Exercise as a treatment for depression: a meta-analysis (2016)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
The most recent depressive bout was probably the most extreme I've gone through, and required a couple close friends to jump in, but again, routine exercise with comfortable bits of a routine mixed in - like making a cup of tea, making sure I have a podcast queued up, a book to read, and a handful of songs I like - has seemed to help pull me from the brink.
Now that I have eclipsed thirty years and I still am over 300 lbs, and some of the recent depression-like feelings, I am making a more of a cognisant action to keep working at this and to journal how I feel before, during, and after the routine.
I look forward to seeing this kind of work being taken a little more seriously as a means to treat depression as opposed to only medication and therapy.
Hope you keep them and keep safe!
I assume it means continuing to be social, helping out, and encouraging the person in question to "get out of their bubble", so to speak.
I haven't had personal experience with the harsher side of depression, so I'm not sure what is effective (on my part).
Depression is a real bitch. It manifests itself differently in everyone. Perhaps coaxing someone to see a therapist, go out or whatever would actually help them. But that's not going to be true for everyone and the coaxing may do more damage than good if it's unprompted. If they express interest in anything (e:g; going to a movie, seeing a therapist, going to the gym), that can be a good time to give them a small nudge. I hope your friends find some light in their tunnels.
Interestingly, it's often exactly the opposite that's needed: just be there and listen.
Once that bond has been made, then one can start to work on improving things.
All of this requires time and a lot of energy.
Verbally expressing your love and support for your friend, and helping them see the positive aspects of their self, their situation, and the world around them can go a long way. If you can get them to talk about their views, and help them see when they're stuck in unproductive negative self-talk, that can be truly eye opening. Help them love themselves. Encourage them to come on a walk or run or other exercise with you; don't force them or over pressure them, but say that you promise they'll feel better.
Sitting alone behind a computer screen every night and weekend is asking for problems.
My understanding is that real clinical depression is not the kind of "feeling down" we all experience at some point or another. That's not something you fix by just having a drink, talk a bit, or go to a party.
It is more like the absence of feelings. Depressive people are more likely to take the least resistance path to everything you try to do. Want them to go out, they will follow you. Want them to talk, they will answer your questions. Leave them alone, they will stay where they are. In fact I know someone with severe depression who didn't even have physical feelings (like hunger, pain, cold, sleepiness, etc...).
Were you diagnosed by a professional psychiatrist ?
As for high intensity, I’m sure that my use of the term isn’t correct, but I do something that raises my heart to 165+ for 30 seconds, keep my heart at 130, do something to spike it after 5 minutes and repeat until tired. I’ve been able to recently accomplish this reliably on an elliptical at the highest resistance level and maintain activity for 60 to 90 minutes.
After longer sessions I feel pretty good and sometimes a bit euphoric.
It didn't make sense to me as I'd always heard that exercise was a solid remedy for mild depression.
It was when I read this 2005 article on Kuro5hin (RIP) called Demystifying Depression [1], that it made sense.
The section "The Role of Sports", with its explanation of the physiology behind the benefits and drawbacks of exercise for people with depression or burnout, is consistent with my own experience.
These days, having done a huge amount of work over 10+ years, including emotion-based treatments, diet/nutrition, and some pharmaceutical treatment, I can and do often undertake intensive exercise without negative effects.
But I still have to be careful - as the article says, listen to your body.
As a general comment about this document:
Anyone experiencing depression should seek professional help and should not make treatment decisions based on comments on internet discussion boards or online articles.
But as a lay-person's summary of the mechanics underpinning depression, I've not found anything better than this in the 14 years since it was first published.
If someone can recommend a better one, I'd be pleased to hear about it and will gladly start recommending it instead.
[1] https://en.wikibooks.org/wiki/Demystifying_Depression/Print_...
Exercise raises few hormones like endorphin, serotonin and reduces cortisol (depending on the kind of exercise, like long walks), but I am not convinced if someone says it balances them.
[1] https://scholar.google.com/scholar?q=depression+cytokines+me...
[2] https://www.youtube.com/watch?v=NOAgplgTxfc [Robert Sapolsky On Depression]
https://www.spandidos-publications.com/ijmm/42/1/425
I think its use for stress & anxiety reduction is studied too,
In general, expecting that the intake of some chemical will fix the multitude of factors contributing to this complex disease seems short sighted and may create false hopes in people suffering from it, so far no easy chemical fix has been found or it would instantly replace SSRIs in their lacking efficacy. For me personally the only things that helped over long were radical mental discipline (daily mindfulness, cognitive behavior therapy), daily exercise, nutritional changes and a willingness to be comfortable being uncomfortable to make those changes.
