something inspirational. Then, I start my day.

I would highly suggest you watch some of Tony robbins' seminars on youtube.

Volunteer your time to help others. I believe the only way to be truly happy is to help others. Try to treat everyone as if they were part of your extended family.

Watch this video at least once a week: http://www.youtube.com/watch?v=cRMogDrHnMQ

It's not realistic with someone with serious depression and especially with anhedonia. You don't want anything. You don't feel pleasure, you don't feel relief, nothing changes when something "good" happens. Nothing is fun, and you can't even tell if you like something, if you hate it, or if you're neutral. It is the worst sensation imaginable, and hard to explain to someone who has not been through it.

It's easy to see how living life breaks down at this point, and a more immediate and serious solution is needed. You can't just pull yourself up and motivate yourself because nothing means anything anymore.

If you don't have any first hand experience with depression, please check out this comic from Hyperbole and a Half: http://hyperboleandahalf.blogspot.com/2013/05/depression-par...

It may seem goofy but it actually helped some family members of mine make a major breakthrough in understanding what I was going through.

The only suggestion I can give you is to see a psychiatrist now, and educate yourself about the side effects and long term effects of different medications so you aren't trapped on something that turns you into a zombie. Look into Nootropics and supplements - there is stuff that really can help and isn't total BS if you do the research (examine.com). The mental health care system in most countries is awful, and people are generally awful about understanding it, so sadly I basically had to do everything myself and be my own advocate. Which was awful when I was feeling so bad. So I don't envy you in the least. Best of luck.

The rationale is that an office-work centric lifestyle in a city is only one option. Quite frankly; the way many of us live is stupendously artificial, and it's not surprising the body sometimes rejects it. In the west people are raised to follow that path, with tremendous social and family pressures to continue. Soon, you can find your self-worth tied up in what are essentially the worthless trivialities of a treadmill existence. There can be a tremendous amount of social pressure to keep going. However, that's not for everyone ... it's tremendously valuable to see and explore others and meet people from other backgrounds before committing yourself to 20-30 years more of the same. You can always come back to it. Trust me, I took 7 years out of the rat race and unexpectedly that experience helped me to come back so far on top I quit after another two and don't expect to ever return. (PS. I'm not fabulously wealthy, I'm just a different person than I was)

Try it.

Another thing to check is diet, exercise and environment - it's easy to get depressed if you sleep weird hours, don't move, don't get enough sunlight / fresh food (hint: a lot of what is sold as fresh isn't really, eg. pretty much all juices, much fruit, and prepackaged salads/sandwiches. Ban sugar and sugar-with-caffeine). You seem like a rational person - if in doubt, try changing some aspect of things awhile and see if it doesn't improve.

Viscerally, the nicest way to say it is that you need to get perspective. Go volunteer as a mentor for inner city youth at the boys and girl's club and instead of spending your time being sad at home, just man up and use your time to help people that have real problems. There are so many people that are dealing with life and death struggles every day and a successful, college educated guy can make a huge difference. Also, this will give you perspective on what is important in life and teach you about the real world and growing up.

OP doesn't need to "man up", he is a man and life is tough. He needs help. The two posts above this one direct him to useful resources, therapists and an emergency line.

I struggle to understand the drive to post in threads where you're not qualified to comment. Especially when you're dealing with a vulnerable person who is in pain.

OP is obviously collected and intelligent enough to write a coherent post on HN about this. I gave direct, actionable advice and I'm saying that OP is a smart, capable person with the ability to do good in the world who doesn't need to be coddled like a 12 year old. How likely is it that when one is asking HN for advice, one hasn't heard this same boilerplate drivel? I took time out of my day to think out both of these posts and try to find something original. OP has probably been trying to deal with this many different ways and maybe my way isn't his way, but it's more likely to be helpful than some crap you can find by googling depression for 5 minutes. I chose to get involved for that reason and I'm here participating in the thread for followup if it resonated with OP. The therapy and emergency hotline approach is obnoxiously bad - great advice if your employee comes to you and you want to avoid legal entanglement, not particularly good in reality... if you're at the point of posting on HN, you probably have thought about going to a therapist right? So are you really helping or hurting by giving that advice, probably for the 100th time?

"man up" means acting according to typical masculine values of practicality and altruism : get out of bed, go find someone with real life and death problems and help them. It means just think about the next hour or the next minute and do something helpful for other human beings. This builds a support network, fires the social parts of the brain, level sets how bad things can get in the world and how much one smart guy can actually matter and gives a direct resource (boys and girls club) to follow up.

... also I explicitly discussed the intellectual, emotional and physical aspects of depression in there... it's a self reinforcing loop.

