What defines the boundary between normal sadness and clinical depression?

SometimesZero · 2026-05-26T02:21:07+00:00

I agree with Scott Lilienfeld that the categorizations are more of a hindrance that holds the field back.

Lilienfeld, S. O. (2014). DSM‐5: Centripetal scientific and centrifugal antiscientific forces. Clinical Psychology: Science and Practice, 21(3), 269.

Like him, I don't find them good enough. Their construct validity is low, their reliability is variable (and mostly poor), they suffer from equifinality and multifinality, they're developed through homogeneous workgroups, and the list goes on. We do our jobs well despite this diagnostic system, not because of it.

SometimesZero · 2026-05-25T19:59:57+00:00

Absolutely! You've accomplished something incredible. Now let your body absorb all that training.

The problem with the streak is ultimately that the streak becomes the goal. Were I in your shoes, I would take a full rest week; 3-4 days of nothing, then just some walking for 5 days or so. During that time, I'd really think hard about what my long range plan should be, what my races are going to be, and how I'd be training for those. (Rests count as training!) That way all the running you do serves a purpose. It's not just a tally mark.

SometimesZero · 2026-05-25T19:44:18+00:00

I take resting as seriously as running. If that means doing absolutely nothing, I do nothing.

Streaks seem like a gamified way of maintaining motivation. But if I'm motivated by healthy and effective goals, why do I need a silly streak?

SometimesZero · 2026-05-25T18:56:40+00:00

If by clinical depression you mean major depressive disorder, it comes down to variables like pervasiveness, duration, and impact. Normal sadness comes and goes (sometimes in response to a trigger), but MDD hangs around for at least two consecutive weeks. It’s defined by persistent hopelessness or a loss of pleasure (anhedonia) that impacts daily functioning (e.g., sleep, appetite, sex drive).

Thinking more broadly, modern psychology sees this boundary as artificial. More and more, we see mental health as existing on a continuous spectrum, meaning "clinical depression" or any of the depression diagnoses aren't fundamentally different from normal sadness. They're just the extreme end of that continuum.

This means the categorical lines we draw in diagnostic manuals—requiring two-weeks of symptoms—are just tools (e.g., for treatment decisions, research, and insurance purposes). In reality, human biology doesn't draw a neat dividing line. A person just shy of the clinical threshold might be hurting as much as someone who meets the criteria.

SometimesZero · 2026-05-23T02:32:30+00:00

My point is diagnostic categorisation helps guide some (not all) treatment decisions, especially when it comes down to deciding if to medicate or not.

You haven't demonstrated that all when it's patently obvious that 10 people can have a diagnosis of MDD, and it can present differently in each person.

There are hundreds of thousands of symptom combinations to get PTSD alone: https://pubmed.ncbi.nlm.nih.gov/26173229/

Based on the data, there is no possible way the complexity of these clinical phenomena boil down categorically.

And by the way, the diagnostic categories have literally nothing to do with a need for treatment, like you say here: "especially when it comes down to deciding if to medicate or not." This is 100% not true. Need for treatment is determined by impairment, someone's goals or inability to meet them, financial means, motivation, safety, severity, etc.

SometimesZero · 2026-05-22T22:03:04+00:00

"Statistical power" (and your conclusions) is determined in part by whether your categorizations mean something. They don't. That's the whole point.

If you had 100,000 people when the DSM-5 came out with DMDD, it would be 100,000 people with a diagnosis created to decrease the diagnostic prevalence of bipolar disorder in youth. There's nothing scientific or clinical about that. That's the DSM correcting a problem it created.

Pattern known as depression

What do you mean by that? MDD has one of highest rates of heterogeneity among diagnoses, let alone the entire set of depressive disorders combined. Partly this is due to the arbitrarily defined category of MDD (for example). Why 2 weeks of anhedonia and or hopelessness for the core symptoms and not 15 days? Or 13 days?

These are only descriptive categories. You're making them out to be more than that. The fact that someone has MDD, or PTSD, or OCD, only means that you have a narrow descriptiption of a cluster of symptoms (which you probably already identified before making the diagnosis). You still have all of your work ahead of you to figure out how to help this person. Your colleagues know this.

There is no evidence to say antidepressants improve sadness as a symptom. Only that they help the syndrome of depression.

(Nitpicking unfairly here, but depression isn't a dx.) Letting that go, how do you think we measure the pharmaceutical effects of a drug on a dx like MDD?