> A wide range of things affect cytokines, nutrition and exercise are central, but also cognitive stress and sleep
If that is true, you get best sleep when using Ashwagandha and its effect on stress, like I said previously is well studied.
https://examine.com/supplements/ashwagandha/
it is there for centuries and affects in a multitude of ways for a body to bring it into balance in every front. In ayurveda, if a practitioner or doctor was unable to diagnose a disease properly, they simply give them Ashwagandha, as it will work or fail to but never works adversely. I still strongly recommend trying it with any other interventions you mentioned like exercise, etc. I never discouraged any other interventions. It helped me personally, so I am inclined to suggest it to others who are hopeless at the moment. Like I said, zero harm. I never suggested it as a one shot solution. People with depression need more caring than any other.
I've used that at times, and it's been somewhat beneficial some of the time.
But there's no silver bullet and no one-size-fits-all approach.
The causes are complex and different from one person to another, so a complete recovery will require multiple forms of treatment and a tailored approach.
I've used it occasionally before bed and it did seem to reduce stress, but I'm not sure how much it was placebo.
It might be for some important reason to keep your body in homeostasis while dealing with a different problem.
Other literature I’ve read suggests that, for this very reason, prolonged use of adaptogens (including maca, rhodiola, ginseng) is inadvisable.
In my own case, I suspect it may have led to problems (e.g., caused HPA axis to slow down further) after a while, having shown benefits in the beginning.
Long story short: the body always fights back.
However, after I got well enough to move, regular movement helped wonders (I also think it helps get you into an embodied consciousness that contains less interpretation and more direct experience/awareness - esp somatic practices of moving meditation, yoga, contact improvisation)
Also, once I started getting /serious/ about exercise - like actual cardio and weightlifting 5 days a week - my energy levels skyrocketed after about 2-3 months, but it did take a bit.
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Slightly off topic, but I'm convinced we'll also eventually have a lot of robust data that shows that alcohol, even in minor but regular amounts (2-3 drinks most days of the week, say) has large negative effects on mood/energy that build up over time.
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I don't have any problems with psychoactive drugs, SSRIs never helped me, nor tricyclics, (stimulants help mood/energy a lot but have significant negative effects)- but if someone wants to try them, by all means do!
However, if someone came to me struggling with depression, I'd nearly 100% of the time encourage them to start exercising regularly, cut alcohol/eat better, and see a talk therapist or work through a self-help workbook and see where they are at in 3 months whether or not they also wanted to take anti-depressants.
Yeah, the "getting well enough to move" part is the crucial thing. Telling people with depression to just get off their asses and exercise will usually make things worse, not better. Even if you tell them they will feel better after. Even if they really believe that this is the case.
Exercise is great, but it's not the one magic thing that you can start with to treat depression. At least not for most people.
There is no one magic thing for depression usually...neither in a pill, nor in an ECT or ketamine treatment (though those last two can come close for some people), nor in exercise. But we don't need to approach exercise with the attitude of strict parent telling the lazy depressed person to get off their butt!
Instead, we can be examples of people that are living, embodied and active, and tell what it has done for us, and encourage them to think of movement as both a natural birthright and medicine.
Do you remember any particular studies that show this? Would love to read more on this topic.
Everywhere there are blood vessels there are lymph vessels, they carry away the interstitial fluid our cells are bathed in. That fluid contains some of the waste products from our cells. The lymphatic system is also an immune organ in its own right.
Often rest is the diametric opposite of what we need during convalescence or healing. Movement and exercise within our ability is vital.
Specifically, heavy weights.
The unfortunate thing is that often times when one is depressed, exercise is the the last thing on one's mind. And it also doesn't help that it can take a long time to have noticeable effects.
My recent epiphany is a lot like "putting one foot in front of the other". It's mostly a change in values--instead of worrying so damn much about my own happiness, I just kind of thought, "I don't have to ENJOY being a high-functioning human being, but at least I can BE a high-functioning human being." Grim determination isn't really that much fun, but at least it breaks the part of the depressive spiral where you feel useless and your obligations continue to pile up.
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It's not getting in shape what lifts depression, it is physical activity in itself. You generally feel better after exercise.
It becomes much easier to hit the gym after realizing the reason to go is simply to feel better. Instead of thinking _I don't feel like going to the gym_ the correct cognition is _my medicine is there_.
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There's a variety of options to exercise. Don't stick to running if you don't enjoy it (but you keep doing it because you feel better). There's a large menu of activities, at first try what is convenient, deliberately try many things and find what is more fulfilling to you.
