I bet strongly no one this, because for so called “endogenous depression” that is not primarily from outside factors, my experience is that it is something you do not fix. It is an inherent part of you that you can learn to manage or lessen with time and medication, but it will never go away 100%.

Pharmaceuticals can be a great resource, but you need to pick the right ones. Neurotransmitters are responsible for a lot of different things in the body, and so the most efficacious antidepressants will necessarily come with side effects. It’s just a balancing act.

If you want to pursue medications further, I would recommend the Psychotropical site of Dr. Gillman, and particularly his article on his antidepressant algorithm for next steps. (https://www.psychotropical.com/ken-gillman-ad-algorithm/) He has a wealth of knowledge on MAOIs and other ADs.

Alright, I’m going to approach this from a different angle and suggest that she joins some type of church/religious institution.

Look, I get it - that’s not necessarily going to be a super popular suggestion here. Hear me out:

1. It sounds like she either has trouble sticking with the common suggestions or they don’t work for her.

2. Religion provides a sense of community, connection, and natural friendship networks.

3. It typically revolves around doing something out of the house at least once a week (“going to church”).

4. It increases belief in something outside yourself and is optimistic in nature (heaven is good).

5. There is a reason people refer to it as “the opiate of the masses”. By all means, be cynical about why it works, but if you want something that works history suggests this isn’t a crazy suggestion.

I’m not going to try and convert you to my specific church. Which religious institution you connect with is likely driven largely by your upbringing and social ties for most people. I don’t personally believe all of them are equally valid in terms of “accuracy”.

But for her purposes, pick a reasonable mainstream option (not some esoteric religion that .0001% of people follow). Failing that, pick the closest geographic Christian church.

I’m all for trying rational solutions first. But if the standard things everyone says aren’t getting it done, your choices are to rage about why they should work or do something less conventional. Religion is a pretty safe option compared to illegal/unregulated drugs, etc.

Please tell her to give this a read, I think this will help her✨:

The Illusion of Certainty

500 years ago, people believed the sun revolved around the earth, doctors amputated limbs to cure serious illnesses, and cigarettes were prescribed for asthma. Some women even used dog urine, thinking it made their skin younger.

Today, we laugh at these ideas. But 500 years from now, future generations might laugh at our "certainties" too.

Why? Because we’re often wrong. And yet, we cling to certainty because it feels safe and comfortable.

Think about yourself. You probably have a fixed idea of who you are. Maybe you're certain you're an introvert. So, when a new classmate comes along, someone you feel you'd vibe with, your certainty about being introverted stops you from making a move.

But what if you were uncertain? What if you approached them anyway? The worst that could happen is they won’t become your friend, but even that wouldn’t be the end of the world. The point is, certainty limits growth.

The more certain we are about who we are or what we believe, the more we close ourselves off from new experiences and possibilities.

So maybe, instead of trying to "know thyself", we should embrace uncertainty and explore the unknown.

Because sometimes, certainty is the real obstacle to becoming who we might yet be.

Visit the Community of PACK Life in Colorado Springs for psychedelic therapy. It's the one thing that has worked for the people in my life with long-standing treatment-resistant depression, and because the treatments last ~months or more, it's easier to stick with than many other options.

Get her into pickleball

I wish your partner luck

I'll take the cash, thanks.

https://www.health.harvard.edu/blog/ketamine-for-treatment-resistant-depression-when-and-where-is-it-safe-202208092797

magnesium deficiencies are very common and can cause all sorts of weird symptoms. same goes for iron/b12/thyroid/vitamin d. has she gotten a blood test to see if it might be any of these common physical causes?

also just, not giving up on the therapy/meds, shopping around to see if one works - when it does, it’s like magic. this happened to me with wellbutrin, i was in a similar state where i was doing everything right and just couldn’t get better. apparently rigorous therapy (like cbt, rather than occasional talk therapy) can be good but i don’t have personal experience

here’s my thoughts!

make sure to set up therapy (trust me, the right therapist works wonders for getting through the worst moments if you find one that clicks), and have a follow up with the psychiatrist noting that the fluoxetine isn’t working.