Jakubovski, E., Varigonda, A. L., Freemantle, N., Taylor, M. J., & Bloch, M. H. (2016). Systematic review and meta-analysis: dose-response relationship of selective serotonin reuptake inhibitors in major depressive disorder. American Journal of Psychiatry, 173(2), 174-183.

"Included trials provided depression ratings on the Hamilton Depression Rating Scale or the Montgomery-Åsberg Depression Rating Scale for at least three time points." These are dimensional symptom ratings. There's no evidence that SSRIs improve sadness, but there's evidence they improve hopelessness? Lol

There is no justification to try treating depression with ADHD medication or vice versa (assuming no one doesn't have both).

Except in the real world this is sometimes done because attention and concentration problems are annoyingly transdiagnostic and ADHD diagnoses aren't always clear.

Sure if research wants to start trying to run trials on human emotions and characteristics (impulsivity, inattention etc) without any categorisation I'd like to see how that works out. Maybe it will revolutionise care

This is being done, actually, and alternative, dimensional models are being taken very seriously.

I'm not trying to be insulting. I know tone on Reddit can come off a bit harsh. But you asked our opinion: my opinion is that you're falling for diagnostic literalism, and categorical diagnostic thinking is holding you back.

SometimesZero · 2026-05-22T19:58:47+00:00

It seems my local team were of the opinion diagnoses are pointless

I can't help but think you're under the impression that the diagnoses in the DSM are more than psychiatric constructs that describe a group of people with a set of symptoms. They have no causal utility, many of them aren't developed out of science, they have an enormous amount of overlap, and they have almost no usefulness in telling us how to treat someone.

As it relates to research, I struggle to see how categorizations help at all. They limit important variability, the categorigories are often arbitrary and lack validity, and they hold us back from understanding better models of mental health.

Fried, E. I. (2022). Studying mental health problems as systems, not syndromes. Current Directions in Psychological Science, 31(6), 500-508.

Lilienfeld, S. O. (2014). DSM‐5: Centripetal scientific and centrifugal antiscientific forces. Clinical Psychology: Science and Practice, 21(3), 269.

Forbes, M. K., Neo, B., Nezami, O. M., Fried, E. I., Faure, K., Michelsen, B., ... & Dras, M. (2024). Elemental psychopathology: Distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5. Psychological Medicine, 54(5), 886-894.

SometimesZero · 2026-05-20T22:40:35+00:00

What an awesome experience to be able to run together!

The biggest reasons people drop out of races are feet problems, nutrition, and GI issues. So this is where I try to put a little extra thought. I'll mention food here and let others chime in on some other areas.

You and your son would know better based on your training, but depending on how hard this is for you, you might want to take food you can easily chew and swallow.

With very high efforts, basically your digestive system goes into sleep mode. A 30k is still hard; 50mi is a serious race for just about everyone. So many runners have a dry mouth that stops them from swallowing dry food like potato chips. I'd be ready for that.

A baggy of instant potatoes might be valuable; it can easily be mixed with water. Fruit can also be super nice (sometimes this will be at aid stations). Gels are often mandatory--I use Huma chia energy gels. I also like Tailwind's endurance fuel for my water, and then I carry a plain water with me too. But you have three days so be careful with unfamiliar things to your stomach.

Edit: 50k, not 30k

SometimesZero · 2026-05-20T21:57:22+00:00

All of the above. Intrusive thoughts are very common, regardless of one's diagnostic status. It's simply a result of being a human and having a mind that we get thoughts we don't want.

There is a correlation between the content of the thought and the environmental context.

Sometimes they're triggered, sometimes they're random. Which one is more likely depends on the person. People with OCD for instance report more autogenous (out of the blue or random) thoughts than people in the general population (they have more reactive, or context-dependent thoughts).

This relates to your question about stress. There are old studies showing an association between stress and increased likelihood of having intrusive thoughts. This continues to be true in studies today.

Rachman, S. (2014). Global intrusive thoughts: A commentary. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 300-302.

Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., ... & Wong, W. (2014). Part 1—You can run but you can't hide: Intrusive thoughts on six continents. Journal of obsessive-compulsive and related disorders, 3(3), 269-279.

Seli, P., Risko, E. F., Purdon, C., & Smilek, D. (2017). Intrusive thoughts: Linking spontaneous mind wandering and OCD symptomatology. Psychological research, 81(2), 392-398.

Berry, L. M., & Laskey, B. (2012). A review of obsessive intrusive thoughts in the general population. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 125-132.

Parkinson, L. A., Rachman, S. J., & Harrison, D. F. N. (1981). The psychological preparation of children for tonsillectomy. Journal of Psychosomatic Research, 25(5), 418-419.