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With exercise nutrition follows quite naturally. It's difficult to navigate all the BS in nutrition, but in general eating fresh things closer to nature (leafs, fruit, veggies, nuts, lean meats) also has an impact on your wellbeing.
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Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
You can tell anything you want to a 200 pound loaded barbell, over and over again...
- Make sure you don't overtrain, as it can make you feel burned out, which can last a week or longer, and certainly will not help a depression. It also will not make your muscles grow faster. It's better to start slowly.
- If you can't do an exercise in a controlled manner, reduce the weight.
- Also don't target the same muscle-group more than once a week. Your muscles need time to recover.
- Muscles grow most if you load them (slowly) while they are being stretched.
- Find a training buddy.
- If you take supplements, be aware that they can have an effect on your mood. For example, L-glutamine and taurine (which are in many protein shakes) are known to affect neurotransmitters.
Also, training a muscle once a week is bad advice. Protein synthesis for trained individuals drops to normal after 48 hours, and for untrained individuals/novices after 72 hours. Your muscles aren't growing after that.
The only reason to wait longer than that is if your workout incurred a lot of muscle damage. Muscle damage should be avoided at all cost. People used to believe that it was a trigger for muscle growth, but many studies later we know that that isn't the case.
Load a muscle twice a week if a novice or intermediate, up to three times a week if advanced. Use lower volume per workout to ensure you don't incur too much muscle damage.
Although being in shape can make the physical activity itself less miserable, and the sense of accomplishment is often deeply fulfilling to people.
> Often there are more issues other than lack of exercise. If you are socially isolated, if you are under constant stress, if your home situation is dire, exercise will help you cope with it but it's not getting at the root cause. Identify and work on the cause too.
It's a process. It's always a process. Tackling the simpler things (e.g. exercising, cleaning your room, getting up in the morning instead of throwing off your circadian rhythms, going to bed at night instead of throwing off your circadian rhythms, grooming yourself) makes you better at addressing these other problems. You need a foundation where you have at least some discipline and order and routine in your life to have the mental energy to cope with the harder parts of life.
I like to think in terms of "level 1" and "level 2" food.
* Level 1 is things that come from the ground/water (salt), grow from the ground/water (vegetables, etc.), or come from things eat things that grow from the ground/water (egg, fish, etc.).
* Level 2 is recipes made from level 1 stuff.
Conversely, rabbit is one of the most lean game animals out there.
It contained very basic things, like questions if I had eaten enough, slept enough, whether I spent time outdoors (fresh air/sun), had met friends recently or exercised recently and corrective actions for each item (and yes, "eat something" was on it). Some items were accompanied by comments like "exercise will only help for the next day or two, do not skip for longer than that".
Another thing that helped surprisingly well was having a shower, shaving and dressing up. Basically the opposite of letting oneself go.
And in really bad moments, jamming/DoS-ing my brain by some sort of meaningless meditation (sitting, breathing and counting so that no other thoughts appeared anymore) helped as well.
The best thing is that I haven't had to use the list in a long time now and hopefully never will have to again.
Otherwise, your mention of the mood implications of dressing up reminded me of the many times I've noticed that, after waking up in the morning feeling depressed and shitty, sometimes just pushing through and eating breakfast/getting showered/dressed makes me feel significantly better. Something about getting that last shoe on and standing up and suddenly my brain flips a 180.
It grows and shrinks exponentially. You have to spend energy, to get more energy (or even conserve it) but the return is uncertain. The optimal strategy is to invest an amount relative to the energy I have, to avoid draining my reserves.
To escape the effects of depression [alongside medical treatment] I have to invest my energy wisely, and ultimately I can (and have, in the past) achieve motivational abundance again. And I must adjust the investment strategy to my current capital. Exercise can be a very rewarding way of investing energy. But it can also be really hard at first.
* Strength training tends to be a long term benefit. It can be really draining if you put in a difficult workout every session. Copious logging matters to lock in the sweet spot of difficulty, and maximizing recovery rate matters just as much - I found that increasing vitamin D intake did the trick here. But I find that the strength isn't the beginning and end - it helps to have it as a barometer of progress, but it's only one thing.
