That is the tragedy of depression.
I always try to make the point, that depression has a physical basis. Everyone has a mood set point. Imagine mood as a symmetrical hill, one side is pessimistic, the other optimistic. Normal mood is set near the top, generally towards the optimistic side. This is called the 'optimism bias'. In chronic depression, I feel the set point has moved over to the pessimism side and a lot further down so it's a lot harder to be positive. Life becomes hell as motivation and pleasure go away. Just getting through the day becomes an impossible battle. There is no 'just get over it' or 'think positive' choice that can be made. Sink low enough and the other side of the equation presents the only choice.
Over 50 percent of all people who die by suicide suffer from major depression. If one includes alcoholics who are depressed, this figure rises to over 75 percent.
There are many reasons for depression but a tiny brain region is responsible for the set point. If the habenula is dominant/overactive, drugs are really the only choice. Traditional anti-depressants, when they work, can move the set point but take weeks to work. New discoveries on drugs that work directly on the habenula and are rapid acting are coming. The only drug known to work on the habenula now has a bad reputation of abuse, is very costly to administer and has a large adverse-event profile. But it is rapid acting and has a high efficacy in reducing suicide ideation.
The only reason an NGO, The Ketamine Advocacy Network came to be was because the founder was a week away from a planned suicide when he received his first ketamine infusion which changed his life.
So there is hope in the near future for a real cure for depression. And this is important. Because without hope, it's hard to carry on, and the scary choice begins to seem like the only choice...
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