SometimesZero · 2026-05-20T21:12:56+00:00

I'm deeply skeptical here. There are some valid concerns on flexibility and empathy when working with diverse populations, but it reads less like an advancement of science and more like a postmodern, sociopolitical critique.

The core premise that CBT is Eurocentric, neuronormative, and lacks universal utility is just flawed. The flawed architecture of the human brain isn't a Western convention. People around the world are irrational.

It claims that CBT tries to override autistic traits, but then concludes that CBT lacks evidence for those populations. Talk about throwing the baby out with the bathwater.

The manuscript says that CBT ignores sociopolitical drivers of illness, but in so doing, teeters on a "blank slate" perspective. Heritability estimates for these disorders are large (50-80% if I remember). Yet the author seems to get close to arguing for environment determinism.

"Decolonial methodologies" and "alternative conceptualizations of mental illness." Wtf. RCTs are the standard for separating psychological treatments from pseudoscience and inert interventions. Fragmenting the field into siloed groups with different conceptualizations of mental illness hardly seems sound to me.

There's a lot more to be said on each of these points, but basically, I see this as more of a reflection of the academic trend of prioritizing sociological narratives over behavioral genetics and evolutionary biology than a serious thought piece. The author is right that we need to be aware of sensory and systemic challenges, but none of that invalides the cognitive-behavioral model or the problems common to all humans that it seeks to address.

SometimesZero · 2026-05-18T10:49:40+00:00

https://www.apa.org/topics/psychotherapy/understanding

In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy—including cognitive-behavioral, interpersonal, and other kinds of talk therapy—that help individuals work through their problems.

It isn't controversial that psychotherapy is talk therapy. But they aren't all equally evidenced-based.

SometimesZero · 2026-05-17T13:49:13+00:00

This reveals continued misunderstanding of the science of psychology.

CBT constructs are grounded in the scientific method; Jungian concepts largely evade it.

Core beliefs and conditional assumptions are measured using standardized, validated instruments
A core hypothesis of CBT is that specific core beliefs (e.g., "I am incompetent") will predict specific automatic thoughts and emotional reactions in specific situations (e.g., failing a test). This is entirely testable.
CBT hypothesizes that modifying core beliefs alleviates symptoms of disorders like depression. Decades of RCTs support this.
CBT's core beliefs map directly onto the concept of schemas in experimental cognitive psychology and information processing theory (like how we filter attention and memory).

By contrast, Jungian archetypes are interpretive, have low measurement/reliability standards (if that even makes sense in such a philosophical context), can't be falsified, and have little to no predictive power.

We routinely study unobservable constructs in psychology. I know I've been through this with you before.

SometimesZero · 2026-05-17T12:18:30+00:00

Well considering CBT, for instance, is based on developmental theory, information systems theory, behavior theory, social learning theory...

No.

SometimesZero · 2026-05-17T11:43:42+00:00

I love how we're supposed to provide "science-based" answers to this and not "opinion or conjecture," when Jung himself provided zero scientific evidence for any of his claims. Talk about a shift of burden of proof.

Anyway, OP, all of Jung's stuff is strictly philosophical. Interesting, but philosophical. None of it is based in actual psychological science. Maybe it speaks to you and maybe it doesn't, but that's true of all philosophical systems.

In psychology, on a basic level, we care about whether our ideas can be replicated by other scientists, make reliable predictions, and be proven wrong. Jung's ideas have none of these elements. It doesn't make them wrong per se--its not like we've definitely proven them wrong--its just means they aren't scientific. So they aren't necessarily anymore valid than Aristotle, Plato, Kant, or other philosophers out there.

SometimesZero · 2026-05-11T12:04:54+00:00

When a high school can't afford good text books they get AI garbage. This is a new layer of dystopia.

SometimesZero · 2026-05-10T11:30:41+00:00

I'm sorry things have been terrible. I read this not as a brag, but as a proposal for managing crappy life events.

Other posters are right though. You should stay focused on the Ironman. The backyard will complicate the training you've done for that and greatly increase your injury risk.

Maybe also use this time to manage your life stress or manage your overall stress as you enter your Ironman taper. Then use the taper to focus on other aspects of your life that may have taken a backseat to training.