* Cardio-intensive activity helps my mood throughout the day. Last year I trained judo, which rewards all-around athleticism(though my desire to compete is limited) and it pushed me to take cardio more seriously. I got gifted a Fitbit last Christmas, and took up a jogging routine first thing out of bed by way of pleasing the hourly activity monitor. By focusing mostly on the technique and habit instead of pace, I've improved my form quite a bit, gotten my sleep schedule under control and also hit on another supplement that seems to get my anxiety down(magnesium citrate). However, this led me to something else which I'm still working on:
* I would tend to finish my jog with a cup of coffee and I finally realized last week that I had been letting my caffeine consumption creep up, and this was throwing off a lot of other stuff. My gym numbers were still coming in, but my concentration was mostly shot, and finally at an event Thursday I had one of the free diet sodas and soon after found that I was unusually anxious and had developed an eye twitch. This is too much, I told myself. I had gone through phases of overconsuming and cutting back before, but I was tired of the cycle.
So I decided later that night that I would cold turkey caffeined drinks. I'm still consuming a little bit of chocolate, but it's been an eye-opener. I started having bottled water instead of coffee so as to keep my other habits in the same place. Day one was the most difficult, but my sleep improved immediately and my focus already started getting better on the second day. By the third I realized that I was smiling and engaging with activities better than I had in a long time. My depressive spells never quite went away with the other things, but they seem to be gone after dropping the caffeine(although I'm still getting the eye twitch).
So, yes, it's a lot of things. Sobering up from coffee is something that's helped by getting all my other habits together. If you're starting from a "sodas every day/no exercise/no gym experience" standpoint, this is roughly the path I've recommended to friends:
* Get some resistance bands and start a program with those. They're some of the simplest and most accessible strength training around. Focus on developing some technique and logging your progress.
* Get a fitness tracker and try to hit some of the goals. I like the hourly goals(even though they do not measure when I get up and do housework), others like daily steps.
* Switch either from sugar + caffeine to just sugar or just caffeine. I shifted away from soda about a year into my first job(by - surprise surprise - overconsuming until I felt ill). Then work your way down from there by getting bottled water more often.
* Research supplements. This is not easy with so many options, but there are usually common ones that come up with respect to certain sports and activities.
rock climbing in an indoor gym is safe and low impact and programmers often enjoy the mental aspect of it. it incentivizes you strongly to keep weight down as well.
* There's a point--learning how to use your body/leverage.
* It's social. There will be fellows to motivate you to train consistently. You might even make a few friends.
* There's progression. Whether belts, tournaments, or just being about to beat your training partners improvement is pretty noticeable.
A gym membership is ~$100-200/mo. There are bad gyms. Make sure not to commit too early and try others if you don't like the environment.
These effects keep going for about two to three days and then vanish suddenly and I can do my work and routine, workouts, clean my place, etc.
I did depression comics/art when I was trying to fix it with meds, therapy and excercise, I'd be happy to cooperate if someone would like to help me market the stuff https://www.deviantart.com/aszantu/gallery/52706431/key-proj...
Have you thought about histamine intolerance?
(Anecdotally, your 15km a week is only going to get you 428km in 200 days.)
However, exercise alone is not always sufficient. Daily meditation sessions help tremendously. But the icing on the cake (pun intended) is, in the end, nutrition.
Our body (and thus our mind) works with what we put inside it. In fact, our body is made exclusively of what we, or our mother, ingested in the past. There is no escaping that fact, and most people seem to ignore it every single day.
Personally, switching to a zero-carb ketogenic diet has done wonders for my overall health and well-being, including mental health. I am of course very biased in affirming this, but I honestly think sugar and most other plant substances (except perhaps some fruits and their oils) are there to harm us. The phytotoxin defense hypothesis really resonates with my experience.
^: I have had recurrent depressive episodes throughout most of my life, and antidepressants make me manic, but I otherwise experience no "natural" mania, only a mild hypomania.
The lack of energy is extraordinary and what I experienced must have been mild compared to what others with severe depression suffer from.
Anecdote: a sliding door slipped from its rail because there was no stopper at the end of the rail and it had to be moved back in place. It is neither heavy nor difficult to do it.
I gave up after the first attempt to fix it.
Depression is nothing that I would ever wish on anyone, no matter how much I might hate that person.
OK - no one really likes running...
All these activities have casual social groups attached to them you can join. If you miss a meetup, someone's gonna check in with ya.
The initial bump to make it habit is hard, and it could take a few tries, but that's true for any positive habit.
Exercise has a large and significant antidepressant effect in people with depression (including MDD). Our data strongly support the claim that exercise is an evidence-based treatment for depression.
MDD I assume it means major depressive disorder
From personal experience, being (extremely) fit made me feel better about myself.
Just based on the fact that I can do a lot of things (sprint, hike, some cool gymnastic moves, solid flexibility, can run good distances) makes me feel better about myself.
Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says. But you have to do it "the right way": change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice. I recommend anyone struggling with "bad thoughts" to at least consider this - give it a couple of months, see how it plays out.
> Also, once you get in a good shape, it's really not difficult to stay in it. Contrary to what anyone says.
How old are you? This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
In my opinion, if you are not fit, then it won't have as good effect as it would otherwise. That might be.. jarring a little bit, but I don't think an obese person can workout 30 minutes and then call it a day, and believe he'll reap the benefits. Maybe I am wrong, but I don't think it is so.
So the goal should always be to get in great shape, the best you can get (in your circumstances, I mean; age/cardiovascular fitness/joint health etc.)
Our default mode should be being fit and everything else an abomination.
> This: "change your approach to exercising, eating, sleeping, etc. There will be things that you have to sacrifice" is one of the hardest things to do in life.
Sorry, I just fail to realize how can someone consciously think that this is one of the hardest thing in life. We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
And the best part? There's no downside for you. Better health, mental and physical, longevity, mood, etc..
Then it's probably not helpful to treat depression though. At least not as a prescribed action. Send it back to "things everyone should do with rewards down the line".
> We have really way different view of life, then. To me, it takes some work, but it's not even hard. It's just something you do for couple of hours in your day, that's all.
Again. How old are you? This seems to just be a complete lack of experience being around depressed or unhealthy people, and a complete lack of understanding why anyone would find themselves in bad health. Weight issues and bad health are not only a result of people not wanting to put in effort.
Just try looking at long term weight loss success rates or something. Your ideas are not based in reality here.
There is a bit of a motivational hump to get over, but once you are over it (forcing yourself to cycle half an hour for as week maybe?) then it doesn't seem like a problem at all.
There are quite a few cities in Belgium and the Netherlands that promote cycling though. :)
I would love to cycle to work in Brussels but I do not feel comfortable doing so.
Despite appearances we humans are much more animal than intellect, so that means the simple physical act will much more easily inform our mood and sentiment than just thinking alone.
Extra care should be taken with diet and rest to avoid lowering the immune system by over stressing the body too quickly. You don't want to catch a cold and interrupt your momentum.
Regarding 'the right way', thinking in systems/implementations/solutions rather than goals/KPIs might help (at least it does for me):
Depression is an umbrella term and it covers a wide range of experience. Some people will recover even if you do nothing to treat them; others will recover if you do anything (such as providing homeopathy) to treat them. Correcting for this is difficult, which is why respected organisations disagree about whether exercise works or not.
Felipe suggest that publication bias explains why other analyses don't show benefit of exercise as a treatment, but that doesn't make much sense. The only reason he sees such large effect sizes is because he includes huge amounts of low quality research.
When you restrict the analysis to good quality research the effect reduces and it's much harder to see any difference between no treatment and depression as treatment.
It's not particularly suprising that physiotherapists and sports therapists think what they do works. What is somewhat suprising is that HN routinely falls for it.
It's only exactly the same if you consider their formal argument in a vacuum, neglecting everything you know and reasonably believe about the world.
An intervention with a plausible mechanism has a greater chance of being effective than an intervention with no conceivable scientific mechanism (healing crystals; homeopathy). Anecdotal evidence isn't high-quality scientific evidence, but it does work as a decision support method to think about what to study more carefully -- or what to stick with because it works for some reason and you don't have the resources to scientifically validate the effect.
Furthermore, and this does overlap with the placebo effect as well as fraudulent medicine: if a specific person tests a mood-elevating intervention on themselves and perceives a benefit, nobody can contradict them. Not to defend ardent believers of nonsensical cures, but if it's stupid and it works, it's not stupid.
Since we know homeopathy is bullshit we can conclude that these low quality trials should be removed from our meta analysis.
And when you do that the effect for exercise as a treatment for depression almost disappears.
Many of us work inside office with hardly any sunlight coming in. Going out under sun in the morning for 30 minutes will be helpful.
I still run, lift weights, and keep my body fat % low, and if I can help it, I'll never go back. If I go days without exercise I start to feel terrible, foggy headed, lethargic. One 5 mile run will immediately make me feel great for the rest of the day.
Also, if I was overweight I simply wouldn't bother with excercise for losing it - it's so inefficient. I'd just skip a day of eating every other day.
Lifting weights feels pretty good though. Doesn't constantly leave me with injured-feeling levels of joint or muscle pain like running and friends do. Just the good kind of aches.
Among nearly all western countries there has been a decrease in testosterone levels, higher BMIs, and lower birthrates.
Go read Chateau Heartiste.