I've learnt (although I still have my ups and downs) that to get better, you have to get rid of bad habits and stick to a "healthy" plan; ie. 1) Try to regulate your sleep time 2) Exercise 3) go out in the sun or take vitamin D supplements 4) meditate

Hope you get better

I can empathise with your position.

Just this morning I came up and out of a bout of depression that had been holding me under for the past 4-6 (ish?) weeks - possibly the worst bout that I have had for the past few years.

The feelings of loneliness were certainly there - as were the feelings of anxiety and uncertainty and chaos - there was a lot of cynicism and hatred also, almost entirely turned against myself, again, to the point where I too was starting to worry about my capacity for self harm.

As a person who (at least nominally) values rationality, I found (and still find) the irrational and unpredictable ups and downs of my emotional brain to be immensely irritating and frustrating. Perhaps the most frustrating part of it all is that - even knowing perfectly well that the depression has no rational basis - we are unable to do anything meaningful about it.

Indeed, it was not until this weekend just gone that I felt able to reach out to my family and ask for help - I needed to recover from the depression in order to ask for help recovering from the depression! fking stupid-a*s brain! Who designed this stupid thing, anyway!

Funnily enough, reaching out to strangers is often easier than reaching out to those we know and love - particularly when the issues are as emotionally loaded as these. Personally, I found the Samaritans to be particularly helpful (email jo@samaritans.org for help).

The usual advice that people give is pretty good: "don't suffer in silence", "reach out to your doctor to get help", "diet", "exercise" and so on, but you and I both know how difficult (impossible, more like) following that advice is in practice, and how mind-blowingly irritating it is to receive it when you are down in the dumps (so apologies for repeating the bleedin' obvious).

Anyway, posting here was a good start, so kudos for that, anyhow.

-Will

Get professional help immediately. Any/all of your reservations against doing so are misplaced.

We can't tell you what meds to take, which exercises to do, which foods to eat or avoid, or what lifestyle changes to make. Different people experience depression for different reasons, and for _no reason at all_.

See a pro.

In your place I would be traveling pursuing the adventure of my life.

What good will it be for someone to gain the whole world, yet forfeit their soul? Or what can anyone give in exchange for their soul? Math 16:26

1. If you intend to kill yourself or someone else, please call this number: 1-800-273-8255. It is a crisis hotline for suicidality. Even if you are highly doubtful that it can help, make the call. Everyone who is suicidal is highly doubtful there's a better way, almost by definition. And yet this number does help the vast majority of those people who do call it. It's worth a chance.

2. You seem to be describing a "major depressive episode." This is not something you should try to address only through self-help or HN (though taking the steps you have taken was an excellent move in that it is going to help you find the next ones to take).

For one thing, there is a physiological element that medication may be required to address. For another thing, the very faculties that you would use to try to help yourself are almost certainly hindered and distorted while in this depressed state. Your problem-solving abilities are likely compromised. Your ability to see alternatives is likely compromised. Your sense of realism in evaluating your situation is likely compromised.

You should seek professional help - from a professional counselor, clinical social worker, clinical or counseling psychologist, or psychiatrist. I would say the same thing even if you were one of those things.

3. There are barriers to seeing a professional for many people. It might be money, it might be stigma, it might be bad experiences in the past, lack of motivation, lack of information, feelings that it won't be helpful -- it's different for different people.

Also, some people will see a therapist one or two times and then decide that therapy didn't work. Therapists are like graphic designers, software engineers, carpenters, or any other profession -- there is variable quality and variable styles. And even among the good ones, some of them may just not a fit for you.

But I assure you there are competent therapists that you will feel a connection with. In fact, most therapists are pretty solid people to sit down with, and they won't have their feelings hurt if they turn out not to be the one to help you -- they'll want to help you find that one.

So consult with a professional. Make a call. Schedule an appointment. Tell them where you are. And if they suck or you don't like them, go try another one.

4. Depression can cause hopelessness, and it feels real and appears real -- that the world is actually that way, that life will always be that way. You can't trust those thoughts and feelings. You've got to take some steps in spite of them. Recognize that it is as if you are under a dark spell. Resist the influence of that dark spell as you try to get it lifted.

5. As I said above, I will check back here tonight to see if you reply to this. Odds are good that you are skeptical about some or all of what I've said here (though if you're not, that's fine too). I can't provide therapy (and this isn't therapy), but I can help with this kind of process of seeking information and exploring your options.

Edit: 6. (Forgot to add...) You should be very very careful with drugs and alcohol right now. Many people who are depressed but not actively suicidal take their lives when under the influence.

SEEK PROFESSIONAL HELP IMMEDIATELY

Please see a doctor, psychiatrist, or a psychologist.

1. Change your life.

2. You suffer (but why?).

Something in your life-arrangement is wrong. Fix it and move to something you enjoy.