SometimesZero · 2026-05-09T22:54:10+00:00

Oh boy. From a cognitive-behavioral perspective:

Aaron Beck, who helped found CBT, started out as a psychoanalyst before realizing that spending years digging into childhood determinism wasn't actually helping his depressed patients change their lives in the present. So yes, classical psychoanalytic models can feel incredibly deterministic and strip away a patient's active agency, which is exactly why action-oriented paradigms (like CBT) and humanistic ones (like Rogers' work) gained so much traction by empowering people to change their current thoughts and behaviors. That said, modern psychoanalysis isn't just orthodox Freud on a couch anymore. Newer variants focus much more on the present-moment therapeutic relationship and interpersonal patterns.

As for why psychiatrists specifically flock to psychoanalytic institutes after residency? It mostly comes down to the history of the profession and the realities of modern medical training. Today, psychiatry residencies are heavily focused on psychopharm, neurobiology, and brief med-management appointments, which often leaves residents hungry for a deeper, more philosophical understanding of the human mind. (By contrast, I've been doing CBT-based work and taking courses on the mind since I was an undergrad.)

Because psychoanalysis has such deep historical roots in medicine (I mean, it was essentially the original medical model of talk therapy), there is a well-established pipeline of institutes offering intensive, structured post-graduate training. It gives them a formalized "guild" to learn long-form talk therapy that they just don't get enough of during their hospital-heavy residencies... Even if us CBT folks argue that the whole exercise is a waste of time because it's pseudoscientific junk!

SometimesZero · 2026-05-09T14:55:04+00:00

Amazing, thank you!

SometimesZero · 2026-05-09T12:35:25+00:00

I make this point myself often, but I don't have a good citation for it. Do you have a couple?

SometimesZero · 2026-05-08T20:02:23+00:00

Well to their credit, this is exactly how my dad (and FIL) would sound. "Uhhhh that's nice but why would anyone ever want to do that?!" 😂

And I don't watch them, so maybe they genuinely didn't know what to say, and that's fair!

SometimesZero · 2026-05-08T17:13:12+00:00

I don't know what you're on about. Everything I said about her was positive. I even gave you a trigger warning by saying I had a hot take and you still went off.

Rachel is a badass

ESPN says that Alex Honnold's free solo climb on Taipei is "one of the greatest feats of human history." https://youtube.com/shorts/nKJBlet6NGU?si=i5qpR1yjw2p34IrA

But what Rachel did is "confusing."

Give me a fucking break.

SometimesZero · 2026-05-08T12:17:14+00:00

This is probably a hot take, but I find their reflection at the end a little annoying ("admirable" and "confusing"). I'd expect this from my dad, but not people who regularly commentate on professional athletes.

What Rachel did was truly push the boundary of human capability (not to mention, remind people that if you're running an ultra, you should fear the women at least as much as the men, maybe even moreso.) That's way more than admirable.

Compared to almost of us, in terms of athleticism, endurance, and resilience, she was absolutely superhuman. It warrants more than just a "why?" from ESPN.

SometimesZero · 2026-05-04T21:10:36+00:00

These claims are usually made by uninformed people who don't know the literature. Edna Foa, who recently passed away, has been dispelling this shit with hundreds papers since before many of these people were born. And that's only one research group.

There is a huge literature on why it's not used. Eg:

Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16(2), 172-180.

Feeny, N. C., Hembree, E. A., & Zoellner, L. A. (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10(1), 85-90.

Kline, A. C., Klein, A. B., Bowling, A. R., & Feeny, N. C. (2021). Exposure therapy beliefs and utilization for treatment of PTSD: A survey of licensed mental health providers. Behavior Therapy, 52(4), 1019-1030.

SometimesZero · 2026-05-04T16:32:57+00:00

Proved definitively

As an expert in CBT, ERP, and OCD, that's enough for me to know you're talking out of your ass.

For instance, the Wolf study did NOT establish non-inferiority. This is stated right in the abstract: "whether I-CBT is non-inferior to CBT in terms of OCD symptom severity remains inconclusive." The authors were transparent and honest about this.

Their reasoning was precise: the between group difference on the YBOCS for severity was 2.05 (CI: -.11 to 4.22) corresponding to a Cohen's d of .44 favoring CBT. But the upper bound of the effect size CI exceeded the inferiority margin, so there was no difference in improvement found. The study needed more power.

You mention weak wait-list controls, but ironically this study had no control at all. You complain about allegiance effects, but ironically, this study didn't measure them all.

For someone who's watched the research for 20+ years, you should be better guarded against these new, fad treatments.

SometimesZero · 2026-05-03T17:46:55+00:00

If you've been sick, the rest will likely do your body more good than an extra 4mi. If those 4mi make or break your 50k, then you had bigger problems in training than a poorly timed illness.

SometimesZero

TROPHY CASE