ramping on/off of SSRIs is a lot of effort, but if you find one that works it can be what you need to get the ball rolling on feeling better and better.

certain other medications I’ve found can be excellent alongside SSRIs too; sometimes in persistent cases, a lithium (or other mood stabilizer) adjunct alongside a SSRI works. it may be worth inquiring about this to the psychiatrist if you’ve tried a few SSRIs prior.

additionally, it’s a cliche, but the endorphins from exercise can be an incredible aid with depression. building up a regular walking/hiking habit takes a bit of work, but is accessible and helps a lot. kettlebell swings are excellent for an at-home “I need something to stop the depression right now” workout in my experience.

sometimes, it can also be helpful to remember (as ridiculous as it sounds) that you are allowed to actively embrace yourself and shower yourself in love. while the fog of depression isn’t going to magically lift itself at the first spark of self-love, it’s almost a given that anyone feeling depressed has dealt with the same familiar malaise of negative thoughts, and gently combatting those by explicitly embracing yourself can help.

as a spot treatment for difficult days, I personally like to make use of techniques from EMDR to ground myself. let me know if you’d like to hear additional details on this, it’s something that was a really helpful finding for me, especially when I find myself severely deregulated.

lastly, it goes without saying, but forcing yourself into habits which get you out regularly can disrupt a lot of the painful mental feedback loops concomitant with depression. even joining a reading club, while possibly something that fees meaningless now, can do a lot for mental well-being a month down the line.

be well! ❤️ wishing you both the best

(disclaimer: I am not a doctor, I don’t have any grounds to offer medical advice, just been through a lot)

https://m.youtube.com/watch?v=LO1mTELoj6o&pp=ygUQY2dwIGdyZXkgdW5oYXBweQ%3D%3D

Trauma release exercises followed by immediate journaling and preceded by vagal toning practices (breathwork)
https://x.com/nosilverv/status/1949101947874640253
I really hope this helps! ❤

I am not an expert and this is not medical advice. Talk to a healthcare professional. This is just my impressions from online research and my own experiences.

Please consider hormones, particularly in relation to contraception, but even if she not using it. I believe there's evidence that progestin-only methods (mini pill, hormonal IUD, implant, injection) can have a different effect on depression than methods that contain both progestin and estrogen (COC, patch, ring). I believe there there was even a study that showed one of those categories actually having lower depression rates than baseline; I am however remaining vague in case I'm mistaken. My point is to research it and discuss with healthcare professionals.

Please also note that different progestins can have different effects on people. Look up their androgenicity and associated symptoms. Sometimes it is recommended to switch to a method that contains a different progestin.

I want to also mention that some sources say that IUDs and the ring can't cause depression because the hormones supposedly only act locally, but I think overall there are mixed messages on this, and due to personal experiences I am highly disinclined to believe that they can't cause depression. But I'm not sure if there is real evidence for this or only anecdotes. Again, this is not to tell you what is true, but only to give you an idea of things to research. Wishing you both the best of luck.

1. Professional help should be a safe bet, but I doubt this'll suffice for a bounty

2. I suppose you know the rationalist standard literature: https://www.astralcodexten.com/p/peer-review-request-depression

3. Personally, I'm trying to get my mother (chronic depression, several medications and therapies) to try psilocybin. I can try to explain why I could imagine magic mushrooms to help if that's within "open to experimentation"

If you want to help seriously, please find professionel help. Depression is a severe mental illness which does not need experiments on this platform.

Has she been to therapy?

@MaxE A little bit. It seems more physiological than psychological, but IDK.

How is the sunlight exposure? This rhymes with how a family member felt while living in Michigan. Getting outside more kinda helped, moving to a sunny place really helped.

@ArtimisFowl She used to go on a run every morning, which didn't seem to help.

I feel like when I saw the movie I Heart Huckabees for the first time it partially alleviated my depression/existential dread/whatever you want to call it.

But I didn't know that it would do that when I sat down to watch it and maybe if my expectations had been raised to that level it would have ruined the experience.

wow, might be the biggest bounty ever

@JeromeHPowell symbiotic rivalry offered the same amount to anyone who could crack a code.